What's your approval process?

[jlb8080 45]

Hey guys! Ok, so I got my surgery on 12/12. I made my 1st appointment on 10/14 and within a week I was scheduled. I am seeing other people are having to go through more steps, including my good friend. He needs a series of visits to get approved for surgery. What is the difference and why such a crazy change in whether you will get approved?

[Uomograsso 364]

It all comes down to insurance. Each company has there own requirements. Some overlap, some don't. I had 90 day medically supervised "weight loss." I didn't have to lose weight though, just couldn't gain any weight. Had to have psychological evaluation as well. Also had EGD and ultrasound of fall bladder to check for stones. Those two were surgeon's requirements not insurance. Got approved in about 5 business days.

[ImsexyandIknowit 50]

Gosh mine is a lot longer lol. A total of 7 appointments. The first one was the information part then I had to go see them once a month for 6 months. Had a Neropysc appointment. 1 support group. sleep apnea testing, which I do have. Quit smoking everything. And I finally quit cigarettes I have to wait 3 months more and test clean again before surgery. Could not get a date until I did all of that. So about a total of 11 months for me. But I am very close to my date April 7th four days after my birthday. My present to my self. I am very excited

Sent from my LM-Q710(FGN) using BariatricPal mobile app

[Krimsonbutterflies 661]

1 hour ago, galannin1010 said:

Gosh mine is a lot longer lol. A total of 7 appointments. The first one was the information part then I had to go see them once a month for 6 months. Had a Neropysc appointment. 1 support group. sleep apnea testing, which I do have. Quit smoking everything. And I finally quit cigarettes I have to wait 3 months more and test clean again before surgery. Could not get a date until I did all of that. So about a total of 11 months for me. But I am very close to my date April 7th four days after my birthday. My present to my self. I am very excited

Sent from my LM-Q710(FGN) using BariatricPal mobile app

Quit smoking everything, lol. You'll do fine and pass.

[Repeatingthoughts 77]

My process changed due to a health insurance change. So I now have to go back to my PCP Next week for a formal referral and pre approval before I go back to my surgeon next month. My insurance doesn’t ask for a weight management history or monthly check ins, they just want it to be a medical necessity.

Edited January 10, 2020 by Repeatingthoughts

[New&Improved 1,780]

If self pay then will be very quick.

Some surgeons and insurance set numerous rules and regulations in my mind some are overbearing... I'm in Australia I have insurance with a co pay I got surgery within 3 months of 1st appt.

[New&Improved 1,780]

Sorry my internet is double posting today

Edited January 10, 2020 by Superman84

[GradyCat 3,697]

It's largely determined by your insurance carrier and your surgeon's office. I went through Medicare, so I didn't have to do the six months of weight loss first before approval. Most commercial insurances require that. But mine still took 9 months to get records, have evaluations, etc.

[jlb8080 45]

I have BCBS of ND and they just required my BMI be at 40 or above at my initial visit and then I did a psych eval that day as well. The patient coordinator said it used to be more complicated but within the last year it's changed. That insurance companies are loosening up on their requirements. Maybe others will come back around as well. It's def in their best interest to prevent a lifetime of paying for medications due to being overweight and what issues that causes.

[Jenni L 8]

I had quite a list to accomplish:

6 months nutrition counseling (one class per month)

Pych evaluation

Cardiologist appt.

Chest x Ray

Mammogram

Pap Smear

I would have had to take a sleep test but we already know I have sleep apnea so I didn’t have to do that.

lose 50 pounds

I’m not sure what was required by insurance and what was required by the surgeon. I just know I had to complete the list.

[momof3_angels 465]

Well, I was lucky... I only had to go through 3 months of nutrition visits (but 4 appointments-one per month after the first appt) instead of 6. I already had a sleep study, a cardiologist, an EKG and an Echocardiogram... so I just shared those reports with my surgeon. I had to have a chest x-ray, lots of blood work, and EGD and a barrium swallow. Plus a psych eval. I also had to lose weight consistently at each appt before surgery

My first appointment with the surgeon was May 20, my first nutritionist appointment was the same week. I had nutrition appointments in July and August (skipped June only because I was out of the country). And then at the end of August I called to see when they were thinking of scheduling me because I needed to arrange time with work... and since all of my pre-reqs were done (except the last nutrition appt) the scheduler asked if I had any previous documentation of weight loss attempts. I had some doctors office visit summaries from my PCP and cardiologist office that talked about weight and nutrition guidance and sent them to the scheduler. They changed my last nutrition appointment to an earlier date and to a pre-op nutritionist counseling appointment... at which time the scheduler informed me that my surgery was approved for Sept 4th. I didn't think I was going to be eligible until at LEAST September 20th. Again... I was lucky. Most people have 6-7 months before they can have surgery at the earliest.

Edited January 12, 2020 by momof3_angels