Approval process question!

[reachbree 140]

Hello- Im new around and have made the first step towards having vsg, meaning that my Dr has referred me to the bariatric surgery center and they have me scheduled for an information session in November. (Ive made an appt with a dietician and a Dr. (to start sleep study process).

I have called my insurance company and they said that my plan does cover BS long as it is medically necessary and my Dr submits required authorization. They were not able to answer my question of "how long must I do a medically-supervised diet to qualify" the surgery center just told me to start with 3 months...hopefully by then I know.

I have no medical issues besides being obese....I am at the borderline of qualifying with no medical issues. My BMI is currently 40.3. If my insurance requires a 3-6 month diet plan and I loose weight and go under the BMI of 40 does anyone know if they deny surgery from that point?

I was also denied by the surgery center about 6 months ago because my BMI was under 40. Now they have accepted me because Ive gained and its just over 40. This whole process is already stressful and I feel like my insurance co (blueshield ca (thru employer) is not giving me direct answers to the questions I am asking.

[Miss Mac 6,261]

I have BCBS Federal Employee insurance. It is interesting that the person you spoke to has no idea of what they cover or what the requirements are. My doctor submitted the weight I was on the first day I came in, even though I had lost 23 pounds during my three month diet.

You might ask for a case manager. That way you have one person to talk to so that the info is not confusing. By the way, when my packet was submitted, I was approved in two days.

[reachbree 140]

Thanks so much for responding. So for you they required a 3 month plan? I will call back on tomorrow and see if I can dig for more info. Everytime I call I get a different response and I think that is the most frustrating part of all this....that and the fact that the nearest information session date is so far out!

[newmebithebypass 713]

Call back your insurance and ask to speak with the bariatric Coordinator I know bcbs has one. They will give you all the info

[ambrosia916 9]

I have BS of CA also. I was told they no longer require a wait time or supervised diet before surgery so it is up to your surgeon to determine what is right for you. Mine has decided on 4 months. Have you done all your other stuff yet like psych eval and EKG?

[ambrosia916 9]

Also I am right there with you with a BMI of 40.2 and my surgeons office advised me not to lose any weight pre-op to assure that I won't be denied.

[lauriev 71]

well, I have two co-workers that have had surgery with the same surgeon that I saw. Me and one lady had to have one visit with the NUT and a BMI of over 40; our other co-worker had to have 6 visits with the NUT and a BMI of over 40.

When they weighed me I didn't think my BMI was high enough so I was quite surprised to find out I was approved. I actually spoke to two different surgeons before I made my choice and the other surgeon told me in no uncertain terms that I needed a sleep study (at a cost of $900 out of my pocket). I was prepared to go to Mexico early next year and now I am having surgery with the doctor I was interested in originally.

I still have no clue how all three of us have the same doctor and the same insurance but don't necessarily have the same requirements.