Athem insurance approval?

[Feebalicious 0]

I have decided that I want to get a vertical sleeve gastrectomy. I'm concerned about insurance approval and wondering if anyone has any experience with a similar set of circumstances.

My BMI is 39.7 (talk about a bogus double edged sword)

I have high cholesterol, though not enough for medication.

I also have generalized anxiety, a titch of depression, hidradenitis supuritiva, chronically sore back and knees.

I know my specific insurance covers VSG but I'm worried they won't cover me.

I've already seen my PCP and she's onboard and has given me a referral to a bariatric center here. Now I'm just waiting for my consult.

Anyone have a similar set of circumstances and get approved?

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[billho 243]

the insurance specialist at your bariatric center should be able to help you figure out what is covered and what is not. If yours is like mine, I had coverage at a BMI of 40 and above 35 if I had comorbidities (like high blood pressure, diabetes, sleep apnea, etc.). If you don't have any of the qualifying conditions, they might even recommend gaining a few pounds, since you're right on the edge.

I was right at that line with a BMI of 40.5 and my doctor recommended that I not lose any weight before my surgery. But the battery of specialists included psych and she wouldn't clear me without me demonstrating that I could follow the diet. So, I lost weight pre-op and then had to jump through a lot more hoops to show sleep apnea (borderline) and high blood pressure (also borderline). Insurance did pay, so it all worked out in the end.

[The Greater Fool 1,949]

Welcome to the forums.

Billho is spot on.

The team at your WLS Surgeons' office will walk you through identifying Anthem's requirement and what you need to to do fulfill them. Your team want's you to get surgery as much as you do. They are on your side.

Good luck.

Tek

[Feebalicious 0]

Thank you both.
Its just so frustrating to be in limbo.

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[The Greater Fool 1,949]

8 minutes ago, Feebalicious said:

Thank you both.
Its just so frustrating to be in limbo.

Well, you'll have ample opportunity to work on that in the coming months

Tek