what's a typical timeline from first office visit to surgery?

[abbylamb 1]

Hi there. I just made the first call to my insurance company to find out the rules to get pre-authorized for the lap-band surgery. I have BCBS for Federal Employees, and was told that the surgery is definitely covered if approved.

I was told I need a letter from the provider detailing my name, age and member number, the provider info, the CPT code, a diagnosis code, and "supporting documentation and relevant info including any test results that support medical necessity".

First of all, what does "supporting documentation" entail? I'm 5'5" and have a BMI of 40.7, so by regular medical standards, I qualify, right? I don't think I have any other qualifying things I can count, besides the obvious aches and pains from being fat. I have asthma, but it's well controlled, and I've had it since I was a kid, so I don't think that counts. But I don't have sleep apnea, high blood pressure or cholesterol or diabetes. Does that mean that they will refuse me even if my BMI is 40 or better?

I've tried diets, and exercise and Weight Watchers more times than I can count, but I've never kept a documented book outlining exactly what I was doing (unless you count the weight I weighed-that I have records of for years), and it was never "doctor supervised" or anything like that. Will that be enough or does everyone have to do the medical supervised diet first? The insurance company didn't say anything about that. They just told me I needed the things I mentioned previously in order to get pre-authorization.

Also, what is the typical wait from first doctor visit to approval to actual surgery date? I'm just really excited to get this show on the road, as it were. I've done so much research my eyes are crossing and I'm convinced this is what I want to do, and I don't want the insurance derailing my hopes and dreams on this one. Any thoughts or comments would be greatly appreciated. :thumbup: Thanks!

-abby

[ParrotheadCathy 0]

With most insurance policies, there is a requirement of a BMI of 40 if there are no comorbidities and a BMI of 35 with at least 2 comorbidities. The "accepted" comorbidities are high blood pressure, type 2 diabetes, sleep apnea and maybe high cholesterol (I can't remember for sure on that one).

Some insurance policies do require a supervised pre-op diet, but I had heard than many of the insurers have dropped that now. Only a few are left. Some do require a history of being overweight for 5 years prior to surgery but if you've been going to your doctor (like the OB-GYN every year), there is a written record of weight, and as long as there are no gaps you could take care of that if it were a requirement.

Time line for approval? That will depend in large part upon what pre-op testing the surgeon requires. Note that if they require a sleep study to absolutely rule out sleep apnea, schedule that as quick as you can. That held me up for 2 extra weeks because the doctor didn't have an opening for me right way.