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  897 People Lost in total 77828 lbs = 28.71 % Give us permission to add your before & after Weight Loss Photos |   |
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08-16-2008, 08:07 PM
| #1 (permalink) |
| Whipper Snapper Join Date: Aug 2008 Location: Indianapolis, Indiana
Posts: 36
Weight Statistics 08/12/2008 Start Date:
5' 1"
Height:
215 lb Start Weight:
215 lb Current Weight:
125 lb Goal Weight:
90 lb Lb Left to Lose:
12/10/2009 Goal Date:
Body Mass Index 40.6194571352 BMI Start:
40.6194571352 BMI Current:
23.6159634507 BMI Goal:
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UHC said that I am covered (and actually have very good coverage once board approves) and that as far as criteria they said that while some people have to meet 40 bmi, 5 years, etc. (all of things that I meet anyway) my plan's only criteria is that it be a medical necessity. My question is... if you know that you meet medical necessity (and all the other things that other plans require even though yours only requires med. necessity) and you know that it will not be a question... did it still take the 6-8 months to get everything done in order to just send off to them for approval? Did anyone run into road blocks on the medical necessity even though they had a long laundry list of things that fell within the other categories?
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Yes, you can often get insurance cover for your Weight Loss Surgery. Our own Craig "Big-T" Thompson has been there and done that, and he's written an e-book about it.  |
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08-16-2008, 09:02 PM
| #2 (permalink) |
| WLS Guru  Join Date: Feb 2008 Location: Mira Loma, CA 91752
Posts: 434
Blog Entries: 6 Weight Statistics April 15, 2006 Start Date:
May 10, 2006 Surgery Date:
6' 3"
Height:
345 lb Start Weight:
189 lb Current Weight:
200 lb Goal Weight:
156 lb Weight Loss:
-11 lb Lb Left to Lose:
45.2173913043 % % Lost:
anytime Goal Date:
Body Mass Index 43.1173333333 BMI Start:
23.6208 BMI Current:
24.9955555556 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass    | 
Each insurance company has their own rules to qualify for surgery. I had co morbidities to qualify for surgery, BMI<40, participated in a wt loss program of 6+ months duration--yet I still had to take nutrional classes that lasted several weeks. Once the classes were almost over, then the approval was granted, consultation with surgeon occurred, and then the tests were needed. I had a secondary consultation with one of the doctors, as requested by the RNY surgeon. There is no quick way to determine the length of time required to get surgery, especially when an insurance company is involved. If you are self paying for surgery, then the wait time is greatly reduced. I looked a the fact that I was able to get the surgery under my insurance, not the time it took to actually happened. It may have taken over 6 months, but I'm glad I had the surgery, some 150 pounds ago. DAVE
__________________ Dave Chambers  Dave in 2005, a few months prior to surgery  BariCare-whey isolate protein that tastes GOOD: http://www.liquidbariatricvitamins.com/baricare.htm Liquid vitamins: www.liquidbariatricvitamins.com www.dried-peas.com, a high protein snack www.dried-edamame.com a high protein snack Inexpensive unflavored whey protein HERE  |
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08-16-2008, 09:03 PM
| #3 (permalink) |
| WLS Mentor  Join Date: Feb 2007 Location: No. Los Angeles County, CA
Posts: 1,353
Weight Statistics 4.29.08 RNY Surgery Date:
5' 8"
Height:
301 lb Start Weight:
204 lb Current Weight:
170 lb Goal Weight:
97 lb Weight Loss:
34 lb Lb Left to Lose:
32.2259136213 % % Lost:
Body Mass Index 45.7618944637 BMI Start:
31.0147058824 BMI Current:
25.8455882353 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
My medical group will not give access to the surgeon until a 6 month bariatric nutrition program has been completed, and for the time desired, there may be a 3 month wait for that to begin! THEN there are the other tests required. I don't think any of this is required outright by the insurance co. But it is an arrangement decided between the ins. co, the surgeon, and the medical group, as such programs and tests resolve issues before the surgeon's referral and promotes better results in the long run.
__________________ Judijo  7/2008: I no longer qualify for WLS! BMI <40 with NO co-morbidities!  9/29/08: 5 months post-op and 70 pounds gone forever, babeeee!  11-29-08: 7 months post-op and down 90 lbs. Total cholesterol is under 200 for the first time in my adult life!   Starting weight: beginning of nutrition classes, August, 2007 My blog on my weight loss journey and thoughts that go with it. My MySpace Page. |
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08-16-2008, 09:06 PM
| #4 (permalink) |
| Seasoned Veteran Join Date: Apr 2007 Location: Mount Vernon, NY
Posts: 8,132
Weight Statistics all my life Start Date:
4/19/2007 Surgery Date:
5' 9"
Height:
260 lb Start Weight:
143 lb Current Weight:
160 lb Goal Weight:
117 lb Weight Loss:
-17 lb Lb Left to Lose:
45 % % Lost:
Body Mass Index 38.3910943079 BMI Start:
21.1151018694 BMI Current:
23.6252888049 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
i guess each program and each insurance have separate requirements. there were none for me. all my pre-op physicals and evaluations were done, paperwork submitted and surgey performed within a 3 weeks timeframe. check into who is requiring what. the actual surgeons office may be the hold up; if there is one. sometimes they have requirements of their own. let us know how it turns out. 
__________________ Anything worth having is worth working for!   KenyaR.  Lap RNY 4/19/07  |
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08-16-2008, 09:19 PM
| #5 (permalink) | |
| Whipper Snapper Join Date: Aug 2008 Location: Indianapolis, Indiana
Posts: 36
Weight Statistics 08/12/2008 Start Date:
5' 1"
Height:
215 lb Start Weight:
215 lb Current Weight:
125 lb Goal Weight:
90 lb Lb Left to Lose:
12/10/2009 Goal Date:
Body Mass Index 40.6194571352 BMI Start:
40.6194571352 BMI Current:
23.6159634507 BMI Goal:
| Quote:
That is what I was wondering. I do not have any requirements, other than it be a medical necessity, on my plan. They said that our plan is the best that UHC has and that while other plans require a lot of criteria the medical necessity is the ONLY one that my plan requires. So that would be basically the same as what you had. I'm not going to get my hopes up, of course, but I hadn't seen anything on here as of yet about anyone having a policy where the medical necessity was the only requirement. As far as reaching the medical necessity... it isn't hard to know that I have reached that. Thank you for your insight. :O) Tammy
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08-16-2008, 09:19 PM
| #6 (permalink) |
| Whipper Snapper Join Date: Aug 2008 Location: Indianapolis, Indiana
Posts: 36
Weight Statistics 08/12/2008 Start Date:
5' 1"
Height:
215 lb Start Weight:
215 lb Current Weight:
125 lb Goal Weight:
90 lb Lb Left to Lose:
12/10/2009 Goal Date:
Body Mass Index 40.6194571352 BMI Start:
40.6194571352 BMI Current:
23.6159634507 BMI Goal:
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Thank you everyone for your insight. You gave me some good information to consider. :O) You are all so awesome!
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08-17-2008, 09:56 AM
| #7 (permalink) |
| Seasoned Veteran  Join Date: May 2007 Location: minnesota
Posts: 5,331
Weight Statistics july 21, 2007 Start Date:
august 17, 2007 Surgery Date:
5' 6"
Height:
339 lb Start Weight:
177 lb Current Weight:
160 lb Goal Weight:
162 lb Weight Loss:
17 lb Lb Left to Lose:
47.7876106195 % % Lost:
Body Mass Index 54.7100550964 BMI Start:
28.5654269972 BMI Current:
25.8218549128 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
depends on what your program at your hospital requires and how fast you can get your appts in...i went to the first seminar in january and had my surgery in aug. i did have some extra things i had to do that made it take longer, i had H Pylori pre op, good luck on speeding things up!!
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