Good News!

ok i just called my insurance again this time i said does my plan cover Morbid Obesity? They said YES as long as it medical which its going to be! But it has to go to a review board, Is it hard to get passed the review board? What are they wanting to know about me?               Thanks, adam       

Well, do you have any co-morbidities in addition to your obesity? To be honest I had none, was kind of a lightweight, and still approved very quickly, so I dunno. I just know co-morbities will help the review, I think.  From what I have heard anyways. It is in their best interest to keep you alive and paying your premiums.

yeah i have Asthma take 3 different kinds of meds, and have my own breathing machine. and have alot of depression! form being big my whole life. but i havent been tested for anything else yet

Your insurance company can provide you with a list of their requirements. However, if you are using a surgeon thats innetwork with your insurance they should know exaclty what your plan requires in order to be approval. As for it being hard to pass the review board - depends on what they require and if you meet their critera and your medical history... some insurance companies are tougher than others.

Because, my BMI was over 40 I did not have to have any CO-Morbidities to get approval. I did have to be on a 6 month supervised diet and get 5 years of health records from my PCP. Then I had to have my PCP write two letters approving the surgery and saying that I was in good enough health to go through the surgery. I actually wrote the letters my self and he read, approved and signed them. It took me about 4 1/2 months to get through everything and get approval and have the surgery. 

Hey Adam, Just jumping in on the discussion here...not knowing your case, this info may or may not be helpful. Every insurance company requires different documentation.  Have your ins send you in writing their exact list of required documents for WLS approval.  Then, gather document s from every visit to your PCP and include clinical notes.  Make sure your PCP mentions in the clinical notes all of their concerns regarding your "comorbidities"  and lack of weight loss.  Even if it's not required by your ins, have your PCP write a specific letter detailing all of your comorbidities, failed attempts at weight loss through conventional methods, all the ways WLS will greatly improve your health, and their professional recommendation that you are an ideal candidate for surgery. And lastly, be diligent in providing every single piece of required documentation to your insurance company.  If you have to do a 6 mos diet, don't let that discourage you.  Keep careful notes of your progress and utilize the time to further prepare for surgery by reading and researching all that you can. Some of the info you may have to submit could include: Nutrition evaluation Exercise evaluation Psychological Evaluation Pre-Op Diet Bloodtests and Thyroid Panel Health History and Physical Weight charts proving morbid obesity over a certain number of years A complete list of all diets and resulting weight loss Pre and post-op surgical plan of care Letter of medical necessity Your surgeon's office and PCP can be very helpful in providing some of these items.   As for the review board, that's not uncommon for WLS approval.  Your paperwork will first go to a claims agent who will make sure every document is in your file (like a check-off list).  Then, your file is sent to the review board for consideration.  My ins review board included a panel of nurses who carefully examined all my paperwork to make sure I wasn't a risk.  All together, it took about 6 weeks for approval. Best of luck to you!  Patience, focus, and a never-give-up attitude will carry you through! Heather

First off - Congrats!  The fact that your insurance covers WLS under some cir****tances is a definate plus and means that you have more than a fighting chance of getting approval.  Second, you might be able to look up post-ops on OH with experience with your insurance company to figure out more what they are looking for - but even better than that, you should ask your surgeon (or your surgeon's insurance coordinator) what their experience has been with your insurance provider.  Ask the coordinator for specifics - like a checklist - of things you can do to help your odds of getting a fast approval. I hope you are able to meet all of the insurance criteria in quick order.  If it gets tough (and I really hope it doesn't!) don't give up! It'll be worth it in the end!

Let me tell you that if anyone has a sucky insurance package it would be me. I pay $680/mo. for me and my family to be covered (and this is a "discounted" group policy from my work) and this is just for the basic plan.

It is called Blue Cross PowerSelect HMO and it just sucks! Granted, I have been approved for my surgery but only after 15 months of calling, writing letters, going to appointments and being EXTREMELY organized with everything. If your insurance company is as bad as mine, you need to be the one on top of everything because they sure aren't going to be and they are always losing things, mixing stuff up or just trying to annoy you.

Every person on here has a different spin on the pre-op phase but if you have any problems like I did, the key is to be on top of this like crazy. If you have a PDA or a smart-phone, log everything in your calendar. I don't know how many times I've been told I needed this or that but I already had done it and being able to tell them an exact date and time of when I did it was the only thing that saved me. If they see you're organized, they tend to back off because they don't don't like being wrong all the time. Also, get a folder/portfolio thing that has dividers in it (like at a drug store or at Walmart) and keep everything that you get related to your surgery in there. Make and ask for copies of all your lab work, EKG's, psych evaluations, etc., it will all come in handy when someone tells you they don't have something and you tell them, "Oh I can fax that to you right now, what is your fax number!".

Here are the appointments I went through. Keep in mind this is just the stuff I did up until the point I got my actual surgery date:

1. Initial Surgeon Consult
2. Psych Evaluation
3. Lab Work
4. Weigh-In
5. Nutrition Class
6. EKG
7. Chest X-Ray
8. History/Physical Exam
9. DVT Ultrasound (Legs)
10. Weigh-In
11. Lab Work
12. Sleep Study
13. Respiratory PFT
14. Abdominal Ultrasound
15. Follow-Up Appt. (Surgeon's office)
16. Upper GI
17. Doppler Echocardiogram
18. Lab Work
19. Weigh-In
20. Meeting with Hospital Rep
21. Chest X-Ray
22. EKG
23. Orientation at the Hospital (3 hours!)
24. One-on-one with Nutritionist


After doing this, I got my approval and then my date. Now, I have to donate two units of blood and I have to have some lab work done within 5 days of my surgery. I also have to meet one last time with the surgeon before the date and I have a consent appointment at the hospital the day before I go in.

And to think, the hard part of all of this hasn't even come yet!

sweet thanks for all the info. and good luck