I have waited a long time.....

to post this. I have been APPROVED. Some of you may know that my journey has taken about 3 years. My insurance co (UHC) and employer (State of AZ) repeatedly denied my request for approval and appeals. But a while back I was diagnosed with sleep apnea, and that seemed to have made the difference. I am scheduled with Dr Blackstone for August, and this is finally starting to feel REAL. I urge anyone who has become discouraged to persist. Dr. Blackstone's office was terrific, and even though it seemed at times to be impossible, they never gave up. Thank you to everyone who encouraged, supported, and urged me to hang in there.

Wow Maxine that is quiet a fight 3 years!! Congrats on getting approved!!! You must be sooo happy!! I am so very happy for you!

That is so encouraging for me to hear even though it sucks that it took you a while to get approved, I am a state employee as well but with the RAN-AMN insurance but I think it's all the same criteria for approval. Anyway, I am in the beginning of my 6 month diet and I live in fear of not being approved and having to fight it through appeals but at least you give me encouragement that it can be done! Good luck and congratulations!

Congratulations! :-D I hope things work out for you. I have an interview for a job with the state and I wasn't sure if they covered it. It is a little scary to think that it might take me three years to get spproved for my surgery. The company I work for covers it if medically necessary and you must have 6 months of medically supervised weightloss. I am just starting the process...again......and hope to suceed and post my surgery date like you.

I want to clarify for anyone in the same situation - working for the state, fighting insurance, etc- that I have to take responsibility for some of that 3 years! The insurance companies are clever, and they know what they are doing. When they deny you, their denial is so perfectly absolute, that you might foolishly (like me) think there's no chance - that's it's final. It's discouraging, and for a couple of denials, I walked away from it, thinking, "oh well...I guess it's not meant to be." That was dumb. Because then I had to start over, instead of just appealing. Some further delay was caused when the State switched insurance companies, and I had to start over again. Lessons to be learned: DO NOT BE DISCOURAGED. MOVE FORWARD. PERSIST. If you have any questions, just pm me, and I will be happy to share anything I have learned in this process. I will tell you now- be sure that your supervised weight loss program is properly documented! Your surgeon's office and/or the insurance company should be able to tell you EXACTLY what is required. Hang in there. Dreams can and do come true. Maxine

I am a state of AZ employee with UHC, as well. I was originally denied (back in Nov.) due to not having a 6-month physician supervised weight loss program and because they claimed my sleep apnea was not severe and therefore not life threatening. I have since been diagnosed with hypoventilation and completed my 6-month program. I was approved last week! Yeehaw! I just wanted to second the comment that it is possible to get approved even though the state has extensive criteria to be met. I would also be glad to share my experiences and documentation. Let me know if I can be of assistance. I have the current state of AZ criteria, contact #'s, a template for the summary sheet I had my PCP sign at each visit (which was a supplement to the office visit notes), and a sample letter of medical necessity. I wish you all the best of luck in getting approved. Congrats Maxine for winning the good fight and getting approval from UHC and state of AZ! Take care, Sandi

Congrats Sandi! I am a state employee as well and I am justing starting this whole crazy process and am one month into my 6 month supervised program. One answer I could never get from the insurance was if they required an actual weight loss with the program or just the 6 months supervised. Did you lose weight during your 6 months and do you feel it helped get you approved?

Thanks Rebecca. Regarding the weight loss, actually on my denial letter they stated that the 10% weight loss was required. They were wrong though and were using outdated criteria. I have the current criteria and would be happy to fax it or email it to you. I had to pressure UHC care coordination and they finally located the updated and approved criteria. The 10% weight loss requirement was actually removed back in 2004 or 2005. Personally, I gained for the first three months and then I lost about 23 pds for the last 3+ months. My overall loss was only 9 pds from my starting weight at the beginning of the program. I am majorly in the "last supper" state of mind right now though. I am hoping I don't gain it all back before surgery. I didn't really diet for the last three months but mainly just cut out items such as sugar sodas, chips, fast food etc. I think a lot of it depends on your PCP too. If you have one who is strict and wants to see progress then you may run into a roadblock with the documentation you will need to send to the insurance company. My PCP was great. She basically let me guide her as to what to put in her office visit notes. She also let me provide a summary sheet that I had crafted to reflect meeting all of the state of AZ criteria each month that she signed and included in my medical records. I am not sure if the weight loss influenced UHC's final decision. It really shouldn't and they cannot hold you to requirements that they haven't held others to. Of course some weight loss is a good thing as far as preparing your body for surgery. Plus, some of the surgeons have their own requirements regarding weight loss. Have you picked a surgeon yet? I would recommend getting started now so you know what they expect. I have found that it is best to get whatever you can done as soon as you can because there are so many delays and roadblocks that can occur. It is good to have a PCP that will help you out with some of the requirements. For instance, I would have had a longer wait for a surgery date if I had waited for the surgeon's office to schedule my cardiac clearance. My PCP's office was able to schedule it for me. My best advice is to not wait until the 6 months is over to start some of the other requirements or tests or surgical consult etc. or you will have another 2-4 months of steps to get through before you can get a surgery date. I would also recommend becoming your own health advocate because most of the surgeon's offices and the insurance companies have issues, delays, incompetencies etc. that can impact your progress. I have made sure to hand deliver paperwork, talk to managers versus front line employees, and basically bugged and annoyed people until they paid attention and resolved any issues I had. It hasn't been a fun process but I do think it will be worth it. I honestly think that the department that handled my appeal was more knowledgeable and proficient than the original medical director who denied my first request. I hope that you don't have to go through the appeal process and I hope you get approved on your first request. However, I think I had a better opportunity to get approved on appeal. The six-month program is a long wait. I don't think insurance companies realized that most of us have already tried many different ways to lose weight. They also don't realize that we do not just decide to have surgery in an instant and that it actually takes a lot of research and self-reflection prior to making the decision. Making us wait six months after the decision is made seems a little cruel to me. I am grateful though because I know it has taken others much much longer to get approval or insurance coverage. Plus, others have had to self-pay. Well, I just got my surgery date today. I am scheduled for June 15th - yeehaw! I wish you the best of luck! Let me know if I can help. Take care, Sandi

Sandi... Thanks so much for your encouraging words. I have actually chosen a surgeon already, Dr. Blackstone, and attended her seminar. I also got the go ahead from her office to schedule my initial visit but I am waiting a month or so to make the appointment so I can save up the money for the psych exam. I am hoping then I can get a bunch of the pre-op testing done during my 6 month diet rather than waiting until the end. I lucked out with my primary care phsyician in that she thinks the 6 month diet is ridiculous on somebody with such a long dieting history and I think she will be very generous to my cause in the way she writes her monthly chart notes. My PCP will also be willing to schedule additional tests for me as needed. So far, based on what I learned at my seminar and talking to her about some of my other potential health problems, she has already ordered a sleep study and that's next week. I am convinced that if I follow this plan, the State will approve me, either the first go round or on appeal. I do have the RAN/AMN insurance instead of UHC but from what I understand the state is now self-insured and so those companies just administer the plan and so the requirements should be the same from company to company. Your story makes me believe its possible, thank you so much and good luck on your surgery!

Hey Maxine, It is so good to hear your words of encouragement...I, too, went throught a very lengthy approval process, due in part to the changes in my medical coverage. I am also scheduled with Dr. Blackstone in July for my RNY amd I am very excited. I will go to my pre-op orientation day in June. Yes, now I am feeling that this is real. I hope that I am up to the challenge. Please keep in touch and let me know how you are doing. Robin