insurance approval... IMAGINE THIS!

[geccofoxx 0]

I began my journey over six months ago, researched doctors, insurance etc. finally chose NYU. empire and my doctor told me I would need 6 months of medically supervised visits. so I began going each month. I am now in month 6, and had a meeting with my sureons office last week. I gave them what ppwk I had ( sleep apnea test, bloodwork, etc, and said that my letter from my PCP would be ready in a week or two, aafter I officially completed my 6 months of weight loss visits. well, my surgeon sent in everything they had (minus the letter) and I was approved!!!!!!! the insurance companies explaination was that with my BMI and sleep apnea, I was concidered an automatic approval. I DIDNT NEED THE 6 MONTHS MEDICALLY SUPERVISED DIET AFTERALL!. I dont know whether to be pissed for waiting :angry, or estatic for getting approved :clap2:. I am supposed to pick up the letter on monday, and I am going to get it anyway just in case, but bottom line is Im approved for my surgery November 8th!!!!!!!

[taismommy 0]

CONGRATS!

[geccofoxx 0]

thanks....I tell you, these insurance companies can make you crazy. to think I could have had the surgery 6 months ago and be half way to goal by now, but alls well that ends well....right now I am this odd combination of nervous and excited.

[edeva3 0]

Great! I have my surgery schduled on NOv 1st but I still dont know if my insurace will pay for it. So far they paid for all those tests and sresults...I am wondering how it will look like I am freaking out that they will deny it!

[luvmydogs 0]

I had my surgery a week ago and I feel wonderful! I to had to walk the insurance tight rope to get approved. But....come to find out....in my state (Illinois) there is a law that says "if my doctor says I need it, the insurance company has to pay for it". A "letter of necessity" from the Dr. is required. So...my insurance reluctantly agreed to pay. If anybody out there is having trouble getting approved you might want to check out your state laws. As you can guess the insurance company was not the ones who told me about this law.

[Caramel 6]

what is your measurements and your BMI?

[geccofoxx 0]

Great! I have my surgery schduled on NOv 1st but I still dont know if my insurace will pay for it. So far they paid for all those tests and sresults...I am wondering how it will look like I am freaking out that they will deny it!

all I can say is documentation, documentation, documentation.....I am using my iunsurance as out of network, so they will only cover 80%, but NYU will actually accept 80% of usual and customary in my case. so I wont have to worry about the other 20 %.

just keep plugging, and be persistent. if you dont get the answer you want, ask for a supervisor...if they dont give you the answer you want, ask for their supervisor. you have to be pleasant, but stearn. write down all your conversations (I have an entire notebook!) and remember, the insurance companies have this liitle clasue thats recorded before each call that says basically no matter what they say, they basiucally can still change their mind. but be persistent and you should be fine. the hoops they make you jusmpthrough are basically so that you will give up...JUST DONT GIVE UP. even if you get denied, allow yourself 5 minutes to be upset, then get pissed, and keep going. if you really do medically need the surgery, you will get it approved.

[lindahol 0]

Where did you find the state law? I would like to know what the law is in Minnesota.

[edeva3 0]

I think my doc is really into the insurance buisness - specially it is a clinic where they teaching so it is academic level. I learn from the insurance that I will have to pay only around 500$ for all my stay.

Btw they deny me once on the beginning but it was a really stupid move from my primary care doc which I changed after all.

The insurance request specialist and I went to my surgean and he is the one who will apply for the financing..so I think I will just wait untill they will get back to me(I am scared even call them anymore).

But you right be my boss and fight for that it is worth!

So, its been a week - how amazing I wish to be there! and you are feeling great! that is even more amazing! I am scared to feel weak and hungry and lost my hair!

[luvmydogs 0]

My BMI is 39.0

I'm 5 ft 1 inch. Start weight was 207.5 lbs. I'm at 194 today. I'm new at the forum scene so I don't know how to do those cute little Tickerfactory thinggy's!

Lisa

[luvmydogs 0]

My human resources lady pushed and pushed until finally someone at the insurance company admitted about the state law. They only admitted it because my employer was asking if they could buy a writer to their policy to include this surgery for me. There is no "weight loss surgery" writer that we could buy and the insurance company finally admitted the reason for that is a writer isn't necessary in my state because of this law. I work for a great company!! Anyway I have been told that the people who make the lap band have people on staff who find out about these state laws and will go to bat for you with the insurance company. I would sick the lap band people on them.

[luvmydogs 0]

Don't be scared. You won't be weak, hungry and loose your hair. Hair loss is only from malnutrition. Eat good food and take a chewable Vitamin daily and you'll be good to go. Remember this is a tool so we don't have to feel hungry and all while eating less. I already feel the difference in my energy level! I'm SOOOO glad I did this and you will be too!!!!

Good luck

Lisa

[Sdaviscs 0]

Can you tell me which insurance you have? I was told the same thing...BMI and high blood pressure, asthma, etc. was enough.

[luvmydogs 0]

United Healthcare. I have the high blood pressure, borderline diabetic, and a really really bad knee that needs to be replaced. My Dr had no problem giving me the "letter of necessity" I needed for the insurance. I will say it helps to have a Dr. that is willing to help.

[OH Juli 15]

Don't be scared. You won't be weak, hungry and loose your hair. Hair loss is only from malnutrition. Eat good food and take a chewable Vitamin daily and you'll be good to go. Remember this is a tool so we don't have to feel hungry and all while eating less. I already feel the difference in my energy level! I'm SOOOO glad I did this and you will be too!!!!

Good luck

Lisa

hair loss happens as a result of surgery for some people. I lost mine...I wasn't bald, but I had lots of hair in the drian...it was about 4 months out.

I wasn't malnurished but I certainly had/have thinner hair.

Just FYI