Update: I just got my approval today 8/15! It took them the entire 10 business days. I'm off to see Dr. Quilici on the 24th!

I'm having a really hard time getting my insurance to approve my consultation request to meet with my surgeon. I have never had an HMO until now (I had to switch from a PPO to get coverage for WLS) and I'm finding this to be incredibly frustrating. I can't even get a CONSULTATION! They have kept it "pending in the final stages" for over a week now! I mean, if this is how long it takes just to MEET the guy, I can't even imagine how long it's going to take to get any kind of surgery approved.

I'm not really sure what the problem is. I have a BMI of 51 - Clearly I am a candidate for this request. My PCP's office is completely frustrated and baffled too. They keep e-mailing and getting no response. Has anyone else with HealthNet HMO had these kind of issues? Is this going to be a really long road to approval?

Thanks in advance!

I have submitted my info to United Healthcare. Does anyone know how long it takes?

Where you ever approved through Tricare? If so what did they require? I am wondering as I am also going for a referal today. PS: I am Tricare Prime.

The $30,000 is a lifetime pre and post ma cap.  It applies to all related procedures as well.  Hopefully I will talk to the doctors office today.  .....This is just so frusterating

I have the state health plan (NJ Plus) and my surgeon was out of network.  For his patients, he works with those who are in network ans well as those who are out of network.  I am pretty sure for most physicians they overbill insurance companies for patients who are out of network in order to get paid the same amount of money as in-network patients.  I did have to pay out of pocket but not a lot (seriously, it wasn't much and you can PM me for the exact number).  

Your surgeon might not want to discuss specific numbers but maybe he can explain how payment works and what you will be responsible for and what you won't be responsible for.  I think most surgeons or their staff will explain to you what is possible and not possible depending on your health insurance plan.

What I would watch out for are a couple of things:

I know your health insurance company said there is a $30,000 max cap but is that just for the actual procedure or does that also apply to related procedures as well (i.e. endoscopies, lifetime blood tests, complications from surgeries).  You want to find that out now so you don't get stuck with a huge bill later.

I know it seems like your insurance company is really limiting the procedures available to you but don't let cost determine which procedure you will have done.  Any WLS procedure is meant to be a lifetime procedure so you don't want to do one procedure due to cost only to later regret it.  I know that is easier said than done but while revisions are possible, I can't imagine why you would ever want one.