90 day diet questions....

[doordie 9]

I really don't know anyone who has been through gastric bypass rny and I have so many questions about my pre-approval process. I have a patient advocate but I'm so nervous and fearful of not being approved. I really don't know what to do.

I have a BMI of 40.5 and my 90 day diet will be up on January 23, I have Cigna health ins and they do cover bariatric with a 40 BMI and a 90 day med supervised diet. My physician does not normally do these things he refers patients to a nutrionist however I could not see a nutrionist bc they kept cancelling due to the holiday season.

During my 90 days there has been no blood work no tests to see if I am diabetic or anything...just talks about my weight my excercise and mindful eating with notes each time. I have not lost any weight at all so far...and my physician is set to refer me to a surgeon. Once the surgeon sees me then they will file with my insurance ...I guess my question is has anyone had a similar experience? Did you get approved without having to run all those tests with your physician in the 90 day period? My surgeon will run tests of course, and I meet the minimum for BMI without any co-morbiditites... But I am afraid that I will not be approved bc I have not seen a nutrionist yet, just going to the Dr and talking about my weight loss attempts, with no actual weight loss.

I wish I knew someone who had the surgery so I could ask things...but I don't. This support group is really my only outlet for this..

[Niki15 198]

I had the bypass on August 4th this year I had to have proof of supervised diet 6 months and did several dr appt ..pulmonologist, cardiologist, nut, physc, surgeon etc my BMI was over 50 .This was the plan of the bariatric center All ins and plans are different .Only in Mexico they dont do all the testing . But not sure you ins requires you to do all of that.. wish I could be more help

[doordie 9]

Thank you! I know my surgeon is going to run some tests, but I really feel like my insurance is going to deny me, bc I am new to the state I live in and have only had a physician for 3 months and they want documentation my BMI has been 40+ for over two years...so I am prepared mentally I may have to appeal

[doordie 9]

Thank you! I know my surgeon is going to run some tests, but I really feel like my insurance is going to deny me, bc I am new to the state I live in and have only had a physician for 3 months and they want documentation my BMI has been 40+ for over two years...so I am prepared mentally I may have to appeal

[Djmohr 6,965]

Hi there, I had the bypass 14 months ago. Yes, they make you jump through a lot of hoops, mine was a 6 months supervised diet which actually turned in to 9 given all the testing required.

If you are most worried about showing that your BMI has been over 40 for the past 2 years you can have your medical records pulled from the docs in your previous state.

Is there a reason you are working with your general doctor and not a Bariatric center of excellence? Those centers know exactly what to pull and how to pull it. Usually your Primary care physicians really don't know what to do when it comes to this approval process and in some cases can actually screw things up. These days most insurance companies require a Bariatric center of excellence for that reason.

I am guessing you have the exact requirements from your insurance?

[doordie 9]

I do have the exact requirements from my insurance and they do require me to see a physician, and my physician has no idea what he is doing....he has to refer me to the bariatric center and they have assigned me a patient advocate who told me the general stipulation is to have my once a month clinic notes for every visit, and then once he refers me their center will do the rest. The answers are always vague from everyone, the advocate, the Dr, the ins company....I have no real dietary program other than watching my calories and talking about my current exercises... As for pulling record from a previous Dr...they could go all the way back to 5 yelrs ago but I had a good two hrs prior to this where I did not see any drs because I did not have insurance.

So as of now I am waiting to be referred where I will meet with a nutrionis one time the surgeon will request some blood work, and I meet with a psychiatrist...then they submit for approval. ??? Is this abnormal?

[catwoman7 10,945]

I did my six-month supervised diet before I switched insurance plans to one that covered bariatric surgery. My PCP referred me to a general dietitian, as yours did. I had a nutritionist who canceled a couple of times due to a sick parent. Once I started working with the bariatric center (*after* I'd done my six-month diet), they had me meet with *their* nutritionist a couple of times just in case the insurance company balked about my original nutritionist canceling a couple of times. The bariatric center is going to want your business if you qualify - they're pretty good at working with people to get things through. Or at least they were for me

[doordie 9]

@@catwoman7 That's really comforting to hear...I guess I really didn't think of the fact that they would "want my business" that's a good point.

It is very expensive even with my insurance and I can not imagine going through this whole process paying for everything and not having surgery. Sheeeeesh that's a lot