Insurance woes 😩😩

[RaeSavage 82]

Hello everyone!

I’m new here! So I’m anxiously anticipating the start of this journey. I have a consultation scheduled for 4/29 for a consultation with Emory Healthcare here in Atlanta GA. I have no idea what to expect. I recently realized that my Cigna insurance will cover 80% of this surgery. That’s all I know as of yet, but as I search the forums and do research I realize that I don’t have HALF of what other people have on this site. I don’t usually see a DR. I don’t even have a primary care physician. No medically supervised weight loss and no co morbidities. All that I have is a BMI of 43% PCOS and possible sleep apnea (fiancé wakes me up all the time because I’m not “breathing”). I’m concerned this will be all for nothing and I won’t get approved. I’m 32 and I need to nip this in the bud BEFORE I end up with co morbidities. Is there ANYone on this forum like me?

[Panda333 276]

10 hours ago, RaeSavage said:

Hello everyone!

I’m new here! So I’m anxiously anticipating the start of this journey. I have a consultation scheduled for 4/29 for a consultation with Emory Healthcare here in Atlanta GA. I have no idea what to expect. I recently realized that my Cigna insurance will cover 80% of this surgery. That’s all I know as of yet, but as I search the forums and do research I realize that I don’t have HALF of what other people have on this site. I don’t usually see a DR. I don’t even have a primary care physician. No medically supervised weight loss and no co morbidities. All that I have is a BMI of 43% PCOS and possible sleep apnea (fiancé wakes me up all the time because I’m not “breathing”). I’m concerned this will be all for nothing and I won’t get approved. I’m 32 and I need to nip this in the bud BEFORE I end up with co morbidities. Is there ANYone on this forum like me?

Hi, I'm older than you but similar and just started my journey a month ago. I am 48 with a bmi of 54. I have no co-morbidities but decided I wanted the surgery since I'm getting close to 50 and 150 extra pounds is hard on my short frame. My insurance, Aetna will cover 80% of the surgery also. (Just found out last week) I also didn't have a regular ;primary doctor but have tried and failed at diets for 25 years. What I did was establish a primary doctor relationship, had my first appointment yesterday. It was like, "hi, nice to meet you, can you sign off that bariatric surgery is necessary" lol And you know what? He did. He sAid that appointment could be the 1st of the 3 required physician monitored/supervised diets and he let me pick the diet, which I chose Keto. We then set up two more appoints, one for May and one for June. After the 3rd appt he will sign the letter of necessity. After you go to your consultation on 04/29 you will know more and they will assign you a patient advocate at Emory but it's a good time for you to establish a primary relationship in the meantime with a local doctor, preferably before your consultation. I hope this helps. I'm still at the beginning of this journey and

[RaeSavage 82]

Thanks for responding!!! Good idea, I will actually reach out to an MD! I appreciate the feedback. Maybe we can be twins in the whole process

[GradyCat 3,697]

I'm 53 and didn't have to have 6 months of weight loss management either. I just had to have the 40 BMI.

[RaeSavage 82]

On 04/18/2019 at 08:18, GradyCat said:

I'm 53 and didn't have to have 6 months of weight loss management either. I just had to have the 40 BMI.

Who’s your insurance company?

[GradyCat 3,697]

15 hours ago, RaeSavage said:

23 hours ago, GradyCat said:

I'm 53 and didn't have to have 6 months of weight loss management either. I just had to have the 40 BMI.

Who’s your insurance company?

Humana Medicare Advantage plan.

[sshrader1208 16]

Hey there! I don’t have any co-morbidities either. No PCP here really. I used to see a doctor but he was really judgmental so I left. This is the first I’m hearing of needing to have a PCP?? My consult is this Monday.

[RaeSavage 82]

On 04/19/2019 at 11:10, sshrader1208 said:

Hey there! I don’t have any co-morbidities either. No PCP here really. I used to see a doctor but he was really judgmental so I left. This is the first I’m hearing of needing to have a PCP?? My consult is this Monday.

Well looking at other posts I see that this is the easiest way to get a letter of approval or recommendation. I have CIGNA insurance. So they require a stamp of approval from a doctor that has NOTHING to do with the surgery. So I got on Zocdoc last night and made an appointment today. Funny enough, it’s a doctor that I know personally 😂😂 That should help.

[RaeSavage 82]

On 04/19/2019 at 08:12, GradyCat said:

Who’s your insurance company?

Humana Medicare Advantage plan.

[RaeSavage 82]

On 04/19/2019 at 11:10, sshrader1208 said:

Hey there! I don’t have any co-morbidities either. No PCP here really. I used to see a doctor but he was really judgmental so I left. This is the first I’m hearing of needing to have a PCP?? My consult is this Monday.

I had a doctor tell me that I wasn’t fat enough VERBATIM. At that time I was 240. I hopped on a scale yesterday and I’m 270. TWO SEVENTY!!! 😞 I’m 5’6. So I decided to change my pcp totally. Hopefully I have a more understanding relationship with the new one. I know him personally anyway. 🤷🏾‍♀️