If you were self pay but had insurance...

If insurance requires a 1 year supervised diet, they won't cover the anesthesia & hospital charges associated with the surgery. You may be able to get some of the pre-op testing paid by the insurance as long as it's not coded as WLS pre-op.

Was she undergoing a medically supervised diet prior to her insurance change? If so those month should count as long as they were consecutive and documented.

 

My insurance company when I called to inquire about it actually sent me a whole policy section that pertained to the WLS. She might want to call her carrier and see is there is any acceptance to the 1 year rule like medical conditions, etc. 

Nyu is a great hospital ,I used to work there (ps It is a teaching hospital so a student may be doing your surgery)but your in Nyc where there are many other great hospitals and surgeons

I never heard of 1 year supervised diet

My insurance required a 2 year diet history and 6 month supervised diet, maybe you misunderstood them , call the insurance person ant you surgeons office or

the insurance company ( ask for a supervisor most of the people answering the phone know little about wls requirements)

I would wait the year to have them pay

 It took me 9 month to meet my surgeons weight loss requirements and was delayed an other month by illness 

this is a life long journey and a few extra months to have a great surgeon is worth the weight

My only concern is if she hasn't already been on a supervised diet for any length of time, who is to say that if she started today, her plan won't change next year and have different criteria. It sounds like it's just a way to get out of paying for a surgery to me. 

If it were me, I wouldn't pay an extra ~$25,000+ out of pocket to have surgery a year earlier and have my pre-op meetings with a surgeon who I already know will give me the warm fuzzies (as opposed to meeting other surgeons who I might also like)... but that's just one woman's opinion.

 

Just a different avenue to look in to. My co-workers wife wanted to have the surgery and our employee insurance would not cover it at all.. no matter what her co-morbidities were,  they appealed it three times, and was denied by United Heathcare all 3 times.   Then finally he purchased a individual  policy for her thru Blue Cross and Blue Shield.  The monthly premium were high but no where near the cost of the surgery it self, and BCBS approved her for the surgery right away.

 

Good Luck

I was just going over United Healthcare's changes for 2014 and they updated their bariatric policy starting Jan 2014. They do cover WLS now after 6 months of supervised dieting.

 

BTW we share the same surgeon 

She had her surgery in Oct 2012.  So how are you liking the program at HUP so far?  Don't expect to see Dr William very often but he did a excellent job surgery wise I have not had any issue and recovery was very quick. The staff NUT, and PA are very helpful. I was just surprised that I never saw Dr, Williams,  the day of my surgery not before surgery not after surgery,  not until the day I was discharged.  good luck

I like the programso far. The staff seems great. When I was picking a surgeon I opted for Dr Williams knowing that I wouldn't get a lot of time with him because of how busy he is. I opted for his experience over someone with a lighter workload that did these surgeries less often.

thanks everyone for your insightful and helpful answers! After discussing with my friend, I'm making her search around for more surgeons (one of whom I already recommended as great) and I'm encouraging her to also call her insurance company.  I'm just hoping and praying for her success!