There may be hope for my hubby and WLS

Deanna798
on 9/13/17 9:20 am

RNY on 08/04/15

My hubby has been in contact with the surgeons office about the denial for WLS from our insurance company. A little background on the issue: He had jumped through all of the hoops this year and when the surgeon submitted for approval he was denied because they said he didn't meet the criteria. This was back in May or early June of this year. When I was off on medical leave from my plastics, I called our insurance company so I could get clarification of what the criteria actually is. I had RNY 2 years ago with the exact same policy, so I was familiar with the criteria.

Anway, when I called them in June, they told me that his employer had changed the policy as of January 2017, and that he was not covered. We both got pissed and upset and he kinda lost hope of having surgery. So, when the bariatric nurse called him recently, she insisted that the insurance company had verified the criteria with them in 2017, and that he was missing some documentation under that criteria. He went to his PCP and picked up the records needed (5 years of BMI and comorbidiites). He took them to his surgeon today and they are resubmitting this week. They feel very confident that he will be approved. They will fast track him to have surgery this year, since we've met our max out of pocket and the surgery would be completely free. The insurance company has to respond by October 11th, so we'll know quickly if he will have surgery or not.

I'm so super excited and any prayers, swinging chickens or good thoughts that you guys can offer would be greatly appreciated. Both of us had written off the surgery for him for the foreseeable future, and now we have hope!

Age: 44 | Height: 5' 3" | Starting January 2015: 291 | RNY 8/4/15 with Dr. Arthur Carlin| Goal: 150

Listen to advice and accept discipline, and at the end you will be counted among the wise. ~Proverbs 19:20

teresafr
on 9/13/17 9:36 am

RNY on 08/14/17

That's so awesome! And since you went through it already it'll be a bit easier on him. What a great support structure!

Rosemi
on 9/13/17 9:57 am

Here's to hoping with you....and I know you're busy but I miss you on the menu thread( computer neophyte and former lurker so I don't actually know if it's a thread or actually what a thread is...?) Again hoping the insurance comes through for you guys.

pammieanne
on 9/13/17 10:17 am - OK

RNY on 05/16/16

Hoping he gets good answers, and quickly too!

Height 5'5" HW 260 SW 251 CW 141.6 (2/27/18)

RNY 5-16-16 Pre-Op 9lbs, M1-18.5lbs, M2-18.1lbs, M3-14.8lbs, M4-10.4lbs, M5-9.2lbs, M6-7lbs, M7-6.2lbs, M8-8.8lbs,M9-7.8lbs, M10-1 lb, M11-.6lbs, M12-4.4lbs