Is this too easy? - Page 2 - ThinnerTimes

PollyC · 11-29-2007, 08:16 PM

Quote:

Originally Posted by VanessaSFL

No problems, this was almost three years ago , but had no issues.I also did not have to do a supervised diet before hand , however my DR. submitted my attempts.

GL to you,

Van I had the same results with UHC. My policy required a 12 month supervised diet. My PCP submitted my many years of attempts and I had 3 co-morbidities, diabetes, hyper tension and high cholesterol. I have kicked 2 out of three still on insulin but not as much as pre wls.
It took 4 months to wrap it all up and be approved then my surgery was only 6 weeks after approval.
I am 11 weeks out and love my new tummy!

I wish you a speedy approval!

Godsblessedme · 11-30-2007, 04:01 PM

that is amazing! good for you! i too had a almost 2 year battle but finally after my appeal i will be having surgery in december good luck to you

Toony · 11-30-2007, 04:41 PM

Mom of 3... You're on your way! How exciting!!! Sounds like you're more than ready... My best!

katie

txchick1971 · 12-07-2007, 10:14 AM

cigna was not hard......i had a clinic doing all my paperwork and i just had to do the 6 month diet......i went in for my 6th weigh in and they submitted that day and i was approved that day.....already did my phsyc, my blood work, nutritional, everything....i got preop 12/11 with my surgeon and 12/20 with the hospital.....yeah!!!!

Jeanie · 12-07-2007, 11:35 AM

Quote:

Originally Posted by txchick1971

cigna was not hard......i had a clinic doing all my paperwork and i just had to do the 6 month diet......i went in for my 6th weigh in and they submitted that day and i was approved that day.....already did my phsyc, my blood work, nutritional, everything....i got preop 12/11 with my surgeon and 12/20 with the hospital.....yeah!!!!

Man I had to fight with Cigna to get it done. I had to appeal twice. JERKS

I'm glad it was eaiser for you.

smurfswifey · 01-21-2008, 11:55 AM

I also have UHC and am just trying to get started with all of this. I actually called the insurance company to see if they could tell me anything as far as what the requirments were...the lady that answered the phone was NOT helpful at all. All she told me is I should send in some letters from my doctor. There has to be more that I have to do than that. She was soooo vague it was ridiculous! I was reading some of the other post in this thread, and I have a question. I haven't been to the doctor on a steady basis for a long time, because up until now I didn't have insurance and couldn't afford to go otherwise. I have been overweight my whole life, but don't really have a doctor supervised weight loss plan on file with my doc, is that going to be a problem?? by the way I have a bmi of 60, so its not like I am slightly overwieght or anything.the only doctor supervised weight loss I have is when I was 12. I go to the seminar in 3 days.

rappaport · 01-21-2008, 12:16 PM

Quote:

Originally Posted by smurfswifey

I also have UHC and am just trying to get started with all of this. I actually called the insurance company to see if they could tell me anything as far as what the requirments were...the lady that answered the phone was NOT helpful at all. All she told me is I should send in some letters from my doctor. There has to be more that I have to do than that. She was soooo vague it was ridiculous! I was reading some of the other post in this thread, and I have a question. I haven't been to the doctor on a steady basis for a long time, because up until now I didn't have insurance and couldn't afford to go otherwise. I have been overweight my whole life, but don't really have a doctor supervised weight loss plan on file with my doc, is that going to be a problem?? by the way I have a bmi of 60, so its not like I am slightly overwieght or anything.the only doctor supervised weight loss I have is when I was 12. I go to the seminar in 3 days.

It varies what's needed based on individual situations. My employer actually required more than UHC. Your doctor will have to draft a letter stating that you are morbidly obese, the co-morbidities you have, and how they are affecting your life. UHC typically requires that you have on record with your doctor a six-month weight loss effort. I wasn't specifically on one with my doctor, but I told him I had been on Atkins, so he used that. Talk to your doctor on that. If he/she is seriously trying to help you, they will work something out. On top of that, your surgeon will require certain tests be performed as well. UHC may seem a pain in the beginning, but as long as you have all the pre-requisites fulfilled, you will get approved quickly.

Good luck and hang in there. It's about six month process that can seem like forever, but it's well worth the wait.

Janelle · 01-21-2008, 08:03 PM

I have UHC as well. In addition to the 6 month medically supervised diet and letter from PCP, I had to prove that my BMI was over 35 for the past five years. The only acceptable form of proof was doctors' records. You may want to ask your surgeon's office about that at your first appointment. I wasn't told about that requirement until AFTER the six month diet thing. It took me a while to recall which doctor I was seeing in 2003! But they accepted ANY doctor for those years...ear doctor, primary care, gynecologist, emergency room visit.

Good news is that after I collected all of the documentation, UHC approved me in less than 24 hours. Hopefully, yours will be that quick as well!

Janelle

Persephone · 01-22-2008, 01:21 AM

Quote:

Originally Posted by Momof3

if the other shoe drops, I hope its a Manolo Blahnik

that just made my night. lol

I think all insurance plans are different just like all wls surgeries are different. The requirements can change from year to year even on the same plan. In 2007 I had UHC and all they required was a letter from the surgeon and a qualifying BMI. I was so excited I wouldn't have to jump through all the hoops. In October my employer announced no UHC next year. I would have to start ALL OVER AGAIN with BCBS or HealthNet and it was possible they would have different requirements if my surgery didn't get done before the end of the year.

A miracle happened and I was scheduled for 12-14-07. (Thank you Dr Juarez and staff) I actually think that some insurance companies are of the mindset that it will actually prevent expenses down the road? Who knows with big business. Not me. It would take me two years to save for one Monolo.

Meet you on Barneys forth floor in 2 years ok?

SueRN · 01-22-2008, 03:42 AM

Like I tell anyone asking about insurance, you need to read your benefit book description to see if WLS is a covered benefit that your employer has chosen. Not all policies with the same insurance company cover WLS. And some have stricter guidelines to meet and may also limit how much they pay for anything related to the WLS and/or subsequent surgeries due to complications. Most will require doctors records of recorded weights for the last five years. Most require a pscyh eval for approval. Not all require a documented doctor sponsored weight loss attempt. Since I have reviewed gastric bypass requests, believe me, not all documentation is anywhere near complete. This can cause delays with approval. I had got hung up on the doctor sponsored weight loss with mine. I had done 3 in my life, but none in the previous 2 years. So I had to do another one. It wa 1 year from starting the process till I had my surgery. But it was all worth the effort and don't regret it for a minute. If you haven't gone to any doctor, see if you have photos that are dated showing your size. This may help. I approved a man once that didnt' have insurance and didnt go to the doctor, but had photos of the last 10 years, that had date stamps on them. It was so obvious he had a BMI of over 40, and I thought it was quite creative, that I approved it. He had met all the other criteria. Also, for co-morbids, some insurance companies want to see that you have also had those problems and where treated for them in the last 4 of 5 years as well. These include diabetes, hypertension, and sleep apnea that is being treated with cpap or bipap. GERD, depression, joint pain, osteoarthritis, back pain, dypsnea on extertion don't count. If you are hypothyroid, it won't count you out, but you have to be treated and have an TSH level in normal range. Hope this helps. Sue