I've been working on my prerequisites for my Sleeve for almost a year and have been fighting to get it authorized for the past 3 months. I thought I fulfilled all my requirements but after 2 1/2 weeks of waiting for my insurance company to approve/deny they called me this morning. They cannot approve without medical records from my PCP for a 6 month period showing at least 3 visits with weights where I haven't gained - not even a single pound! But... the 6 month Dr supervised diet period does not count! I don't go to my PCP that often. I try not to. I thought that's what they wanted you to do! I've already submitted records from 2012-2013 like requested. I'm livid and freaking out. I've waited and done everything and if I cannot get this covered in the next few months I will not be able to have it until 2016 due to my work schedule. And, by then I will have to start all my prerequisites over because they will be too old. What now? What can I do?

I'm sick about this. And what makes matters worse is I work for the company my insurance is through! I understand all the ins/outs of insurance better than most!

Thoughts anyone? I'm seriously stuck. :'(

@@dandylion_23 I did have to show I could lose weight during those 6 months and I had to have at least 6 weigh ins. I think that is a pretty common thing. Have you talked to your insurance directly for their requirements and gotten it in writing? I found a lot out the hard way just believing what the Dr's staff told me they'd need.

The insurance says it says absolutely nothing...just that they cover it. We've talked to several people within the insurance company and they all say the same thing.

The insurance says it says absolutely nothing...just that they cover it. We've talked to several people within the insurance company and they all say the same thing.

What insurance do you have? A lot have their criteria online. I know they have to have one, it's simply talking to the right person to get it to you. I work in health insurance and there is a policy/criteria for every single procedure!

We have looked online and in our book and it is outlined that the cover bariatric surgery and needs to be submitted for pre approval. When talking to 6 different people on the phone with insurance they have all said the same thing. My husband talked to a supervisor. Our insurance is BCBS.

Who is your surgeon? I'm curious! I'm going to Dr. Cottam in SLC.

Dr Cottam

What part of the process are you at? Their office staff is a JOKE! :/

Kind of glad I'm doing RMAP then. I have Dr McKinley. They had my approval (through Select Health Advantage) in 8 days!

I wish I had started this process with RMAP! I considered switching but didn't want to prolong my surgery any farther and I knew BMI would never have given me my records or tests to take to RMAP. I've heard great things about McKinley... whens your surgery?

I only got insurance approval yesterday, so the scheduler should call me within the week. They only do LDS hospital on the 1st, 3rd, and 5th Wed of the month, so my guess is June 17th or July 1st given that info. (I would THINK it's too close to the 3rd of June to get in that day!) I'm so excited! I hope you get everything worked out soon!

@@Menelly That would be hilarious if you got July 1st too! I'll be at LDSH too! And yes June 3rd is way too early because you'll still need to do your 2 week pre-op diet. Hopefully soon though!

Edited May 22, 201511 yr by jas84047

@@jas84047 (Midvale?)

I was told I only have to do 10 days cause my BMI is under 40. But I wouldn't even have time for my husband to get time off by then! I'm kind of hoping for the 1st. Gives me time to get everything together and ready and have reliable babysitters for the kids.

Edited May 23, 201511 yr by Menelly

@menelly... lucky you only 10 day! And Yep... correct on midvale! LOL

RMAP has a pretty lenient diet protocol IMO, from what I've been reading on here. It's only half a day clear liquid before surgery (starting at 3pm) and by day 4 after they have you on stuff like light yogurt, cottage cheese, strained Soup, etc. By day 15 you can have soft moist foods. So yeah, it's gotta be the most "liberal" of the diets I've seen! (Including the 10 day preop diet. That's just a 1000 calorie diet with a Protein shake for Breakfast, lunch, and a Lean Cuisine or Healthy Choice meal for dinner. So not bad at all!)

Edited May 23, 201511 yr by Menelly

@@dandylion_23 Yes the staff is very rude! They also are extremely slow and do not return calls or emails. When they do return emails they are snippy and short. I've had this problem with both the insurance "specialist" and scheduler. In fact, the scheduler called today to finally give my date after saying she'd call me back last Thursday. At the end of the call she said she'd send me an email with all my preop details and appt. No email yet....

Here's hoping you have a better experience.

I seriously considered going elsewhere but I'm already this far in.

I have my first appointment with Dr Richards on 6/16, she is Dr. Cottons partner. So far the staff I have talked with (Kim) had been very nice. I hope my process goes smooth. I have Blue Shield of CA and I saw that on 6/30 they are removing their requirements for 6 month supervised weight loss so I hope this can go quickly.