Medicare approval questions

[AK37 26]

Hello, I'm new here.

I'm getting new insurance starting in the new year. I'll have Medicare with Anthem Mediblue Access PPO (I am disabled with mental illness). I have some questions about insurance approval. These are the bariatric surgery requirements for my insurance:

Quote

1. BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to:
   1. diabetes mellitus; or
   2. cardiovascular disease; or
   3. hypertension; or
   4. life threatening cardio-pulmonary problems, (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); and
2. The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery; and
3. The physician requesting authorization for the surgery must provide documentation of ALL of the following (1 through 7):
   1. The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and
   2. The candidate's post-operative expectations have been addressed; and
   3. The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and
   4. The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and
   5. The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and
   6. The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and
   7. The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed.

2

For Part A- I have a BMI of 42, so I meet that requirement.
For Part B- I have not had a primary care doctor for about 3 years. I go to clinics and the ER when needed. I have tried various diets, and have been using a Fitbit for the past 2-3 years. I do not know if this is enough for my insurance requirement though.
For Part C- The mental health requirement; I do not take medication for my illness because I have literally tried almost all of them and they do not help, I only experience the side effects. Doctors know psych medication isn't for me. One of the reasons I am overweight is from all the medications I have taken over the years. My mental illness is under control and I will be able to handle surgery and follow doctor's and nutritionist's advice. I am also getting a new primary care doctor in the new year.

Has anyone else had these issues and had their insurance approve their surgery? Has anyone been denied because of similar problems?

Thank you very much for your help.
~Anna