Speeding up the surgery authorization process question

[Jobber 321]

I tried searching for this question in the forum, but I want a more recent answer, if possible.

My PCP said that she would write me a letter of medical necessity for the surgeon/insurance if need be to help me get qualified for WLS as well as provide any records of mine where she was monitoring my use of prescription appetite suppressants. Does anyone think the insurance would accept this instead of needing to spend 6 months trying another failed diet again?

I know insurance companies will always err on the side of not having to pay for surgery, but I'm just curious if anyone got past that 6 month supervised diet with a note from their PCP before.

[Chrisb428 626]

I had been seeing my PCP, a nutritionist, and an endocrinologist for a year and my insurance wouldn't count it.

[Wanda247 908]

4 minutes ago, PENGU1N said:

I tried searching for this question in the forum, but I want a more recent answer, if possible.

My PCP said that she would write me a letter of medical necessity for the surgeon/insurance if need be to help me get qualified for WLS as well as provide any records of mine where she was monitoring my use of prescription appetite suppressants. Does anyone think the insurance would accept this instead of needing to spend 6 months trying another failed diet again?

I know insurance companies will always err on the side of not having to pay for surgery, but I'm just curious if anyone got past that 6 month supervised diet with a note from their PCP before.

I think that you pretty much have to go through the the steps required by the insurance company and I don't think that there is no other way around it, the insurance company is forking out a lot of money for your surgery so they want to make sure that you are willing to put in the hard work that it takes now and after surgery to succeed. From my experience it does go by quickly and I know for me I needed that time to get my mind in the right direction and in the right place to prepare for surgery. Each insurance requirements are different also, mine required 4 months of supervised nutrionist visits and other test etc. I started in April and my surgery is scheduled for August 29th. When I was first told it would be 4 months I thought wow what a long process but now I am so glad that they required that because it gave me time to research, change my eating habits and to prepare myself mentally. You can do it! Keep us posted on your journey and I wish you the best!

[Jobber 321]

13 minutes ago, Chrisb428 said:

I had been seeing my PCP, a nutritionist, and an endocrinologist for a year and my insurance wouldn't count it.

UGH....

thanks Chris!

[Jobber 321]

4 minutes ago, wanda247 said:

I think that you pretty much have to go through the the steps required by the insurance company and I don't think that there is no other way around it, the insurance company is forking out a lot of money for your surgery so they want to make sure that you are willing to put in the hard work that it takes now and after surgery to succeed. From my experience it does go by quickly and I know for me I needed that time to get my mind in the right direction and in the right place to prepare for surgery. Each insurance requirements are different also, mine required 4 months of supervised nutrionist visits and other test etc. I started in April and my surgery is scheduled for August 29th. When I was first told it would be 4 months I thought wow what a long process but now I am so glad that they required that because it gave me time to research, change my eating habits and to prepare myself mentally. You can do it! Keep us posted on your journey and I wish you the best!

Looks like I just need to strap in and let it happen how it's supposed to. thanks Wanda!

[GreenTealael 24,959]

24 minutes ago, PENGU1N said:

I tried searching for this question in the forum, but I want a more recent answer, if possible.

My PCP said that she would write me a letter of medical necessity for the surgeon/insurance if need be to help me get qualified for WLS as well as provide any records of mine where she was monitoring my use of prescription appetite suppressants. Does anyone think the insurance would accept this instead of needing to spend 6 months trying another failed diet again?

I know insurance companies will always err on the side of not having to pay for surgery, but I'm just curious if anyone got past that 6 month supervised diet with a note from their PCP before.

You are going to be surprised how fast it goes and how necessary it is to make lasting changes like giving up sugar, carbonate beverages, caffeine, and smoking. Or organizing your house and family to not sabotage progress after surgery.

[Wanda247 908]

10 minutes ago, PENGU1N said:

Looks like I just need to strap in and let it happen how it's supposed to. thanks Wanda!

You're welcome hun. When you start the process there is so much that you have to do and it will keep you so busy before you know it...BAM! It's surgery time. LOL

[Chrisb428 626]

Mine was six months and I'm scheduled for August 28th. I agree with Wanda, it gives u time to learn, prepare, and adapt to the changes you need to make. Also gives you time to make sure you really are committed to the changes you will have to make.

[Wanda247 908]

40 minutes ago, Chrisb428 said:

Mine was six months and I'm scheduled for August 28th. I agree with Wanda, it gives u time to learn, prepare, and adapt to the changes you need to make. Also gives you time to make sure you really are committed to the changes you will have to make.

Hey Congratulations!! I'm the day after you.

[Chrisb428 626]

Thank you! Congrats to u as well! We are having different procedures but can still compare notes along the way!

[ChellNC 162]

It wouldn't hurt to call your insurance to see if your PCP visits are acceptable. Have you seen her every single month for 6 months?

If your insurance has specific requirements that weren't met by your PCP a letter won't be useful in bypassing their policy.

Like others have said, the time goes quickly & it prepares you for surgery. My surgery is 2 weeks from today & even though I went through a 6 month program to get here I'm starting to freak out thinking I don't know what I'm doing with the diet & such.

Good luck!

[Jobber 321]

19 hours ago, GreenTealael said:

You are going to be surprised how fast it goes and how necessary it is to make lasting changes like giving up sugar, carbonate beverages, caffeine, and smoking. Or organizing your house and family to not sabotage progress after surgery.

I certainly hope so, thanks GT. I can give up the sugar, carbonated beverages and I don't smoke, but boy o boy, giving up caffeine is going to be a killer...

[Jobber 321]

19 hours ago, wanda247 said:

You're welcome hun. When you start the process there is so much that you have to do and it will keep you so busy before you know it...BAM! It's surgery time. LOL

So is it 6 months for most folks altogether or is it 6 months of the diet, then a month to get approved, then 2 more months to get scheduled?

[Jobber 321]

19 hours ago, Chrisb428 said:

Mine was six months and I'm scheduled for August 28th. I agree with Wanda, it gives u time to learn, prepare, and adapt to the changes you need to make. Also gives you time to make sure you really are committed to the changes you will have to make.

Thanks Chris, I'm just a little eager to get going now that i'm in the mindset where I'm ready to do this.

[Jobber 321]

15 hours ago, ChellNC said:

It wouldn't hurt to call your insurance to see if your PCP visits are acceptable. Have you seen her every single month for 6 months?

If your insurance has specific requirements that weren't met by your PCP a letter won't be useful in bypassing their policy.

Like others have said, the time goes quickly & it prepares you for surgery. My surgery is 2 weeks from today & even though I went through a 6 month program to get here I'm starting to freak out thinking I don't know what I'm doing with the diet & such.

Good luck!

I thought about doing this, but every time I call my insurance I get the most useless people that don't seem to want to help or just don't even know. I may still give it a shot, though, thanks.