How Long?

Hi, everybody I went to my initial consult this past Friday, and, according to my surgeon I qualify for wls because I have comorbidities. I know it's too early to tell, but how long do insurance companies take to approve this type of surgery? I'm planning on having the gastric bypass. One of my colleagues told me she went on a Friday, and that following Monday she received a call from the doctor telling her the good news that her surgery was approved. What's the average wait? Thanks, Nereida

Hi,  My insurance company took TWO weeks after submitting all paperwork. I am having Lap Band.   My ins co is Qualcare in NJ. Hope this helps. Best wishes to ya, Lo

Lo, when you say "after submitting all paperwork" are you referring to all the test results that we're asked to take before the surgery? I'm using my husband's health insurance which is Horizon Health Care. My daughter's septoplasty surgery was denied by this health insurance because, according to them, it's not medically necessary. In the meantime, my daughter suffers from the pain in her nose, not to mention the swelling and bruising. She has a deviated septum, and the insurance won't pay for the surgery. I'm just wondering if they'll give me a hard time with my gastric bypass surgery, as well. Thanks, Nereida

Hi Nereida. If I'm not mistaken Horizon Health is a BC/BS company. Be very careful with them. If approved, document the names of everyone you talk with, get approval numbers and ask for info from them in writing. For the past few mons BC/BS has been denying payment to some surgeons after approval was given and they are telling the docs to go after the patient. Someone who works with me had approval - with all the paperwork in place - for lap band on 5/30. On 5/29 she got a call telling her they wanted more documentation supporting the need for surgery. If she went ahead the next day it would all be out of her own pocket. Needless to say she cancelled and is still working through the appeals process. In all likelihood you won't have a problem but it never hurts to be prepared so DOCUMENT, DOCUMENT, DOCUMENT. The best of luck. Wilma

It varies on the insurance companies and also what pre-testing and or requirements that they and the doctor's might have or need.  I have Oxford and went for my consult on May 26 and received my letter of approval about 2-1/2 weeks later and it was dated just 10 days after the consult, some drag their feet. . .  be patient, it will all come together in the time it is meant too ;)

I just feel so blessed that I'll be having all of the testing done on the week of July 9. Tomorrow I'm going to my personal doctor for a medical release. On July 2 I go to the support group meeting. On the 3rd I go for my psychiatric evaluation. On the 9th I go for all my bloodwork, and other testings. On the 10th I go to see the pulmonologist for a sleep apnea test, On the 11th I go to another group meeting on lapband, and on the 12th I see the nutritionist.  I still can't believe that I was able to schedule all of these appointments for the same week. I'll be pretty busy going to all of these appointments. I had to take out my calendar and write in every appointment I have so I don't forget. I'm trying to do everything in my power to make this process as smooth as possible. I would like to have this surgery before summer's over being that I'm a teacher and I start working on September 4.  Nereida

Hi Nereida, What was sent to the ins co by the surgeon was a letter from my PMD stating that he felt the surgery was medically necessary, the psychiatric evaluation, nutritional evaluation, and whatever the surgeon may have added.   The only thing my insurance "required" was the letter of medical necessity.  ( And of couse, meeting the criteria .... BMI / comorbitities  )  During that two week waiting period I had all my Pre Admission Tests done. ( Blood work, EKG and Chest XRay )   I presented all those results to the PMD so he could write another letter stating that I was "cleared"  for surgery.   I feel very fortunate to have been approved without much grief from the ins co, however, my surgeon is Out Of Network and they are only paying him a small fraction of his fee.  I will be paying the balance of the bill.  I'm not sure if this had any influence on the final decision. Hope this helps.  Good luck with yours !!!! Regards,  Lo  

I have oxford liberty and I went to the seminar on Febraury 23 (or there abouts) and had my surgery on April 9th. With oxford I did not have to jump through hoops or anything like that, but depending on your insurance which hoops they make you jump. Best of Luck !!

I anxiously waiting to have all the required tests done. I see the psychiatrist on Tuesday, July 3, and I can't wait. I want to get this underway. Nereia

I have Horizon BC/BS PPO and I was approved within one day.  The insurance case manager even called to tell me.  I had submitted the last piece of info to the Bariatric Center on a Friday at lunch time and I got the call Monday morning that I was approved.  Could not have gone smoother.