Applying Early For Approval

Sweetish
on 2/22/14 3:10 am
RNY on 12/12/14

I have BC/BS.  I completed 3 months of the required 6 month diet/exercise program that was supervised by my PCP and NUT TWO YEARS ago for ins. purposes.  My insurance rep. that works with the surgeon's office said that she wants to send in everything I have now, (including all med. records and previous attempts for weight loss from 2 yrs ago), to just see if my ins. will approve my surgery.  

Does anyone think this is a bad idea?  I have since developed sleep apnea, my BMI is around 44 and I have pre-diabetes.  I don't want to blow my chances for approval.  Does anyone think this will?  Just trying to get people's thoughts on it.  I am wondering if I should just do the six months all over to not blow my chances, but I don't know if her sending in everything will do that either.  Any thoughts anyone?

pharmagirl_45
on 2/26/14 4:34 am - NJ
VSG on 01/14/14 with

If your insurance company requires 6 month diet/exercise program, why would your rep want to send it in sooner?  If you haven't met all of the requirements, they will just deny you. 

Maybe she knows something different.  Good luck!

     VSG on 1/14/14 with Dr. Samuel Wasser

    

    
noftessa0401
on 3/3/14 5:15 am - San Diego, CA
RNY on 12/27/12

She probably wants to send it in now because there is a limit how far before surgery you can do a diet/exercise regimen and have it count towards surgery.  I believe with Aetna, that limit was no earlier than 2 years prior to surgery.  If you don't use it, you might lose it.  

Worse thing that can happen, as far as I know, is that they deny it due to the requirements not being met.  Then you would have to re-submit once the requirements were met.  I would be more worried about losing that 3-month program since it was so long ago.  You might have to do the whole 6 months over again.  I think it is something definitely worth looking into.

Good luck!

HW: 274 | SW: 232 | CW: 137 | Goal: 145 (ticker includes a 42 pound loss pre-op) | Height: 5'4"

M1: -24 (205) | M2: -14 (191) | M3: -11 (180) | M4: -7 (173) | M5: -7 (166) | M6: -8 (158) | M7: -11 (147) | M8: -2 (145) | M9: -3 (142) | M10: -2 (140) | M11: -4 (136) | M12: -2 (134) | M13: -0 (134) | M14: -3 (131) | M15: +4 (135) | M16: +2 (137)

beldujour
on 4/7/14 1:45 am
VSG on 09/25/14

Your insurance rep is trying to help you. Do you think that she has no idea how insurance companies operate? If this is a covered procedure that they are likely to okay after six months of an approved diet/exercise program, the worst that can happen is that your insurance company will insist on the full six months, which you were expecting anyway. So it's not like you'd be any worse off for giving your insurance rep's idea a shot, and you might get your procedure sooner than you expected. JMO.

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