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Insurance question

Who'sThere

By Who'sThere, in Gastric Bypass Surgery Forums

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Who'sThere    331

Who'sThere
Posted

How many of you had to go through the same criteria as an initial bariatric surgery patient???

My surgeon's office asserts that everyone has to go through the same 6 month process even though my insurance has told me differently--twice! (Even talked to the bariatric nurse in the precert department.) Now, they want me to call the insurance company and have them call the surgeon's office on 3way to tell them that. Does this seem odd to anyone else?

I get why they would want me to do the long process. It is more money for them as I would have to see the surgeon more often and they would not change their routine. However, I would love to have this done before the end of the year to save lots of money!!!

I think "everyone" has done it this way because no one else has done their own legwork and questioned their process. Oh, and it is the office staff that is giving me a hard time, not my surgeon. He says let's get this done. When I had my band, there was one woman who did this. She's gone and now there are 3 doing her job, and none too well, I might add.

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Shaunie    123

Shaunie
Posted

I had to go through the 6 month pre-op!!! I didn't have to meet with surgeon other then the very beginning & at the very end. The process is to prepare you and teach you how to eat proper and make better decision. It also is mentally setting you up for success by meeting with the psychologist. It is very hard to play the waiting game but I think its all for our on good. I also had to loss 10% of my starting weight in those six month to proof to them this is a challange I was reading to take on.

Good luck with your process ;-)

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Who'sThere    331

Who'sThere
Posted (edited)

I had to go through the 6 month pre-op!!! I didn't have to meet with surgeon other then the very beginning & at the very end. The process is to prepare you and teach you how to eat proper and make better decision. It also is mentally setting you up for success by meeting with the psychologist. It is very hard to play the waiting game but I think its all for our on good. I also had to loss 10% of my starting weight in those six month to proof to them this is a challange I was reading to take on.

Good luck with your process ;-)

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This is a revision. I've already done all that the first time. My surgeon only wants me to do a brush up nutrition class, support group meeting, EGD and barium swallow. I agree that this is important for WLS virgins, if you will, and so does my surgeon. He requires all this whether you have insurance or not for a first procedure. He knows I am adequately prepared for the revisions. Well, at least as much as one can be for such a serious life changing surgery.

Oh, and if I DO have to do the 6 month diet, I will NOT qualify if I lose 10% or more of my body weight. I have to show an INABILITY to lose that much by conventional means.

Plus, I have to have been a bmi or 40 or more for 5 years and I haven't been. (I dont have three comorbidities yet.) My band was great until I had it unfilled with my pregnancy and then i a double hit with a Hasimotos flare up. I will have to wait 2 more years.

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Edited by Who'sThere

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Who'sThere    331

Who'sThere
Posted

my insurance only required 4 months of weigh in's plus the other appointments for clearance.. what insurance do u have?

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I have BCBS TN for state employees. post-39479-14774463258034_thumb.jpg

This is what they sent me, but my surgeon's office staff thinks it means I have to meet BOTH unfilled circles. Ugh!

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Who'sThere    331

Who'sThere
Posted (edited)

@@Shaunie and @@CarenL, what insurance do you guys have? Was it an insurance requirement or surgeon requirement that you redo the whole process? Did your policy look anything like mine? I'm very discouraged at this point.

Oh, and what we're y'all's reasons for revision?

I'm hoping the 3 way call will help, too. The lady I talked to at insurance today said she couldn't guarantee that they will do a 3way call but to call and ask whoever was working tomorrow. :/

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Edited by Who'sThere

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Shaunie    123

Shaunie
Posted (edited)

I had gastric bypass10 months after I had to have the lapband emergency removed. I have Tuft!!! It was my insurance requirements but the surgeon recommended it. When I had the band put in I also had to do 6 months and I had Harvard Pilgrim. My bariatric Team had control over making the final dicission if they thought I was ready at the 6 month point. I would think most people are because that's what there job is lol.

Edited by Shaunie

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Who'sThere    331

Who'sThere
Posted

I had gastric bypass10 months after I had to have the lapband emergency removed. I have Tuft!!! It was my insurance requirements but the surgeon recommended it. When I had the band put in I also had to do 6 months and I had Harvard Pilgrim. My bariatric Team had control over making the final dicission if they thought I was ready at the 6 month point. I would think most people are because that's what there job is lol.

The bariatric pre-certification nurse said if they "remove the lapband and convert to RNY in one fell swoop" it is considered a revision and I do not have to meet the initial criteria. If i have two separate procedures, though, I DO have to meet the initial requirements again whether the band is out 2 days or 2 years. Now, I see why your insurance required the 6 months.

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Who'sThere    331

Who'sThere
Posted

O ok that makes sense. I Didn't know that.

It will all work out ;-) you will be skinny before you know it ;-)

I just don't want diabetes! Lol. I want ti be around ti watch my 3 year old get old and sassy. Skinny will be a nice side effect.

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Who'sThere    331

Who'sThere
Posted

My paperwork is being submitted in the morning! I'm on pins and needles

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Who'sThere    331

Who'sThere
Posted

Approved yesterday, scheduled today. My date is December 15

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