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Insurance approval time?

Nchatterton

Nchatterton

Member
Hi everyone! I’m new here so forgive me if this has been answered already. I have started that waiting game of the insurance approval process. I have met all my requirements and have I believe more co-morbidities than needed, but I am still like a pregnant woman at the end of term . How long did your insurance take to approve your surgery? I say “believe” because I was recently diagnosed with diabetes, hypertension, and high cholesterol which are listed as co-morbidities on the insurance’s website. I am just worried because it hasn’t been on my history long. I tried this a few years ago and was diagnosed with sleep apnea and insurance denied me. I believe that requirements have changed though and they only need one now. I’m just so ready to do this! Thank you!
 
Sounds like you should be approved pretty quickly. There have been a couple people here though, who have many comorbidities and they were still turned down. They just might have a lousy Insurance Company. My surgeon sent a letter to Medicare in 2007, saying that I was 100 lb overweight and needed surgery to keep from getting sick. I had surgery a month later and it was 80% covered by Medicare and 20% covered by the hospital's Charitable Care Program. But I was only 56, receiving a social security disability. They've never given me a moment's trouble. Everything I've Ever Needed has been covered. By the way I'm not capitalizing all these words. This happens when I dictate by voice. Do a search for insurance coverage or Insurance Company on the front page of our forum and you will find a lot of posts from people who are giving details about their insurance coverage or struggles.
 
dianeseattle said:
Sounds like you should be approved pretty quickly. There have been a couple people here though, who have many comorbidities and they were still turned down. They just might have a lousy Insurance Company. My surgeon sent a letter to Medicare in 2007, saying that I was 100 lb overweight and needed surgery to keep from getting sick. I had surgery a month later and it was 80% covered by Medicare and 20% covered by the hospital's Charitable Care Program. But I was only 56, receiving a social security disability. They've never given me a moment's trouble. Everything I've Ever Needed has been covered. By the way I'm not capitalizing all these words. This happens when I dictate by voice. Do a search for insurance coverage or Insurance Company on the front page of our forum and you will find a lot of posts from people who are giving details about their insurance coverage or struggles.
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Thank you! I consider my insurance pretty good, so I hope that it goes quickly. I have been fighting this in a way for years. My mother had the RNY years ago and thought maybe I need more “weight management” for them to approve me, so I tried weight watchers, NutriSystem and even Contrave (which made me really ill). Now I’m back trying again and like I said I think my insurance has changed, so I am hoping this will be my last time. I am so glad I found this forum because have already read many threads that have helped answer some of my questions and fears.
 
dianeseattle said:
Annieluv has had the surgery more recently than I did and your experience will probably be more like hers, with a 6-month prep time followed by a surgical window.
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See that’s where I’m confused. My insurance says nothing about prep time or 6 months of weight management. At least when I called and looked it up I was told. My BMI is at 38.5 and the requirements for 35->40 was the one co-morbidity, 1 nutrition class and 1 psych eval. The clinic said that was all I need for them to send it in and they sent it for approval. Does that mean it is just an initial approval? I see nothing else one the insurance’s website other than those requirements. I called and asked if the co-morbidities had to show I was taking medication and for a certain period of time and they said no. Oh I’m so confused.
 
AnnieLuv said:
My insurance required 6 months of stuff until approval. Once approved, I had one year to get surgery. The sleep apnea was ok as long as I was using my device and I had to bring it to hospital with me.
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Hi AnniLuv thank you for responding! So I just looked on my personal insurance page and it shows pre-authorization approved for the procedure. Is that an approval do you think or just a first step? It also show a one year start date to end date.
 
I believe that if they pre-authorized you, then you are good to go. Just as different drs have different requirements, insurances do too. If you want to make sure though, call them. I found out I was approved when they sent me a letter in the mail. It said pre-authorized on it. Also, around the same time the drs office called to say I was approved and could schedule a date.
 
Thank you everyone! After a few years of trying it gets nerve wracking and it feels like minutes get turned into days and days to months. I think I need to focus on the pre-op and post-op care now. Did anyone’s dr recommend that they start taking bariatric vitamins? If so what brand do y’all take?
 
Hi @Nchatterton, welcome to the group:) . Your insurance sounds like mine, with the BMI, 1 co-morbidity, 1 nutrition visit, and 1 psych eval. Once the office submits for approval, sometimes the insurance will seek clarification or additional information before they render a decision. I see this all the time (I work in healthcare and deal with these issues as a sidebar of my job as a nurse). Our surgery requests are not "emergent" or "urgent," so they work on them in routine order. Yes, it seems like it takes forever, but there are things taking place behind the scenes that may slow down the process. Keep the faith. If your insurance is remotely like mine, you'll be approved. Especially if you've already chatted with them about qualifications to meet the medical necessity and your answers have been satisfactory. Keep us posted. We are rooting for you!!!
 
QueAnd said:
Hi @Nchatterton, welcome to the group:) . Your insurance sounds like mine, with the BMI, 1 co-morbidity, 1 nutrition visit, and 1 psych eval. Once the office submits for approval, sometimes the insurance will seek clarification or additional information before they render a decision. I see this all the time (I work in healthcare and deal with these issues as a sidebar of my job as a nurse). Our surgery requests are not "emergent" or "urgent," so they work on them in routine order. Yes, it seems like it takes forever, but there are things taking place behind the scenes that may slow down the process. Keep the faith. If your insurance is remotely like mine, you'll be approved. Especially if you've already chatted with them about qualifications to meet the medical necessity and your answers have been satisfactory. Keep us posted. We are rooting for you!!!
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I work in healthcare also! Yes I think that the first time my listed co-morbidiities required that extra clarification and they were not satisfied. The ones that have developed since then should not need that so I think so. I am in Nuckear Medicine so we don't really deal with the insurance part other than verifying with our RPO office that they are covered. Thank you for that info that definitely makes sense!
 
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