Question:
I know that insurance companies are all different with each person, but

with my co-morbid's of diabetes 2, PCOS, lumbo-pelvic condition and degenerative disc disease as well as my bmi being 46 I am hoping that i will get approved for the wls. I know there are alot of factors that determine the approval but with what I have do you think it is a big possibility?    — hartnell (posted on February 8, 2006)

February 8, 2006
The first thing you need to do is call your health insurance company and ask them if your employer carries the WLS rider. If you employer does not carry that rider then no matter what you have they will not pay. Once you find that out then ask them what their guidelines are. Generally they will give you a list.....and then find a surgeon. Personally I selected a surgeon that was well known and respected in my community...he had a group of staff that did nothing but work with the insurance company. They knew exactly how things had to be submitted for each insurance company...and how they wanted things worded.
   — mmcphee1

February 9, 2006
I am still in the process, just like you, there seems to be quite a few things to get handled before approval for surgery. Besides your BMI and co-morbids most insurance co. also require a doc. weight loss program with DR. mine needs 12 months, which thankfully I have, but some only need 6 months, that is usually the big thing. Usually your insurance co has a web-site where you can pull up what the specs are for the surgery - at least mine did. Jen RNY-soon
   — jlflbf

February 12, 2006
Did I read another question here from you? Look at your insurance company's guidelines. then do them all a tthe same time. For instance, if they require a doctor-supervised diet, go to your doctor immediatley and start. Make sure to go once a month and get it documented that you are complying. Meanwhile, go to your surgeon and get a date for a month later than your diet will last. Finally, go to your other specialists. Get a psychiatirc evaluation. Get letters from yur specialists with their opinions that the surgery will improve your comorbidities. For example, weight loss will help your diabetes, and the surgery often actually cures it. Make sure you get copies of all the letters and reports and keep a file yourself. In other words, marshall all the arguments supporting the need for the surgery! Good luck!
   — Novashannon