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Insurance Approval Jitters

doingitmyway

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Shrinkinqtpi    202

Shrinkinqtpi
Posted

They told me I should know if I need another dietitian appointment by the 11th of July. It is progress and my surgeon is incredibly supportive. It is going to happen in the "right" time. As a junior high school teacher, it would be great if surgery happens in July but I'll take what I can get.

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AmberMc03    59

AmberMc03
Posted

I have Aetna as well. The surgeons insurance coordinator screwed up and didn't submit when I completed all the requirements so when they finally submitted I called Aetna and explained the mix up and that I really needed to schedule ASAP because my kids are with their grandmother for a month and I wanted to be done and back before they get back. They marked it urgent and it was approved the same day! Then it took another almost 1 week before they called me to schedule. I was very disappointed to have to push my surgery back 2 weeks. I will only be about 4 days post when my kids come home..... But they know what's going on.

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biglady904    65

biglady904
Posted

It's really good to have yall to keep up with and check in on:) helps make this wait a little better !

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I feel so relieved as well to have people to talk to. My family knows I'm doing this but in a way I feel alone with this if that makes any sense

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Kyn13    215

Kyn13
Posted

It's really good to have yall to keep up with and check in on:) helps make this wait a little better !

Sent from my SAMSUNG-SM-G870A using the BariatricPal App

I feel so relieved as well to have people to talk to. My family knows I'm doing this but in a way I feel alone with this if that makes any sense

Sent from my iPhone using the BariatricPal App

Yes I know how you feel I'm pretty sure my family wishes I would shut up already lol here lately it's been all that's on my mind

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Shrinkinqtpi    202

Shrinkinqtpi
Posted

I will call as soon as I can to speed things along. Hopefully they can lock me in as well.

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kmorri    1,689

kmorri
Posted

You are all right the waiting for the insurance approval I think was the worst part of the whole thing.....I think it's because you've done all this hard work and jumped through all these hoops and this last thing could just put an end to it all....

As someone who just recently gone through it, let me just say it is all worth it in the end! and once you get past this the next thing you'll be waiting for is getting a surgery date...haha Once you get the date it starts to get real real fast!!!

As far as the insurance approval don't be afraid to call customer service and check on the status of your auth. Wait until it's been submitted for a week.....5 working days and then call to check to make sure they have it and what's the status....from that point call every other day.

I retired from Florida Blue (BCBS of Florida) I think one of you has insurance through them. Back in April when my auth was done they had a 6 business day back log (I found that out through inside connections) so that means about 6 days before it gets to someone's desk to review.........it is probably still about the same, so hang in there!

If anyone gets denied ask your surgeon to request a Peer to Peer review....that's when your surgeon will argue your case with a doctor who works for the insurance company.....most of the time your surgeon will win.....if he doesn't then you or the surgeon can request an official appeal.

I wish all of you the best of luck! You'll get past this stage in no time!!!

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Kyn13    215

Kyn13
Posted

You are all right the waiting for the insurance approval I think was the worst part of the whole thing.....I think it's because you've done all this hard work and jumped through all these hoops and this last thing could just put an end to it all....

As someone who just recently gone through it, let me just say it is all worth it in the end! and once you get past this the next thing you'll be waiting for is getting a surgery date...haha Once you get the date it starts to get real real fast!!!

As far as the insurance approval don't be afraid to call customer service and check on the status of your auth. Wait until it's been submitted for a week.....5 working days and then call to check to make sure they have it and what's the status....from that point call every other day.

I retired from Florida Blue (BCBS of Florida) I think one of you has insurance through them. Back in April when my auth was done they had a 6 business day back log (I found that out through inside connections) so that means about 6 days before it gets to someone's desk to review.........it is probably still about the same, so hang in there!

If anyone gets denied ask your surgeon to request a Peer to Peer review....that's when your surgeon will argue your case with a doctor who works for the insurance company.....most of the time your surgeon will win.....if he doesn't then you or the surgeon can request an official appeal.

I wish all of you the best of luck! You'll get past this stage in no time!!!

Soo good to hear all this from an insider!!! Thanks for all the good info!!!

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kmorri    1,689

kmorri
Posted (edited)

@@doingitmyway If your BMI is over 35 but under 40 it really depends on the seriousness of the hypertension......sometimes if it's controlled with one medication it's not approved......if you have to take more than one medication it's more likely to be approved............Is hypertension the only obesity related condition you have?.....If it's denied try not to worry too much....ask your surgeon to do a peer to peer review.....he obviously thinks you need to surgery, so he can argue your case with a Florida Blue doctor and may be able to get it approved for you.

Wishing you the best of luck!

Kathy

Edited by kmorri

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Kyn13    215

Kyn13
Posted

Omg it's finally a week day, this weekend has drag painfully by for me, will be calling the surgeons office today to see if they got my paper worn and to hopefully set up my appointment. Who else is calling and checking in on ppl today???

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biglady904    65

biglady904
Posted

Omg it's finally a week day, this weekend has drag painfully by for me, will be calling the surgeons office today to see if they got my paper worn and to hopefully set up my appointment. Who else is calling and checking in on ppl today???

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Lol. I'm so happy it's Monday I will be calling and checking today

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
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    • Alisa_S

      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. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      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

        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

      CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.

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