Anyone have to do a 6 month preop for Priority Health?

 Looking for a friend who will be having a VSG through Grand Health Partners where I had mine (highly recommended by the way).  

She has Priority Health and she has to go through a 6 month pre-op because her BMI is not over 50!!  It's only 41!  Mine was only 38 for BCS  

She has the co-morbidities but apparently Priority Health just changed their rules as of 6-1-12.

She was told she can't go below a certain weight.  

But does anyone else know what they're looking for??  What might get her tossed out?? Etc??

Thanks

Sounds like your friend is very close to the minimum BMI to qualify for surgery. I would recommend that they play whatever game the insurance co. is requiring but to NOT loss the weight. I was in a similar situation and looking to have lap band surgery a couple of years ago. I was required to do the 6 month weight loss prior to surgery. When I met with the surgeon, I was assured that losing weight for 6 months would NOT disqualify me from having surgery but....it did. I tried to abide by the insurance company's rules and gave an honest effort and ended up losing 43 lbs which then put my BMI too low to qualify for surgery. So tell your friend to be careful about losing too much weight during the 6 months or they may end up not qualifying. I'd hate to see someone else have to go through the same disappointment as I did. :(

 Thanks for your reply!  That's one of our concerns.  

I'm glad some insurance companies are careful on behalf of patients who want to jump into bariatric surgery thinking it's an "easy" way out and not taking the time to look into eveyrthing and making good judgements as well as getting their head in the right place BEFORE they go through with it.

But sometimes insurance companies react like yours did which just doesn't make sense.  So you put the weight back on and then you qualify again.  

Notice though, the biggest buildings in any large city are owned by insurance companies.  They're not there because they're not making money hand over fist.  They keep those fist tight around that money they make and make us, the patients, fight to get our claims paid.  

I've worked in medical billing for 25 years. I've seen it all.

Good luck on your journey.
Colleen

I did know Priority Health changed the rules...but I was aware they did not include the sleeve in their plan.  It is being reviewed for possible inclusion.  This happened in June.

I had a BMI of 53 and the standard acceptable co-morbidity issues:  High Blood Pressure, Sleep Apnea, Diabetes II, Major  Arthritis

and some minor things.  I did NOT have to go through 6 months of pre-op  BUT the hospital (Beaumont in Royal Oak) had me coming in about every other month and I did have about 4 or 5 visits for which I am grateful...I learned so much and really bonded with the Bariatric Fitness Center and the staff.   Because of my co-morbidities they wanted me to have the RNY surgery and my pouch and I are just fine thanks. I've lost 30 pounds since my surgery November 16, 2012.

Good luck to your friend.