Hello!

After 7 years of telling myself I would get myself back to a healthy range, I finally admitted I just can't do it on my own. I've started the process with Mount Auburn Weight Management Center in Waltham/Cambridge MA, and am suddenly terrified that everything will go wrong.

I contacted my insurance company (Harvard Pilgrim) and confirmed that

1. They do cover Bariatric Procedures
2. There is no condition requiring a certain amount of time on a program
3. There is no waiting period from entry to surgery date

However I just have this feeling that I am going to go through the whole process, only to be told that my insurance denied it and requires me to wait or something. Did any of you run into insurance issues? What are some best practices that I may be able to do to ensure things run smoothly? When I spoke to my insurance, they claimed that *I* didn't have to do anything, that it was all on the docs... but it just can't be that simple!

Help and advice would be most appreciated!

Anyone else on here have Harvard Pilgrim?

Kind regards,

Kay

Hello!
After 7 years of telling myself I would get myself back to a healthy range, I finally admitted I just can't do it on my own. I've started the process with Mount Auburn Weight Management Center in Waltham/Cambridge MA, and am suddenly terrified that everything will go wrong.
I contacted my insurance company (Harvard Pilgrim) and confirmed that

1. They do cover Bariatric Procedures
2. There is no condition requiring a certain amount of time on a program
3. There is no waiting period from entry to surgery date

However I just have this feeling that I am going to go through the whole process, only to be told that my insurance denied it and requires me to wait or something. Did any of you run into insurance issues? What are some best practices that I may be able to do to ensure things run smoothly? When I spoke to my insurance, they claimed that *I* didn't have to do anything, that it was all on the docs... but it just can't be that simple!
Help and advice would be most appreciated!
Anyone else on here have Harvard Pilgrim?
Kind regards,
Kay

Hi Kay! You have fantastic insurance. The stars have aligned in your favor. I'm 4 days post-op and this was the best decision that I've ever made in my life. I doubt you will be denied. I would love to see you take this journey because you're worth it!

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Thank you very much Matty! Do you also have Harvard Pilgrim? I am glad to hear they are good, I think I would be devastated if it got denied.

On a personal note, congratulations on your recent surgery! I hope you are feeling the best you can a few days out.

Thank you very much Matty! Do you also have Harvard Pilgrim? I am glad to hear they are good, I think I would be devastated if it got denied.
On a personal note, congratulations on your recent surgery! I hope you are feeling the best you can a few days out.

Thanks. I don't have Pilgrim but I really don't think you should worry. My insurance required quite a documented history of weight loss attempts. This is a sign that the time is right.

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Thank you very much Matty! Do you also have Harvard Pilgrim? I am glad to hear they are good, I think I would be devastated if it got denied.
On a personal note, congratulations on your recent surgery! I hope you are feeling the best you can a few days out.

I’m 4 months out and I had to do a prerequisite of 6 months of a preop diet before hand but that made me think about my health a lot. I did have some issues with getting sick and I got diagnosed with toxic metabolic encephalopathy and am still recovering. So just be really careful on not getting sick.

I have Blue Cross. My doctor's office processed everything for me. Like you, I was nervous about some last minute denial of benefits. Toward the end, my insurance company sent me an approval letter that outlined the date, the surgery, and that it was approved. Maybe ask your insurance company if they do that? It put my mind at ease to have it in writing that everything was covered.

I have United Healthcare and I had to wait 6 months prior to pre-approval. Once you reach out to a Surgical team, they will do the work for you and figure out exactly what you Insurance requires. I was approved for surgery within about 10 days of submission and had my surgery the following month as my surgeon was booked until then.

If your insurance requires no pre-requisites, your team most likely will have you run through the usual testing and you will have surgery within a month or two. I highly doubt that you will be denied by the surgery as your insurance does not require the usual requirements that most do.

Edited March 17, 20188 yr by Sleeve1stFitNext

You have to do your own homework as well. Originally, the hospital administration told me that I would need 6 months of documented supervised medical weight management. Something did not seem right about this so I did my own research and discovered that they were very wrong. Had I completely trusted in the administration, my surgery would not have been until July or August. I only needed 3 and I got all three of them before I transferred programs. I had to email the insurance coordinator a PDF of the actual document. Once they saw it, the ball got rolling.

Thank you all for your insight! I double and triple checked with my insurance, even read the medical jargon 14 page breakdown of coverage and requisites for it, and no time threshold was set. They only request proof of continued weight gain with attempts at weight loss, which I have.

Here's to hoping that may speed up my process!

So, I think your journey is well underway. Final stop: Thin & Happyville, all aboard!

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My insurance covers as soon as the surgeon's office places the request. I know that I am lucky, but it still feels like it is taking forever.

Dieticians, psychologist, cardiologist and everyone is booked out 4-6 weeks. I am slowly losing weight on the pre-op diet, but getting hungry and impatient. I was ready to start this process months ago, but my little guy wasn't done breastfeeding yet.

Hope it all works out for you soon!

Edited March 17, 20188 yr by Sleeved36

On 3/17/2018 at 5:37 PM, frust8 said:

So, I think your journey is well underway. Final stop: Thin & Happyville, all aboard!

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Can. Not. Wait!

In all seriousness, I can't wait to not have knee pain going up the stairs, or to not avoid taking vacations that involve planes because I hate having to stretch the seat belt out all the way in order to fit. And can't wait to shop in regular stores instead of taking a gamble at online plus size retailers.

All worthy dreams and all soon within your reach. You are going to rock all of New England,with your strong Pilgrim will. You will be a success.

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17 minutes ago, frust8 said:

All worthy dreams and all soon within your reach. You are going to rock all of New England,with your strong Pilgrim will. You will be a success.

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Can I keep you? You are GREAT for confidence

My honor and pleasure[emoji177]

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