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UPMC conflicting information.



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I am going through the approval process with my surgeons office, and I have a question about my insurance. I have UPMC for you in Lehigh County, PA. I am getting conflicting information from call center reps about the requirements. Specifically the medically supervised diet, I have been told 3 months, 6 months and no diet is required. So, I found the Policy and Procedure manual on UPMC's website for my policy. It states that with a bmi over 40 (mine is 43) I need to meet one of the following requirements either have a co-morbidity, or have 6 months of doctor supervised weight loss. I have moderate to severe sleep apnea, which is a listed co-morbidity. So in my mind I meet the qualifications.

However when I called back with the policy and procedure manual I was told that the 6 month weight loss program was a requirement of my surgeons group. This is not the case, I spoke to the nurse at my surgeons office and was told that they don't set those requirements.

I just had my 3 month weigh-in and we decided to submit for instance yesterday.

If I am denied will I be able to speak to UPMC's medical department that makes the decision? How long should I expect to wait for a decision? Any other advice or information would be appreciated! Thanks

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Just in case anyone was wondering the outcome was I was APPROVED! My doctors office even thought I was going to be denied, and be forced to do another 3 months of weigh ins, but I was right about the policy and procedure manual.

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That is great news!! Congrats!!

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Congrats on your approval! I have the same insurance located in Lehigh Valley... Wondering if you would be able to direct me to the area on the website that you found that info? I'm in the very beginning stages of the wls journey and want to be prepared when I go for my first appointment. Surgeons office seems to think that there is a 6month med supervised diet requirement, but when I spoke with UPMC for you directly, they said there is no set requirement... I'd love to follow a 3 month timeline like you did! Any info you can give me would be appreciated! Thanks!

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Congratulations ecburger on deciding to have wls, it was the best decision of my life no regrets! Here is the link, if it doesn't work let me know I can scan and email the document to you. If you need any help understanding the insurance language let me know also willing to help.

https://www.upmchealthplan.com/docs/providers/PandP/MP.040.pdf

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Thank you so much Theresa23! This will be such a help to have with me when I have my first meeting with the surgeon's office.

I'm excited to start this process, so it's great to hear from someone that has gone through it before me!

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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 0 replies
      1. This update has no replies.
    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
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    • KimBaxleyWilson

      Three months and four days ago... I was in Costa Rica having a life changing surgery! Yesterday we had a followup visit with Dr. Esmeral via video chat and this morning my middle number changed.  I'm down 47lbs and two pants sizes. I can wear a Large tshirt for the first time in like... 14 years! Woot!! Everything is going great. I have zero regrets. I went down to the riverwalk with a friend and walked 2 miles on Monday without even getting fatigued. And no more snoring or chugging pickle juice for crazy leg cramps! I need to go to the gym more... I'm making new shirts next week so that will motivate me. LOL But I'm also just not as TIRED all the time! I have a LONG way to go...but seeing the progress on the scales and in the mirror is a huge motivator!! Thank you all for cheering me on and supporting me!!
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      1. This update has no replies.
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      https://alluniqueguide.com/java-burn-coffee-reviews/
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