MMPC'ers

Just need to vent to whoever wants to listen!  The waiting process and not knowing is so hard!!!!  I feel WLS is my only hope after so many years of failed attempts and I want to have some HOPE!
Here's the scoop-Attended orientation, have acceptance from my PCP and a letter recommending WLS for medical neccessity from Internist-that has been sent to my insurance "Priority Health POS"  Now I'm waiting to see what they say.  MMPC says it usually takes 2-3 weeks to hear from priority on authorization to proceed.
My BMI is 45 with comorbidities of IBS, Joint pain, gallbladder disease, urinary incontinence-None of the biggies.  Is there hope for me from the insurance company?????  My policy says  BMI 40-45 must have 1 comorbidity, BMI over 45 no comorbidity-but I'm scared because I don't have any big major one's and I'm on the line of BMI.
Patience is not one of my high points-and I just feel like I'm hanging on a thread waiting to hear if there's a possibilitiy.  I've already done WWatchers for 8 months which does count (I found out) as a medically supervised diet.
What do you think????  Any advise for me or any feelings of what my insurance might do?

I don't have PH, but know your anguish.  The waiting takes forever and I too am not a patient person.  It doesn't seem fair to be at the mercy of so many people, but unfortunately you are. I do  not have any words of wisdom or any help with the insurance stuff.  I do not know what type surgery you are looking into, but I know that makes a difference too. 

 I just wanted you to know I DO - REALLY REALLY DO understand your frustration.  ((hugs))

Thanks-it feels better just to let it out  I'm pretty sure lap band is the one for me with all my IBS problems!  Thanks for listening!

Waiting is AWFUL!!! I just recently went thru the same thing, however, the 2-3 wk wait is a standard time they tell everyone. I have Priority Health & w/the exception of a holiday thrown in, I got my approval letter within 4 days-2 days before MMPC had their copy. I don't know how your ins differs, but it must in some ways because Weigh****chers didn't qualify for me & as long as you have a BMI of 35 & up w/comorbidities(I think you need 3) or 40 & up w/no comorbidities & you comply w/the weight loss program prior, you're golden. So, anyway, I'm rambling but want you to know that we FEEL YOUR WAITING GAME PAIN!!!!!!!!!!!!!! Every minute of the day feels like forever!! If you just can't stand it, call Priority & ask what the status is!

Thanks Lisa-Your reply was something I've been waiting for!  Just to know with my insurance I may have hope is a tremendous relief!  I've called Priority twice already and they still don't show it in the system.  The good thing is next week is vacation all week-so getting away a little will help take my mind off things awhile.  I have another goofy question-----When does your weight offically count for the insurance?  On your information sent in for preapproval from the PCP or when you actually go to MMPC and meet with everyone?  Crazy I know-but my weight can go up and down by 8 pounds every week because I have IBS and since I'm right on the line-it makes me nervous.

Ok-at the point you are at, with my ins, you're actually waiting for approval for "surgical evaluation". Once you get that, MMPC will set up appts w/the doctor(internist), behavorist & the surgeon of your choice. I think-not sure-that the weight taken at the appt w/the internist is the 1 they use to submit. You'll actaully see the internist & behavorist on 1 day & then the surgeon & behavorist the next week(on the same day). If you need any tests done, they'll order those & then it's a waiting game again-doing the tests,  another submission to ins for the actual approval for surgery. They say within 2 weeks to 3 months to wait. I don't think they'll actually give you a date untill all of your test results are in & have been reviewed. I didn't have to have any testing done(except bloodwork) as I have no comorbitities so it moved along pretty quickly. My original date was scheduled for the 9th but I had to change it because hubby was going out of town for work. Once you do get a date, it's pretty quick-Dr Foote was scheduling only 3 weeks out!

Did you get a "Typical Surgical Schedule" sheet in your orientation folder? That really does pretty much follow everything accurately, but for me, it all happened quicker than the times they have listed.

When did your information get sent to PH?? I know for me, I confirmed it was sent and it was 3-4 days at least before they confirmed they received it. then I believe the customer service rep I talked to actually called the department that handles it and they confirmed they had received it even though it wasn't in the system.

I think my policy required a BMI of 55 without any comorbidities and I fall right there, so I was concerned about that as well. I dont know what weight they used, but the surgical eval was approved without any issues.

Good luck!!

Everyone goes thru some sort of waiting period....just do everything you need to get done.  This surgery isnt an emergency surgery, it is an elected surgery.  Think about what you will have to do after surgery.  Research like crazy until your process gets going.  Be patient and keep yourself informed.
Best wishes

S

Hello,
I am 3 years out and I understand your issue! I actually had my surgery delayed 3 times the 2nd I was on the table ready to go in. Just HANG IN THERE! Before you know it you will be celebrating our 1 year anniversary and will look back and wonder just who that person is in the mirror because they are not who you grew up looking at in the mirror. The wait for the surgery can seem like forever but it is a very serious life changing event and sometimes the wait is good because it makes you just that more comitted. We are here for you.
GOOD LUCK!
TRENT :)

I waited nearly a year from start to finish to get my insurance (MMPC lost my insurance card so they said) to approve, so the process sometimes moves slowly. I don't really have patience either.  My advice is to pester MMPC's office a lot otherwise they don't get things done or lose things. I had a high BMI and my comorbidities were arthritis, IBS, borderline high blood pressure, fibromyalgia ... so, none of the really big ones. However, once the insurance was properly submitted, I was approved fairly quickly after a cardio consult (which probably should have been done right away but wasn't). I really don't think you will have a problem getting approved ... don't know anything about Priority Health, however.

I do understand how you feel about WLS ... it was my last hope. I was desperate to lose weight. I had been an overweight child, teen and finally an obese adult, topping out at 355 pounds. I have lost 180 pounds and am maintaining at 170 pounds now after four years. It saved my life. I still have arthritic knees and back, but that's progressive; I still IBS, but it changed it ... no more diarrhea, now it's gas (well, most of us with gastric bypass have gas) and constipation ... a much easier thing to treat, let me tell you. No more high blood pressure ... last time check, it was 100/68. I am so much happier with my life; I have met so many people through Obesity Help's forums.

If you need any help or have any questions along the way, please let me know. I'll be glad to help you.