Question:
What do most insurance companies want before they will approve u for gastric bypass?

I want to have a gastric bypass surgery. I am 27, 5ft, 4in tall, weight is 312. I have insurance and they do cover this surgery, but I have to have something else besides being overweight wrong with me. I was put on HBP meds today, having sleep apnea test next week, borderline astham, and diabetes. Have knee, lower back, and feet pain most of the time. My family doc has never actually put me on a diet till this past week, but I have tried Slim Fast, Weight Watchers Smart Ones Meals all while walking a mile or more a day. My concern is, does anyone think I have enough "wrong" with me to have this surgery? I want to have it so bad, but if I don't get approval thru my insurance co I can't afford to do it on my own. I have been over weight since I was 4-5 and this is a life long dream. I will be waiting till the end of Sept to find out if I have sleep apnea also, as well as diabetes, but does anyone here feel like I might qualify? I guess I am just looking for some positive feedback. My email is [email protected], I would love to hear from u all. Thanks, Angela    — [Deactivated Member] (posted on September 3, 2004)

September 3, 2004
Angela, if you have sleep apnea, that will get you the surgery. High blood pressure and diabetes should get it also. I would call the insurance and tell them that you have HP and diabetes and ask if that is enough and that you will be tested for sleep apnea. Make them be more specific. Your heighth and weight alone should qualify you. Good luck, Judy
   — juju524

September 3, 2004
Dear Angela, Sounds to me like you will not run into any problems with the WLS Approval, based on your BMI and high blood pressure alone. As far as the "supervised" diets, you can list the diets you were on, and although they were not "officially" tracked by your doctor, I'm sure that somplace in his notes he probably has asked you about your diet, exercise, etc. That alone would prove that you have tried different diet programs. In my case, I had diabetes and High Blood Pressure, but because I was also experiencing back aches and leg aches, getting winded when walking up stairs, etc., I was approved in 2 days. I don't think that you will need the diabetes or the sleep apnea in order for the insurance company to approve it, as it is a covered procedure. Keep us informed as to your progress....if there is anything that I can do to assist, let me know. My e-mail is [email protected]. Best of Luck in your journey, and hang in there. Sometimes the approval process can be long and very hard on the nerves, but just the fact that they have approved you to get the necessary tests (sleep apnea, diabetes, etc.) is a good sign. Don't give up, and let me know how things progress for you. Best Regards, Dorrie
   — DorrieB

September 3, 2004
Girl, I don't think you'll have any problems. My insurance co. is Cigna HMO (a BEAR to deal with) and I did pretty okay. Make sure you keep track of any problems you may have sleeping (it may be sleep apnea) any gas reflux you have, any depression (how can you not be overweight and have a LITTLE TINY bit of depression??) and headaches (yes, my surgeon said headaches can be caused by being heavy) I think the biggest thing that helped me was that I called them EVERY DAY to see how my approval was going. Yes, it drove them crazy, but it also made them give in, I believe. I called them all the time and I know that they were just trying to get me off their backs. Don't worry about driving them nuts. Be as pleasant as you can ("Yes, I'm just calling to see what the status of my approval request is...? Oh, okay.. Thank you!") and hang up. Bug them as much as you can. They'll get tired of you and want you to stop bugging. Or, at least it worked that way with me. Good luck! I hope everything works out for you.
   — mars.renee

September 3, 2004
Oops heheh... about the "supervised diet" portion... yes, Cigna wanted to know about that. You know what I did? I turned in my information about being on Weight Watchers for 6 months... and I asked my PCP for my weight history for those 6 months. Any time I had a cold, a back pain, ANYTHING, and they took down my weight, I incorporated that with my Weight Watchers diet. My PCP may not have put me on the diet, but she knew I was on it, she had my weight history between those six months, so as far as both of us were concerned, I was on one! When you go on any diet and you go to the doc to get weighed, to me that counts as "supervised dieting" because it was enough to get me to surgery. Hope this helps.
   — mars.renee

September 4, 2004
My advice is to start a PHYSICIAN supervised diet and exercise plan ASAP and have it documented. I have AETNA and they required this. Best of luck toyou..I am loving p ost op life
   — Kathy S.

September 4, 2004
I had some tricky obstacles to overcome with my insurance. I got approved because I had acid reflux, arthritis in my knees, mild incontinence(from the pressure the weight caused on my bladder) and asthma. My advice to you is to sit down and write down each and every effort you have ever made to lose weight, and each and every disabling health problem you have ever had. You'd be surprised, but in my experience, the insurance companies mainly want to know that you have tried on your own to lose the weight, and that you have alot of health problems. Even list the health problems that you have had that you don't think are related to the weight, as you never know what criteria for the surgery the insurace company has. It does not always have to be life-threatening. I hope this helps.
   — [Deactivated Member]

September 5, 2004
check out www.obesitylawyers.com the links at the bottom, one of them has a sample pcp letter and how to write appeals. Good luck. El
   — superellen