Insurance: What kind of uphill battle do I face in getting approved?

I finally got health coverage for the first time in a decade, so I have no medical records to show prior to the past few months.  My numbers: I am 35, 5'11 with a BMI of 56.  My comorbidities are: high blood pressure/hypertension, sleep apnea (diagnosed with moderate OSA by sleep study two weeks ago) and acid reflux/GERD.  I am wondering what kind of uphill battle I will be facing in getting approved by my health insurance.  I am currently on Amerigroup Medicaid here in Nevada which has a 6 month weightloss requirement but have requested to switch to Health Plan of Nevada Medicaid which has only a 3 month period.  It seems like everyone gets denied at first.  I am wanting to line up all my ducks in a row so I can get the surgery as soon as possible and without having to go through a lengthy process of appeals, etc.  What kind of uphill battle will I be facing in getting approved and what do I need to do to get all my ducks lined up to get approved for surgery?    

Most people do not get denied at first.  You see a lot on the boards because the people who got approved the first time don't do a lot of posting about that.

I would suggest contacting your insurance company for a surgeon referral.  The surgeon can tell you their schedule.  I finished my waiting period and was approved in July but the first opening for my surgeon was in December. 

I was able to get surgery in October because there was a cancellation and I took that surgery spot.

With your BMI, there should be no problem with approval.  The RNY usually cures GERD.

So after the waiting period, you then have to go on a waiting list for months?  I have my first consulation next week and hope to start my weightloss period this month as well.  Was hoping to have my surgery in April or May.   

My sister got denied and she even had a higher BMI and years of medical records.  That's what has me concerned.  

If your insurance does not exclude WLS, then you SHOULD meet the requirements with your BMI and your co-morbidities.

you will have to get through the monitored weight loss period (be it 3 months or 6 months) if you have no documentation to indicate that you have done that previously.

You may also need to have additional testing, such as an EKG, chest X-ray, psychological exam, sleep study.  There are many variables.

Those tests should be allowed to be completed within the monitored weight loss phase, so they should not extend your time.

However, any time you have someone else paying for your surgery, you are subject to their rules and protocol.

Policies vary so much that it would be very difficult for anyone here to give you a detailed timeline.

I had a sleep study done two or three weeks ago and was diagnosed with moderate sleep apnea and I also had an EKG, thought that came out normal.  The doctor does have me on medications for high blood pressure and also said I have high cholesterol.  

The waiting list depends on the surgeon.  Sometimes it is a few weeks.  Why was your sister denied?

She didn't have proof that she was obese beyond 2 years?  She did end up getting the surgery though.  She was in Oklahoma on private insurance.  I am in Nevada on medicaid.  

Another concern.  I have no documentation of previous weightloss attempts other than when I did Nutrisystem this past summer, and maybe gym memberships going back a decade.  

Any physician worth their salt would know at a glance that you've got a long-running problem with obesity.  NOBODY gets a 56 BMI overnight.  

Just resolve to do whatever pre-op program is required, use that time to get your various tests (psych, blood work, ekg, etc.) done, begin to walk gently (no heart attacks allowed!) and go for it.

The delays often are due to surgery scheduling, and have nothing to do with the patient.

Just believe in yourself.  In a year post-op you'll be marveling that you waited so long.