How long was everyone's process from when you met with Dr. to have surgery

(deactivated member)
on 9/23/15 1:23 pm

Thank you for the information. I just did my sleep study, now waiting to go in for my endoscopy on Oct 5th This would be the last thing I was told i needed. 

 

I just need to find a nutritionist then hopefully will get notice on when we can do surgery. Such a long process, its a long process and hard to not give up.

Starlene02
on 9/23/15 8:08 am, edited 9/23/15 8:19 am
VSG on 11/11/15

You may want to triple check with your insurance to make sure you don't require the doctor monitored weight loss. Sometimes it depends who you talk to and give them details! I was told several times by my insurance BCBS ppo that it was not required because I have obesity coverage. I've always had amazing insurance so I trusted that. I did my endoscopy and everything that was suppose to be required. Once they sent off my paper work for approval it was denied! They told me I was told wrong (apparently by several people!) and that since I hadn't been diagnosed with any comorbidities recently and since I hadn't completed my 6 months that it wasn't medically necessary. I had to start seeing my doctor immediately for weight loss visits but because the surgery had already been submitted for approval and denied, anything obesity related would also be denied until and if the surgery was approved because it was considered in relation to the surgery. Therefore I had 6 months of doctors visits that insurance would have paid for had I been given the correct information. I also went ahead and had my cholesterol and sleep apnea diagnosed so that I'd have that and a few more doctors to back me up. Good luck with your journey.

(deactivated member)
on 9/24/15 12:42 am

Thank you for the information.  The reason I was told that my insurance will cover the surgery is due to my bad knee.  Thry will not do a knee surgery until I get wait off.

 

I sure hope I don't run into that problem I would be very devistated.

Starlene02
on 9/24/15 5:16 pm
VSG on 11/11/15

That may be enough for your insurance. I'm not sure since all insurances are different but that was the only comorbidity I had been recently diagnosed with myself. I have osteoarthritis and chondromalacia. I've had issues since I was a teenager with my knees and they are worse than ever at the moment. A couple of years ago I had to have physical therapy again because I couldn't bear any weight on them at all without feeling like they were bending backwards. I really don't want to be a downer at all but your situation is so much like mine and I'd hate for you to owe doctor bills over not completing the process correctly. I have been told by every Dr how great my insurance was and my knees weren't enough for them to pay. Again, though it depends on who you talk to so much more than people realize. Chances are if my case had landed in the hands of a different employee I may not of had even one issue getting it covered. It never hurts to call a hand full of times and have them check and recheck with all of your personal details.

(deactivated member)
on 9/27/15 9:14 pm

OK I will do that.  I do not have employee insurance.  I have state insurance.  So far have not had to pay for any of the work and studies that I had to do except for my nutritionist.

Starlene02
on 9/23/15 3:19 pm
VSG on 11/11/15

Also I felt just as you do when I started my journey. I was in such a HUGE hurry to get the show on the road. I guess for several reasons. For one I wanted to start my new life but also out of fear. I was terrified of the surgery and scared I might back out or that the faster I went the less I'd think about it. A week seemed like an impossible time to wait! I still am terrified but I'm more determined than ever to get to my surgery date. I entirely understand how you're feeling. I felt like all the waiting was unnecessary and it frustrated me to no end! lol The urgency has subsided but I don't think it will ever go away.. it's part of my drive so I'm ok with that.

(deactivated member)
on 9/24/15 12:47 am

When are they going to schedule your surgery. How would I find out if I would be denied or not? My dr. Said it was up to her on the weight loss. She said she would not do it if I don't keep it off. 

 

I can't even imagine being denied. I don't think my knee can handle another couple of months.

Starlene02
on 9/24/15 10:23 am, edited 9/24/15 10:23 am
VSG on 11/11/15

My last weight loss visit with my PCP will be Oct 1st. All of my info will then be resubmitted for insurance and we'll go from there. It shouldn't be long now unless my insurance wants to drag the fight out of me! lol There will be a number on the back of your insurance card for member services. You can call your insurance company directly and let them know what you want to get done and ask them if it's covered under your policy. I'd give them details of your case such as your knees being your only comorbidity and let them make sure you meet all of there standards. I did that probably 3 times and was told wrong all 3 times. There should also be someone at your surgeons office that should be able to help you with that.

(deactivated member)
on 9/24/15 6:52 pm

My primary care doctor is the one that suggested that I get the weight loss surgery because of my knee. He said because of my weight is the reason I would qualify for the surgery. I did call my insurance and was told there was no requirements, that it is up to my doctor.

I just feel I am getting the run around their for i never get a call back on my questions about my progress,

 

At this point I have no idea what to do or think. :(

Starlene02
on 9/25/15 7:00 am
VSG on 11/11/15

Yes I usually feel like I'm talking to someone who has no clue what they are doing when I have to talk to insurance. I was recently billed for one of my doctor appointments as a result of being denied my surgery. It was an appointment they should have paid that had nothing to do with my surgery. I swear to you it took me 3 months and my calling over and over before I found someone who knew what they were talking about. She called the doctor, got the codes changed and that was that. The people they hire at these insurances really need more training. Don't get discouraged. I have 4 doctors backing me at the moment so I'm hoping that helps prevent anymore bumps in the road. My best opinion would be to follow your doctors orders and go with what you know but I'd still keep checking back with insurance. Insurance is a game of chance as much as it is whether you qualify or not. Who you talk to can make all the difference. It doesn't hurt to keep trying to make sure you're on the right track. There is a difference though. I had recently seen my knee doctors but all of my diagnoses for my knees were over a year old. I've recently learned that when you have comorbidities it's best for them to be freshly diagnosed or reevaluated before submitting them. Although they aren't required to be, they only ask for a years worth of medical records so anything before that I don't think they take as seriously. I've been through hell and back trying to get my surgery and my health on the right track but I just keep pushing forward. You'll have to have that drive anyway the way I see it so don't get discouraged. Just keep on putting one foot in front of the other.

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