Tufts HMO: Any advice on getting approved

I am just starting out. I have my first appointment with surgeon on Tuesday and was wondering if anyone had tufts when trying to get approved for gastric bypass. I figuare any help in advance would be great. Thank you!!! Courtney

Hello there I called Tufts last week because I am trying to switch insurances and I was told that if it's medically necessary it is covered.

Thank you Patty for your help. I know that they cover bariatric surgery. I am 22 yrs old and have no co-morbidities. I have severe joint pain, and must take pain meds daily to just be able to walk comfortably. This has come about in the past month. I am a nursing student at Umass, Amherst and have trouble walking around campus. I am easily short of breath, and have recently had a lot of heart burn. I am afraid that Tufts will not cover the surgery because I am so young, and I am covered under my mother's insurance since I am a student. I am 5'2 and weigh 253 so I have a BMI of around 46-47. I know that everyone's cir****tances are unique. I was hoping for some information as to whether or not Tufts likes to fight people about surgery, or if they are pretty easy to deal with, with regard to this issue. Any assistance will be greatly appreciated. Thank you again. Courtney

Hello again Courtney I think you need to do your evaluation and be tested for GERD and Sleep Apnea. I didn't know I had sleep apnea either. Here is the link with all the criterias for Tufts WLS http://www.tuftshealthplan.com/providers/pdf/medical_criteria/obesity-adult-surgical_treat ments.pdf Let me know if I can be of further assistence. Take care and good luck!

Wow, thank you so much Patty. That sets my mind at ease a little more. If you get anymore useful information let me know, and I will do the same. Thank you again. Courtney

I had Tufts HMO, I had no problem with approval, they were great. My BMI was 39. With the surgeons recommendations usually there won't be a problem. I am sure you probably have other health issues and don't realize it, I did. Talk to your doc, you will be put through all the tests. Good luck, Bobbi

Hi Bobbi! I have a BMI of 39.7, without co-morbidities, and I have tufts (ppo) as well. Did you get approved iwth a BMI of 39 without comorbidities? I have been really concerned about being approved. What was your process like? Donna B

Well I have tufts HMO I am 24 about you weight OBVIOUSLy and I was approved on the first shot...Surgery is Monday..You are so young that I think the Lap band is a better choice. I happen to be a nurse and when discussing with my md it was the better choice do to my age and my profession....

Thank you Virginia, I'm so happy for you that your surgery is Monday. I am a nuring student at Umass, Amherst and I have done extensive research. I originally wanted lap band until I heard of so many people not losing weight. I know that many do, but I am a very unlucky person and I don't want to go through surgery just to find out I'm not going to lose. This is just how I feel. I don't want to deal with the fills either, or having that foreign object in me. I am glad that you are happy with your choice and that it is right for you, I think it is not for me though. I like the fact that gastric bypass was around long before I was born, and there are people on here that had it done in the 1970s that have kept the weight off, lap band is much newer, and long term outcomes are not yet known. Good luck with your surgery and I wish you the best.