Question about insurance approval

I was just curious about insurance approval for the DS. My insurance company told me today that the 6 month medically supervised diet is no longer a requirement for them to approve to pay for WLS.   My surgeon's insurance coordinator told me yesterday that my insurance company was pretty much a bunch of liars because she knows for a fact that they still require the 6 month diet before applying for approval and that she just had another patient denied yesterday for not completing the 6 months. When I called my insurance company today the woman stated that as long as someone meets the requirements and it is shown as medically necessary then they do cover WLS. She also told me that someone wouldn't get denied for the single fact that they didn't complete 6 months of dieting prior to surgery if it is shown as medically necessary but that it could help because they will not pay for the surgery for someone who is just too lazy to diet and doesn't meet the requirements.

 Dr Boyce is the only surgeon in East TN who performs the DS. I was wondering how many people got approved for surgery without doing the 6 month diet and how long did it take for insurance to respond once the approval request was submitted

Dr Boyce is not a vetted DS surgeon.  Take a look at www.dsfacts.com.  I don't know which vetted surgeon is closest to you.  My surgeon is in Durham NC which is not too far from ET.

I know of two people who have had the DS with Dr. Boyce and are doing fine. A lot of surgeons won't take my insurance I have tenncare United Healthcare. Dr. Boyce was one of the few who accepted my insurance and performed the DS surgery. Thanks for your advice. I will check into vetted DS surgeons but I believe Dr Boyce is a great surgeon so I've been told by a few people on OH

Regarding the 6 month supervised diet requirement, get your hands on your policy, either on paper or on line, and read it for yourself. The people you speak with by phone don't care whether you get your surgery or not. You do. Why would you trust an unknown person with this huge, important piece of information?

No one cares about your health and whether or not you get your DS more than you. Check the policy yourself. Make sure you jump through all the hoops and you will get to your goal.

Larra

Thank you. I guess I thought that since they are working for insurance they should know more than most about the policy. I haven't seen anything online that suggest you do or do not have to have this 6 month supervised diet to get approved. I also was told that they just recently decided to get rid of requirement. The other surgeon office said they decided to get rid of a few months ago. I'm sure my surgeons office would know much more about this then me and as you said I should jump through all the insurance hoops because I do want this surgery. Better to wait it out these last two months then to hurry the process.

Policies do change from time to time, so it's possible that this is accurage info, but you are entitled to see your policy for yourself to make absolutely certain. You would think the people that work there would know the most, but there are SO many stories about the misinformation people get from company employees, and the person who ends up screwed is you, not the employee.

So I still say, check for yourself. You can't go wrong that way.

Larra

Thanks!