Tell Your Pre Approval Story!

I want to hear your stories! What tests did your insurance require? Was your PCP supportive? What was your consult to surgery time line?? I am sweating my way through this, dreading a denial and dreaming of the possibility of a new chance on life all at once. Hearing your stories helps me feel so much less "alone". TIA Jill in NY 245/???/175 BMI 41 Dr. David Mayer, Huntington NY

I have Independent Health. I had the regular blood work up, including thyroid test which was requested by my PCP who was very supportive. My surgeon required me to attend an info session before I could see him. My first visit with him was in late September. I then had to have a sleep study done, see a nutritionist, and have a psych eval. Did all that in October. Once all the surgeon's office received all the evals, they sent it to the insurance company for approval in early November, and I had my approval within a week. I then had a follow up with surgeon in December and set my surgery date for April 2nd, 2007. At the info session I went to, they said it would be about 6 months from my first visit until surgery. My surgeon also requested a letter of necessity from my PCP and required me to lose 20lbs before surgery. I have another appointment tomorrow, then have my pre-op testing, back to the PCP for medical clearnance, and one more visit with surgeon before surgery. I've read many other stories, and they are all a bit different. My surgeon and PCP pretty much assured me, based on their experience with my insurance company, that I would be approved. Most of the DR's have been through this so many times with the same insurance companies, they know what is required. Good luck on your journey! Michelle

Well...once upon a time until today(!!!!) I am approved. ***I had to have SIX months of CONSECUTIVE visits with my PCP to document my diet and exercise stategies. I said consecutive because although I have seen my PCP since 2000 and weight was always an issue...it did not count. It must be SIX months in a row. ***During this time I had a Psych evaluation OFFICE VISIT with SUPPORT PERSON NUTRITIONISTconsult 2 SUPPORT GROUPS(and I continue to go) 1 EDUCATIONAL GROUP EKG & whatever extra cardiac tests are warranted SLEEP STUDY to r/o Apnea(I have severe apnea) BLOOD WORK GALL BLADDER ULTRA SOUND UPPER ENDOSCOPY METABOLIC TESTING PULMONARY FUNCTION TEST (if needed) COMPREHENSIVE GASTRIC BYPASS QUIZ MY DOCTOR ABSOLUTELY REFUSES TO OPERATE IF YOU SMOKE.YOU ARE NOT EVEN PERMITTED NICOTINE AIDS. ***All of these tests took almost two months (Sept. & Oct.) and the rest of the time was spent completing the 6 month documentation visits with my PCP. ( Last month) ***Surgeon visit to sign consent form ***PRE-OP testing the week of surgery and that includes if I have nicotine in my blood! ***MEDICAL CLEARANCE week of surgey by PCP THE END! Take Care, Diane

Whew! You'd think approval would be a bit easier with all the dough the insurance has to shell out for pre testing!? I watched my sister go through the process, and she went from first consult to surgery in 3 months. She also has Oxford, which apparently ROCKS. I do NOT have Oxford (BCBS) and have to really work for this. I had my first consult on President's day Monday 2/19), where they gave me the dreaded "packet". I dove in head first. I had my PCP visit on Wednesday 2/21 and she wrote my letter that night (a very good one, at that)! I had my fasting bloodwork that evening (thyroid,lipids,cbc,electrolytes,etc) . On Monday 2/26 I had my psych eval with a really amazing woman who I plan to see post-surgery as well (IF approved),Wednesday 2/28 was my EKG & cardio visit, Thursday(3/1) was my esophogram, and Friday(3/2) my Echocardiogram. Apparently the cardiologist wrote a very positive letter too. I saw the Pulmonologist last night(3/6), who has me doing a sleep apnea test Monday night(3/12)! I see the nutritionist tomorrow(3/8)............and that should be IT!!!!! I have my wellness Dr. (nutritionist/chiropractor) writing a letter for monthly weigh ins (which I happened to do without ever knowing it would benefit this). I also have a CT scan that shows that after I had my thyroid removed in 1999, I have slowly had fatty infiltration of my salivary glands and liver......also due to weight gain. I'm not sure if it's necessary but I had all my endocrinologist visits (including around surgery time) for the last 7 years being faxed to my surgeon. Of curse I moved 3 times in-between....so I was a fax queen this week. So, now I WAIT....and I really stink at waiting. But hopefully it will all pay off. I realize that there are people who have been riding this train for months, and I want to give major hugs to all of you. Seeing my sister literally melt before my eyes has made me obsessed....I NEED to do this. I have a son that I want to run and play with...I want to go out socially without hiding in the corner. I'm going on and on......sorry! Thank you for this place, thank you all for listening! Jill in NY 245/???/175 BMI 41 Dr. David Mayer, Huntington N.Y.

Hi, I had my initial orientation on 11/21/06 and I was told approximately 6 months til surgery. I had to: See a nutritionist, Get a clearance from my PCP, who was very supportive Get blood work Sleep Apnea testing (I have apnea) Attend a minimum of 2 support groups (I still attend) Attend 2 educational sessions Psych Eval I had to lose 27lbs Once I had all my clearances (had completed all by 1/19/07) I got an appointment with the surgeon. Saw him on 2/28/07 and I am scheduled for surgery on 4/2/07. Before surgery I have to have an endoscopy, ultrasouond of my legs, pre-op testing and 1 last appt with my surgeon. I have not gotten insurance approval yet. Still waiting..... Good Luck! Janet

I have Oxford Freedom plan. I reviewed my benefits summary and it stated if your BMI is over 40 all you need is a referal from you PCP. After my consultation w/ the WLS surgergon it took three days to approve. Once approved my WLS sent me a week before for all the preop tests. I did extensive research before having the surgery. I thought about it for a year. At first I wanted the LAP Band but then after more thought I wanted something permanent so I switched to Lap Route en Y. I'm glad I did. My surgery was November 14th. I dropped 65 pounds. I exercise daily and feel great. My only down side to this surgery is that I get alot of smelly GAS (sorry so blunt). And my hair is starting to fall out (one clump per wash).

Man, you Oxford people have all the luck Jennifer...65 lbs. GONE! Amazing. Do you see a nutritionist post-surgery? Perhaps they could give you some advice to avoid more hair loss. Today I got some great news, my PCP faxed me copies of recored from the two years I've been seeing her for various issues....and I have 4 solid months of weigh-ins! That means only 2 more (March & April) and should not have any more insurance roadblocks! I am loving my PCP right now...she is so totally supportive of this and is truly an advocate. Sleep Apnea testing Monday night....and then we submit. I am so very excited....so much nervous energy that I've been exercising more than ever (lol...go figure). I feel a little silly saying this...but today is my birthday and I'm feeling somewhat reborn with the idea of this life-changing surgery. My fat has chaged me so (anti-social, chronically depressed, even a bit agorophobic)....thsi could be a key to unlock the door! Thank you all again for your input and ears! JIll in NY 245/??/175 BMI 41 Dr. David Mayer, Huntington NY

Good luck Jill with your approval. Its good you are getting support from your PCP. My PCP always seems like she's in a rush. As for Post surgery w/ my Bariatric Doctor. Well not good! My doctor was Marina Kurian. Hard to get an appt and when you do you wait so long to be seen and its only for five minutes. I felt rushed everytime I saw her. I even saw another doctor while she was on vacation and he made me wait 40 minutes in the checkup room and talk with me for five minutes and recommended Bariatric products. Like he was a salesman. The only support I have is my self support and my husband. But sometimes my husband gets mad a me because he thinks I'm obsessed w/ the gym now and all I care about is my surgery. My reply to him is that I cared about you and the kids for years and now its time to take care of me! D

This is YOUR time Jennifer....enjoy it. I read my DH your post....a kind of "warning" to let me obsess for a while. He will be as happy with the results as I will

Hi Jill, I started out making the decision in May 2004, got all my pre-op stuff done by the end of June and got approved by Aetna within days. I had to have a psych eval, bloodwork, cardio clearance, abdominal sonogram of the gallbladder and liver, regular medical check-up, gastroenterologist clearance - I think that's it, I can't remember too well now. Aetna LOVES documentation so I had a letter from PCP, my diet center doctor, plus proof that I had been going to a diet center off & on for years. Waiting for approval is a pain in the u know what, I know - but when you hear "you're approved", it's all worth it. If you think approval for WLS is bad, approval for plastic surgery is WORSE! But one thing at a time. Try to stay positive and make sure you do everything they require and provide everything they ask for to increase your chances. Good luck to you and keep us posted!