Hopefully I am 1 Step Closer to Having My DS

Hello all. I am scheduled to have an endoscopy on November 1. After that, my surgeon (Dr. Elariny) is going to discuss which route we should take, although I told him that I wanted to have a revision from RNY to DS since the results will probably last the longest. I am praying that my insurance will cover the revision because I am do ready to have my life back. The only comorbidity I have is arthritis so I am praying that insurance will kick in and pay for it anyway. Have any of you had an endoscopy and if so, how long did the whole approval process take after that? Any comments will be appreciated. Thanks.

Hi.  I am a revision from a lap band to the DS.  I had several endoscopy tests.  The approval process varies greatly but expect months vs. weeks.  Also add in the time/wait for your surgeon.  In the end it is all worth it and you will need the time to wrap your thoughts and emotions around the next step in your journey.  Best of Luck!

 

Susan

Thank you, Susan. I do not mind waiting. The wait will come in handy just in case my insurance requires months of documented weight loss.

Good luck.  We hope your pre-op process goes smoothly.  Please keep us posted.

Thank you so much!

I am revising from lap band to DS on November 18th. I had my endoscopy on September 13th, surgeons office submitted my paperwork to insurance on September 16th. I got a denial on September 30th. Surgeons office submitted the appeal info on October 3rd, insurance company "received" it October 9th and I got the call from the surgeons office on October 18th saying I had been approved. So altogether it took just over a month, even with an appeal, and will be just under two months between endoscopy and surgery.

Check your insurance coverage do (summary plan description or whatever they call yours), it should provide timelines for pre-auth determinations and appeals. For example mine said they'd make the initial determination within 15 days and had an option for one 15 day extension.

Best of luck!!! I know how tough it is to have patience once you've started the process.

Thank you, Cindy1976 for your help. I am already thinking of ways to appeal just in case I am denied. You did, however, give me something to think about and that is if my surgeon will appeal for me  or is it best for me to appeal on my own?

I would recommend asking your surgeon's office how they deal with appeals so you can be prepared no matter what happens.

For me, I met with 3 different surgeons before selecting the one I'm going with.  The first doesn't offer DS so that was out but the second was oddly opposed to appeals. He assured me that an appeal wouldn't work and that he had tried more than once with others from my company on my same insurance plan and it was impossible and he suggested I self pay. So, I tried another surgeon (the one I'm going with) and told him right from the beginning that expected to be denied but I planned to appeal. He and his office were completely onboard and took care of everything for me. 

If your surgeons office won't help with the appeal I'd recommend contacting Lindstrom Law. Fortunately, I didn't have to get to that level but I did call them to inquire early on and they were super helpful. I think in the world of health insurance appeals the relationships that people build within the industry are helpful in getting things pushed through so having an advocate with the right connections could really help.

Good luck!!!

That is a very good idea and I will keep Lindstrom Law on file.