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03-13-2008, 09:45 PM
| #1 (permalink) |
| Cub Reporter  Join Date: Jul 2007 Location: Hagerstown, MD
Posts: 53
Weight Statistics July 11, 2007 Start Date:
April 15, 2008 Surgery Date:
5' 4"
Height:
315 lb Start Weight:
215 lb Current Weight:
150 lb Goal Weight:
100 lb Weight Loss:
65 lb Lb Left to Lose:
31.746031746 % % Lost:
Body Mass Index 54.0637207031 BMI Start:
36.9006347656 BMI Current:
25.7446289062 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  |  Confused
Okay, my hubby finally got his approval letter today for RNY. A bit of background...he was originally denied because the surgeon had submitted his paperwork to insurance with a worst case scenario, meaning, that he had submitted it as a two part surgery with doing a gastric sleeve and then once hubby dropped 100lbs, the doc would go back in and do the bypass part. Insurance denied that saying there was not enough medical documentation on the sleeve and they considered it experimental (hubby weighs about 460ish). So we spoke to the surgeon etc and he had no problem just submitting it as a lap RNY, possible open RNY. So the approval letter came today and it says "The request for coverage of lap RNY on a 23 hour observation basis has been approved. The request for coverage of acute inpatient admission has been denied. It goes on to say that there is no documentation of any acute distress or clinical instabilities that would require monitoring in the acute patient setting. So what is this "23 hour observation basis" and what is this "Acute inpatient admission"??? I'm very confused. |
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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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03-13-2008, 09:55 PM
| #2 (permalink) |
| Seasoned Veteran  Join Date: Oct 2007 Location: North West, NJ
Posts: 1,919
Weight Statistics 1/14/2008 Surgery Date:
5' 10"
Height:
330 lb Start Weight:
240 lb Current Weight:
180 lb Goal Weight:
90 lb Weight Loss:
60 lb Lb Left to Lose:
27.2727272727 % % Lost:
Summer 09 Goal Date:
Body Mass Index 47.3448979592 BMI Start:
34.4326530612 BMI Current:
25.8244897959 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
Sorry, that makes no sense to me at all. Hopefully someone here will be able to make something out of that.
__________________  Denise |
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03-13-2008, 10:12 PM
| #3 (permalink) |
| Cub Reporter Join Date: Jul 2007 Location: Hagerstown, MD
Posts: 53
Weight Statistics July 11, 2007 Start Date:
April 15, 2008 Surgery Date:
5' 4"
Height:
315 lb Start Weight:
215 lb Current Weight:
150 lb Goal Weight:
100 lb Weight Loss:
65 lb Lb Left to Lose:
31.746031746 % % Lost:
Body Mass Index 54.0637207031 BMI Start:
36.9006347656 BMI Current:
25.7446289062 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
Okay, so I just called the insurance company and what that means is that they are not approving him to be admitted???? HUH? They approved me three weeks ago with no stipulation on how long I could stay in the hospital, so why on earth would they want him to have major surgery and then leave? What on earth is this about?? |
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03-14-2008, 03:26 AM
| #4 (permalink) |
| Super Moderator  |
I think somebody else got approval for surgery but not for hospital stay, raised a ruckus, so the ins co approved hospital stay as well. This may be a new strategy of the ins cos...you need to get back to them, and get on their backs.
__________________ "In every job that must be done, there is an element of fun."   Just a li'l bit 'bout myself  |
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03-14-2008, 04:48 AM
| #5 (permalink) |
| Seasoned Veteran Join Date: Jun 2007 Location: Tampa, FL
Posts: 2,164
Blog Entries: 8 Weight Statistics July 10, 2007 Surgery Date:
5' 6"
Height:
271 lb Start Weight:
143 lb Current Weight:
145 lb Goal Weight:
128 lb Weight Loss:
-2 lb Lb Left to Lose:
47.2324723247 % % Lost:
Body Mass Index 43.7357667585 BMI Start:
23.0782828283 BMI Current:
23.4010560147 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass | Insurance ~ the blessing, the curse!!! I think the other person got their doc involved too. Good luck! reminds me of when my DD was born - ins didnt cover the birth but covered her hospital stay????!!!! (No maternity coverage at that time) Maybe I should have had her in the parking lot? Hey, that sounds like a splendid idea! We'll set up beds in the parking lot for the patients whose ins dont want them admitted "into" the hospital..... ugh
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03-14-2008, 06:05 AM
| #6 (permalink) |
| Seasoned Veteran  Join Date: Dec 2007 Location: Buffalo, NY
Posts: 2,466
Weight Statistics 12-19-07 Start Date:
1-29-08 Surgery Date:
5' 3"
Height:
286 lb Start Weight:
164 lb Current Weight:
150 lb Goal Weight:
122 lb Weight Loss:
14 lb Lb Left to Lose:
42.6573426573 % % Lost:
eventually Goal Date:
Body Mass Index 50.6570924666 BMI Start:
29.0481229529 BMI Current:
26.5684051398 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
It's a stupid hospital thing where they admit you on 'watch' so to speak, but if you stay less than 24 hours (hence the 23hrs), you aren't technically admitted. But of course if something arises or there is a need for admission, it will happen. I would also call the dr.s office to see if this is typical and if most (if not all) people wind up getting admitted anyway. If they say this is a stupid ins co. tactic, then I wouldn't get too worried, if not, I'd worry. But either way if you have them join in your fight it may be easier to get it fixed. I mean, I can't imagine that most docs want to do such a major procedure on an already at risk morbidly obese pt and send them home so soon.
__________________ Kelly  5'3"    |
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03-14-2008, 07:43 AM
| #7 (permalink) |
| Cub Reporter Join Date: Jul 2007 Location: Hagerstown, MD
Posts: 53
Weight Statistics July 11, 2007 Start Date:
April 15, 2008 Surgery Date:
5' 4"
Height:
315 lb Start Weight:
215 lb Current Weight:
150 lb Goal Weight:
100 lb Weight Loss:
65 lb Lb Left to Lose:
31.746031746 % % Lost:
Body Mass Index 54.0637207031 BMI Start:
36.9006347656 BMI Current:
25.7446289062 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
The killer thing is that I got my approval three weeks before my hubby and I don't have any of that 23 hour crap! So, I'm allowed to be admitted for *ahem* MAJOR SURGERY but he isn't?? I'm gonna call the surgeon's office this morning. This is just stupid!
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03-14-2008, 10:28 AM
| #8 (permalink) |
| Seasoned Veteran  Join Date: Jun 2007 Location: North Texas
Posts: 4,647
Blog Entries: 1 Weight Statistics I've lost/gained my whole life!!! Start Date:
Aug 1, 2007 Surgery Date:
5' 8"
Height:
280 lb Start Weight:
139 lb Current Weight:
150 lb Goal Weight:
141 lb Weight Loss:
-11 lb Lb Left to Lose:
50.3571428571 % % Lost:
Summer 2008 Goal Date:
Body Mass Index 42.5692041522 BMI Start:
21.1325692042 BMI Current:
22.8049307958 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass  |
Interested on what you find out...I can't believe they would approve a surgery of this magnitude...but no hospital stay...I went on a Wednesday and was NOT released until Friday morning!
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03-14-2008, 05:14 PM
| #9 (permalink) |
| Whipper Snapper  Join Date: Apr 2007 Location: NE Ohio
Posts: 42
Weight Statistics 02-04-2008 Start Date:
** 8/11/2008 ** Surgery Date:
5' 4"
Height:
269 lb Start Weight:
210 lb Current Weight:
130 lb Goal Weight:
59 lb Weight Loss:
80 lb Lb Left to Lose:
21.9330855019 % % Lost:
8/24/09 Goal Date:
Body Mass Index 46.1687011719 BMI Start:
36.0424804688 BMI Current:
22.3120117188 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass |
I don't understand why they made that stipulation on his approval and not on yours if dealing with the same ins. co. But like someone else said, the 23 hour observation is just a billing type of issue. Many people start out as a STOP (short term observation program) and then are admitted if/ when medically necessary. The hospital can't kick him out just because he was pre-approved only for 23 hours- it is up to the Doctor to document the necessity for extending the stay, and he will- this is how he gets paid too. I wouldn't let that upset you, just inform the Doctor in advance.
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03-14-2008, 05:18 PM
| #10 (permalink) |
| WLS Master Guru  Join Date: Jul 2007 Location: Maryland
Posts: 500
Weight Statistics 01/03/2007 Start Date:
12/04/2007 Surgery Date:
4' 10"
Height:
246 lb Start Weight:
160 lb Current Weight:
130 lb Goal Weight:
86 lb Weight Loss:
30 lb Lb Left to Lose:
34.9593495935 % % Lost:
08/2008 Goal Date:
Body Mass Index 51.4084423306 BMI Start:
33.4363852556 BMI Current:
27.1670630202 BMI Goal:
Weight Loss Method Roux en Y Gastric Bypass   |
Wow that is something else. I had never heard of such crazy stuff before. Ins companies will do it though. I don't put anything past them. Please keep us posted on how things turn out.
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