I am really concerned with United Healthcare approving my surgery. One of the requirements is 5 years of morbid obesity documented. I believe morbid obesity is considered a bmi of 40 plus. I have a bmi of 40 this past year, but the previous years started at 36 and keep going up till now. Does anyone know if UHC are real sticklers on that? I have about worried myself sick over it. I meet all the other criteria except this one.Thanks for any information anyone can give. Thanks.....

2013:  20 Funny New Year's Resolutions

When it comes to New Year's resolutions, our family members and friends can get quite creative and even funny with what they resolve to do in the New Year.  Here a few good ones I have heard along the way...Oh, and a few of my own!

1.  I resolve to stop procrastinating about procrastinating!

2.  I will stop sending Facebook messages and emails to my loved ones when they are in the same room as I am!

3.  I will use my treadmill for something other than a place to hang my jacket.

4.  I will not sit at the kitchen table in my PJ's all day.  Instead, I will move my computer to my bedroom.

5.  I vow to never take a laxative and a sleeping pill on the same night!

Click here to read more!

Don't have this insurance so I'm unsure of the time frames, but for your other question, google is your friend.

https://www.harvardpilgrim.org/pls/portal/docs/PAGE/PROVIDERS/MEDMGMT/MEDICAL_REVIEW_CRITERIA/BARIATRIC_SURGERIES-6-27-12.PDF

Consider switching your plan to Mercy Care, they approve more often then Health plan.

They all, meaning AHCCCS have to follow the same guidelines for approval.

They claim they are: 5 years medial history of obesity, 6 month supervised weight loss losing 5% of body weight, and then all the pre op evaluations and tests.

They really are: 2 years medical history of obesity, 6 month supervised weight loss program where you do not gain any weight, and the pre op evaluations and tests.

I went to Dr Simon first, and was denied, for I gained 2 lbs in my weight loss regimen. If I had known what I now know, I would of considered wearing heavier clothing on the first weigh in then the last. If they had known, and informed me, I would of starved myself a week to lose those 2 lbs, but at that point I already thought I had failed. I did not know the truth was all I needed to do is stop gaining. 

I switched to Banner Gateway bariatric Center, in East mesa. They are so knowledgeable with dealing with insurance companies hoop jumping and excuse making, that they have a 95% approval rate from them. They require more then they do, but in a good way. All surgeons tell you not to smoke, it interferes in healing, but they actually nicotine test you. All tell you support groups and education are benefits, but they require attendance in a minimum of 2 information sessions. These are examples. 

They also have much better success rate then average with keeping the weight off, because they use a comprehensive weight loss program, where the surgery is just a tool. I highly recommend them. I will be submitting a request fcor coverage again really soon, and am 98% sure they can not deny me this time. 

Have you or anyone you know of been successful at getting Kaiser Northern California or Medicare to cover a revision from VSG to DS?

Almost 2 yrs ago I was injured quite badly in a car accident which I am still recovering from. I had my VSG 1 yr before the car accident and was initially quite successful.

Now I am only down about 25 lbs since the surgery (although still down about 150lbs from my highest weight). There are so many issues at play it’s difficult to determine what caused the weight regain but I think it is largely due to having traumatic brain, spinal and other injuries which have not allowed me to fully follow my food plan or exercise.  Adding in depression and profound fatigue as a result of the accident with a re-occurance of serious thyroid issues and menopause it has been a difficult couple of years all round.

The weight loss allowed me to feel freedom in my body for the first time ever. I want that back.

Currently I have COBRA coverage with Kaiser N Cal and eventually hope to have Medicare coverage.

Any insights or suggestions on how I could possibly get a revision to DS covered?

Thanks very much for your feedback.