Getting Approval

I am meeting with the surgeon next week, I have already been to the NUT and am going to have my psych eval done this week. Is there anything else I can do to get my insurance approval quickly? I know I still have to go see my PCP to get a letter from him ( I dread going, he is a personal aquantiance and has never mentioned my weight). Any assistance is appricated, I want to move this along so I can get it done before I loose my nerve to do it. I have been thinking about it for years and always thought it was too scary or found an excuse not to do it, mainly missing work. Thanks

i just got my approval from the4 insurance company, i have new jersey plus for health insurance. it took about 2 weeks... good luck

I just got my approval and it took about 2 weeks, but they required a lot of paper work, as well as supervised diet for 6 month with my PCP, bloodtests and letters from my PCP, NUT. I also had to show proof of prevous diet attempts such as weigh****cher, jenny craig, Gym memberships. I have heard they can take up to 30 days or longer. I think they like to see us squirm. Good Luck.
Sherri

that is the part I am worried about. The gym I went to closed and I just started WW online at the first of the year & I dont have any proof of anything prior to that cause I moved and did not keep anything, I never thought I would need it.... I feel like I am going to be stuck !!

 

I just realized we have the same Dr. Dr Bertha's office is really good at what they do. Jennifer and Carla work on the insurance approval and they know what they are doing. What kind of ins do you have? I have coresourse because I work in Morristown Memorial, not such a common insurance. Call your ins company and ask exactly what is required. You may not need these things. Good LUck.

Your surgeon should be able to give you a list of what your insurance requires for approval.  Plus, any tests they require. For insurance I needed:  5 year weight history, psych eval, nutrition eval.  The 5 year weight history had to show that I was a BMI over 35 each year.  I was in the same boat as you - and also knew my doctor as a personal aquaintance.  Because of this, I was able to write my own letter, fill in my weights for the past 5 years (ensuring of course the BMI was over 35) and had him sign off on it.  Any co morbid factors (joint pain, back pain, diabetes, hypertension, sleep apnea, social isolation, depression to name a few) should be included.  If you have seen any specialists, get them invovled too.  I also put in the letter ALL of the diets I had tried over the years (Atkins, Weigh****cher, Stacker Two weight loss pills, Fit America, Jenny Craig, South Beach, 1800 cal ada doctor supervised (not really), again to name a few)  The more proof you have of failing, and medical necessity, the better off you probably will be.   So, get the requirments - you may need to do a 6 mos supervised diet.  You aren't really expected to lose anything, but you need to have your doctor write that he told you what to do, that you met with him EVERY month, and your correlating weight.  This has to be done the 6 mos prior to approval I believe.  I don't think a 6 mos supervised diet from a year or two ago would qualify. Best of luck! Pam

Dr. Bertha's staff is great with insurance.  Don't be surprised if Dr. Bertha requests that you have additional tests done.  It varies from patient to patient.  When you go for your visit with Dr. Bertha you can ask to see someone in the insurance department.  Everyone in that office is helpful and easy to deal with.  They had my packet together and reviewed everything before they sent it to insurance and I was approved within 10 days.  Have you checked with your insurance to see what their requirements are? 

Hi,

My surgeon is Dr. Bertha too, and Carla (takes care of Insurance) she is fantastic. On my first visit the gave me a lpacket of things that i need to do.

1. Blood Work. (if there is any deficiencies you need to take care before surgery)

2. Psych & Nutricional Evaluation.

3. Letter from Primary Doctor. (they give you a template)

4. Letter from OBGYN. (if applicable,) i had an iron deficiency so i need to get this.

5. Certificate of completion of a online course, i forget what is the website, but it will cost you $25.00.

Personally i didn't need anything else. I have United Health Care and at first they needed a 6 months supervised diet but Carla spoke to them and i spoke to them too and within 2 weeks i had my approval and 3 weeks later i had my surgery.

When everything is set, you need to go to the office and attend a 3 hour seminar with the dietician and the nurse.

If you have any questions please write.

 

I think the course is Clarity MD.  The tests needed vary from patient to patient depending on your age, co-morbids and medical history. I had to have bloodwork, a recent mammo and ob/gyn visit and a colonoscopy (because I was nearing 50).  I also had to have the psych & Nut (which I think is standard) and my insurance also required 6 months visits with my PCP).  Fortunately I knew that before I made my final decision to have surgery so I started on my visits before I made my final decision.  Carla is fantastic.  I called her to check on the status of my file and she called me back at 7:30 in the evening to go over it with me to make sure she had everything to be submitted to insurance.  I have been impressed with everyone in his office.  

Me too,

I have nothing but GOOD things to say about Advance Laparoscopic Surgeons and the staff. They are great, they make everything so simple and they are very straight forward.

I personally recommended a friend to Dr. Bertha, that is how much i like and trust everyone there.

If i where you, i will just wait and see what the say.

The course is called ClarityMD.

GOD BLESS YOU,

Miriam