Waiting for Approval

[suzannethemom]

Thursday was my final appointment. They submitted my paperwork to my insurance company on Friday and now I WAIT. I’m going stir crazy! I’m worried and anxious and nervous. What if I get denied? I don’t have a plan B. What would be a reason for denial? I’m trying to be optimistic, but I’m such a worrier.

 

[Kcuster83]

Yea, I am thinking the same craziness. I have been pre-approved, but still waiting on "final approval". I have met all of the requirements and I know my insurance covers it and the bariatric center I am going through is under my insurance policy so I literally cannot think of a reason in which I would be denied. But still, I can't stop thinking about the "what if" I am denied. The scheduler also said that she was happy I have Cigna insurance because they never argue her, they always approve on the first attempt without any issues. My experience with them has not been so easy going or lucky. So I keep doubting but I am sure it will be fine for both of us!

 

[suzannethemom]

I have learned from experience that things hardly go smoothly or as planned, which is why I’m such a pessimistic. For example, the first thing I did before I scheduled a consultation was to call my insurance company and make sure everything would be covered. Office visits and tests are covered 100% BUT today I got a bill from the clinic for $512.00 from my first consultation! I called and they said it was a mistake. Seriously, the hoops I have to jump through is exhausting. I just wish it could be easy for once.

 

[Kcuster83]

I called my insurance company for details also before started. I haven't hit my deductible, because really who does unless you have an ER visit or surgery. So although it is all covered, it has basically all been out of pocket so far. New year, new deductible now. So the surgery will cover my deductible and I will likely hit my "max out of pocket too" so at least it is early in the year and I can take advantage of them actually paying for something. Although, other than follow ups I imagine it won't be much because I don't have any serious medical problems that require regular DR visits. Insurance in the US. is a JOKE! IMO, it is pretty much useless unless you have an emergency or major surgery.

 

[TraceyT]

It was a 6 month process for me. I started in July 2019 with my very first visit. I finally had surgery 1/2020.


There were a lot of hoops that required jumping through and I’m pretty sure there some serious asses I puckered up to as well.

My insurance was great in the aspect that it covered most of the surgery. BUT - there were several things that really sucked - if I gained 10 pounds during the waiting they could make me start the process all over again AND if I lost more than 10 pounds during the waiting process they could make me start over or not allow me to have the surgery at all. It was an interesting experience - but it could have been nerve racking as well.

I’m grateful that I was allowed to have the surgery. It was and still is life changing. My ONLY regret is not doing it sooner.

 

[dianeseattle]

Insurance companies have changed a lot about the process. My doc suggested it, then scheduled it spot wouldn't interfere with his vacation time. It all worked out perfectly. But 14 years later, there are a lot more hoops to jump through and people to handle you. It sure wasn't necessary for me, but I think they're trying to see if people can follow rules before approving the surgery. They're really just covering their asses.

I'd work out a schedule with the doc and put it in the chart before going home. Theoretically, every other tech would consult that first and fit their tests around it. The surgeons availability is more important than all the others. They need to follow his/ her schedule.

My wait time was nine days and I wasn't required to lose weight. Worked out fine for me, 75 pounds down in 90 days, then stalls and loss for months, until I dropped 115 pounds. At some point it felt like my body just took over and I obeyed.

I think asking your doc for a letter to expedite things is worth a try. You're having the surgery. You're going to lose weight. Why make the pre-op so hard. Seems very cruel.

 

[Kcuster83]

Insurance companies have changed a lot about the process. My doc suggested it, then scheduled it spot wouldn't interfere with his vacation time. It all worked out perfectly. But 14 years later, there are a lot more hoops to jump through and people to handle you. It sure wasn't necessary for me, but I think they're trying to see if people can follow rules before approving the surgery. They're really just covering their asses.

I'd work out a schedule with the doc and put it in the chart before going home. Theoretically, every other tech would consult that first and fit their tests around it. The surgeons availability is more important than all the others. They need to follow his/ her schedule.

My wait time was nine days and I wasn't required to lose weight. Worked out fine for me, 75 pounds down in 90 days, then stalls and loss for months, until I dropped 115 pounds. At some point it felt like my body just took over and I obeyed.

I think asking your doc for a letter to expedite things is worth a try. You're having the surgery. You're going to lose weight. Why make the pre-op so hard. Seems very cruel.

IMO: Insurances cover WLS to save themselves money. Better health means less medical issues/bills. Less daily maintenance medications to pay for, etc. With that being said, I believe they make you go thru the process (hoops) to ensure you are ready and dedicated to the process. Like everyone says, its not a magic pill. It still requires lifestyle changes and modifying your eating/exercise habits. Insurance wants to get the bang for their buck, they don't want you to fail either. That costs them more money, now they have paid for your surgery and still have to continue to pay for your obesity related health issues. Ultimately, in short, all of their decisions/processes/hoops and what not all revolve around the money they will make or loose.

 

[3momchaos]

I have learned from experience that things hardly go smoothly or as planned, which is why I’m such a pessimistic. For example, the first thing I did before I scheduled a consultation was to call my insurance company and make sure everything would be covered. Office visits and tests are covered 100% BUT today I got a bill from the clinic for $512.00 from my first consultation! I called and they said it was a mistake. Seriously, the hoops I have to jump through is exhausting. I just wish it could be easy for once.

I got a bill last month for my anesthesiologist from my surgery on 10/26/2020 that I already paid! I double checked my records and threw it away, I wasn’t going to waste my time calling them lol