CALLING ALL PRE OPS WAITING FOR INS APPROVAL

Well call them and see what's up! I had RNY In 2000 it worked for me then. I lost 220 pounds. Along the way i got adapted to only eating soft foods and no protein so i regained 80 pounds. 

I printed out my insurance company's list of qualifications for approval last November.  I easily met every requirement on the list EXCEPT the "6 consecutive months of dietary consult care".  My surgeons scheduler submitted my records for approval a month ago. The reply stated I had only 5 consecutive months on record. Which I knew, because I started then missed a month.  But Now the insurance company is stating that I also need 6  consecutive months of doctor visits with the primary objective as weight loss. I have been seeing my GP during this time (not quite monthly) for diabetes and HTN, so that does not meet their criteria.  REALLY. Because of all this past year's medical care I have nearly met my high deductable and was looking forward to a low cost surgery. But now there is only 3 months left to fight for my surgery approval.

Well still fight for it! An appeal doesn't always have to be long and drawn out. I was denied and my advocate sent in asking for reconsideration and submitted all the stuff from all of my different dr trying to loose weight since 2009. When they saw all of the cash i spent trying to loose weight they overturned their decision. The whole process from denial to approval was 4 days. I didn't even know that my advocate had requested them to reconsider when she called and told me i was approved. I would get all your records from all drs that you discussed weight or WLS and submit them. So they know you didn't just wake up one day and say i think i need WLS. 

My information was sent to United Healthcare on 08-16.  I call them everyday to check on it.  As of today, it is still in pending status.  They stated that they have 15 business days to make a decision. Waiting, but not so patiently.

yea insurance companies love to make you weight! I don't understand why it takes 15 business days to look through one file. I could see if they were saying we have a lot of other files to look through and we will get to you file within 15 days,  but to just say yea we have your file and we are looking through it for 15 business days! WTF? I hope you are approved!  When I had my first surgery in 2000 United used to be the best for WLS plus plastic surgery. They usually approved and then if you lost 100 they approved abdominal plasty. I dont know how they are now. What surgery are you going for?

I hear ya!  I'll just keep calling.  I'm having the VSG.

I have BCBS of TN...very strict requirements...I have met everything..except I have one year missing in the "5 years of records proving 40 BMI or above"....in 2008 I moved out of state and didn't see a DR at all...so I have my fingers and toes crossed and lots of prayers...Submitted yesterday...surgery scheduled for Sept 10!

I completed my required 6 months of weight checks, did every other test that was required by UPMC health and my doctor's office.  I have elevated glucose levels, but not diabetic yet, take depression meds, take thyroid meds, have tried everything from WW to high intensity group gym workouts, weight machines, 6 wk body make over etc.  Always lose a little and gain back twice as much.  Surgeon and Dr. felt I was a good candidate.  Submitted August 16th to UPMC, the 23rd I received word I was denied because I do not have enough co-morbidities.  Surgeon even wrote a personal letter for my case and my dr. wrote one also.  Surgeon is doing a peer to peer this week to argue my case.  I was told to appeal when I got paperwork in the mail.  This just seems so crazy to me.  My siblings are all over 300lbs with many health issues.  I am trying to be proactive so that I don't become like them (which is where I will be headed), but insurance apparently wants to pay more later, than now.  I wish the rest of you much better luck than I have had.

Wow that Is crazy you are sick enough yet. DON'T GIVE UP, its the ins company's job to discourage you and save themselves some $$$! They are hoping you give up and walk away. I know that some insurances you don't even have to have any co-morbids if your bmi is over 40. if your doctor is willing to fight for you it probably will be overturned. If that doesn't get it approved try contacting Walter Lindstrom. They say he knows this WLS appeal stuff like the back of his hand. If you throw in the towel and give up they have won. i know its hard to not be depressed. I was denied for my revision but my advocate asked them to reconsider and in a matter of 4 days i was denied and then approved. 

Thanks for all of your supportive comments. Insurance denied 3 times, each time stating a different specific reason to which I then strived to correct. Pretty much down to the wire on coverage days left, I had spiritually given up when I received an approval letter that also stated "be aware this approval in no means assures financial coverage"   What in the heck does that mean??  Screw it. I went for the surgery and am now 1 month post DS. Feeling great. Still have not received the surgery bill/insurance coverage notice. Whatever, I'll deal.