Insurance -- Pre-approvals, appeals, and other stuff I need help with

Read my blog which has my insurance appeal in it. I won. But every policy is different. You have to read the terms of the policy and comply with them. And learn the appeal procedures in your state. GL Diane S

I wrangle insurance for a living and have for years.

I do not think your insurance will make an exception for you. Although it is a pain to have to wait, there is no compelling reason for the waiting period to be shortened.

Your PCP can think anything, but if you do not meet all criteria, you may be denied.

Understood. I did call and get some clarification finally this morning, and she did tell me that there are more things accepted than just "weigh-ins with my PCP". So that actually helped quite a bit.

Thank you for your input!

You've gotten such great input that I don't have much to add. My concern would be staying with a surgeon who said that it's "easy enough" to revise. It may be easy for the surgeon, but it's not a walk in the park for you and your body.

And what MaryAnn said about printing out a copy of your insurance requirements. Do that. A lot can change in a year and with apologies I don't trust insurance companies to uphold the highest ethical standards. Printed policies have saved many bacons.

Good luck, I hope your time passes quickly or that it turns out you don't need to wait the whole year.

Yeah for sure. I feel like I've learned a lot. And I am so glad this community is so supportive/knowledgeable :D!

And yeah, I kind of agree. If I remember, that's what I told him, was that I don't want to have to take time off for another recovery. I found out he is actually retiring the end of this year, so if I have to wait (which it's seeming like I might) it will actually be with his successor. I will have a more in-depth conversation when I go back. Definitely going to print out the policy tho.

Thanks! Me too!

Many insurance plans will only pay for 1 bariatric surgery per person, per lifetime. So if a revision to RNY is indicated after VSG surgery, it may end up costing you many thousands of dollars out-of-pocket. Find out your insurance company's stated policy on this topic before making a decision on which surgery to have done. Good luck.

Thanks for the warning. If I remember correctly, they cover a revision if it's "medically necessary" (ah, those words again). Ergo, something other than 'didn't lose enough' I think. But I will certainly double check. And, as people have suggested, print out the requirements.

My insurance requires 6 months and my surgeon offered to write a letter of medical necessity to try to get the surgery sooner. He told me that according to the medical research, there is no valid medical reason to wait 6 months and that he's had some success with the letters, but that my specific insurance company had become more resistant. In my case, I WANTED to wait the 6 months due to a busy summer work schedule. To my benefit, I've already lost about 49 pounds during the medically supervised portion, which I'm told is a little outside the norm, but will put me in a better place before surgery. Not all insurance requires 6 months and I believe Medicare only requires a month, so it really varies.

So, my point is 12 months is incredibly excessive and YES have your doctor try to convince the insurance company to permit you to have a sooner date, especially with your high BMI. My surgeon would recommend Bypass with your BMI - when I started I was told that I was on the cusp of his Bypass requirement so he would let me choose. My BMI has dropped but I am still selecting Bypass due to the GERD issue. The increase in GERD is the number one complication of the Sleeve. I read a JAMA article from January saying that 7% of sleeve patients have a significant increase in GERD.

Good luck to you...I'm looking at surgery in September or October and am extremely nervous. But, I've done my research and believe it's the right solution for me.

Thank you for the info. I'm still trying to get somewhere with the INS. But in the meantime, I guess I'll keep checking in as I've been told. I don't want to rush, I don't mind waiting the sixth months. I honestly expected it as kind of a prep period.

Anyway. Good luck to you too! Thanks for the input.