Insurance auth request submitted -- now I hold my breath!

My insurance has a 2-year waiting period for WLS, so I wasn't officially eligible until 4/1, and I talked to the MA at my surgeon's office yesterday to confirm that my husband's and my prior authorization requests were submitted Wednesday, woohoo! I've had a tentative date for awhile (with my husband's a week later), but I will feel SO much better once it's set in stone, especially since my mom already bought plane tickets to come take care of us. Arrgh, I'm just a bundle of nerves! I've been waiting for this for 3 years (my previous insurance didn't cover WLS at all, and medical problems prevented me from going self-pay as planned in 2012). I've done everything they asked for and even lost close to 70 lbs during my 6-month weight management period...I know there's no rational reason they could deny me, but I'm still nervous as hell! Has anyone been denied for an unanticipated reason even after jumping through all the right hoops?

I know how hard it is to wait for your WLS.  From the moment I decided I wanted to do it, to the moment I laid on the operating table was 15 months.  Part of my waiting was insurance approval, which could only come after 3 months of documented weightloss program, 6 months of classes, 3 months of lab and physical testing, then I got the approval and had to wait 2 more months to get the time off work.

All along the way I was terrified I would not be approved, and even after approval, they warned that if I gained even a pound more before the actual surgery, they would turn me away.  I had my surgery almost 8 weeks ago, and now I believe a lot of it was scare tactics.  BTW = I got the E.O.B. from the insurance department and my hospital stay alone cost the insurance company $74,000.  That doesn't even count the surgeon's bill.  So... with that kind of a bill for WLS, you can expect the insurance companies are going to play hardball with you.

But don't worry - you've done great on your own, and believe me... that goes a long way in your favor.

Good luck!

Thank you! I'm actually a little worried that they'll see my progress over the past 6 months and say, "look, she doesn't need surgery to lose weight, DENY!" But I'm really lucky in the insurance arena -- my insurance is a self-funded plan from my employer, which is a large health system, so they know exactly how much they'll save down the road in healthcare costs and lost productivity by approving WLS now. According to my clinic, my insurance is one of the easiest they deal with. However, the weight that matters for reimbursement is the weight right before surgery, after a 2-week liver-shrinking diet, in nothing but a hospital gown, so I need to be super careful to not my BMI drop below 35 in the next month. That's crazy to even comprehend since it was over 50 last October!

I had nowhere NEAR the wait you had, and I was twitchy and nervous until I was approved.  But I was approved.  After all you've done, and all you've been through, if feel confident for you.  You've done great and that will definitely weigh in your favor.  I lost very little weight but was very compliant with my pre-surgery nutrition counseling and I think that is what probably got me approved in spite of my lousy weight loss numbers.  

Sending you all sorts of good thoughts and prayers! 

Christine