I have a surgery date and an Approval from the Insurance Company!!!

[Marsh17]

So happy that all of the office visits, documentation, phone calls, classes, and pre-op testing has finally ended and now I have a surgery date (March 27th) and it has all been approved by the insurance company! What a journey! I'm excited and nervous all at the same time. I can't wait for this new beginning. Many thanks to all of you on this site that have helped answer my questions and shared your stories. I feel like I have an extended group of knowledgeable friends that are helping me navigate these new waters. Thank you!

[AnnieG]

Congratulations! You are going to be on the way. And this group will be right here with you.

[Marsh17]

Thank you! What a journey you have had. Your honesty and sharing is greatly appreciated. I have learned so much from the folks on the forum. Thx

[BamaBrit]

Woo hoo!!!!! Congrats!!!!! I’m so excited for you! It’s like a new life in a new body! Ooohhh I’m excited for you!!!

[shrinkvi]

How exciting - good for you!!

[Christie13]

YAY Marsh17!! That is great news and it is going to be here before you know it!!! Congrats!!

[Fredd]

So happy that all of the office visits, documentation, phone calls, classes, and pre-op testing has finally ended and now I have a surgery date (March 27th) and it has all been approved by the insurance company! What a journey! I'm excited and nervous all at the same time. I can't wait for this new beginning. Many thanks to all of you on this site that have helped answer my questions and shared your stories. I feel like I have an extended group of knowledgeable friends that are helping me navigate these new waters. Thank you!

Wow! Congratulations! That is AMAZING news. I am just starting this process and I was wondering how long did your whole approval process take? I have a list of "to dos" from my surgeon - medically supervised weight loss, psych eval, etc. and he says that once I complete this list, info will be submitted to my insurer for approval. Once "the list" is completed, how long does it take for your insurer to get on board? Once approved, does your surgery have to be right away, or can you schedule it a couple months down the line?

Sorry for all the questions, just so confused about this whole process!

Again, HUGE CONGRATS on your upcoming surgery! Everyone I talked to who has been through this says it is the BEST decision they ever made...and I am sure this will hold true for you! Best of luck!

[Marsh17]

Thank you for the well wishes! One item that helped me is getting a copy of the Summary Plan Description from the employer where our health insurance is through. This is where all the specific detail is on what your benefits are. I knew exactly what the insurance company needed to be sent in to them for the approval process. You can also get this information by calling your insurance company. Each insurance company/employer is different. I needed a 5 year medical history with a certain BMI, along with other items.

I became the "driver" of the process. I contacted my doctors and made sure they sent the information to the Weight Loss surgeon's office. I only had me to worry about and the surgeon's office has 100+ people they are following up on. I made the appointment with the psych office and followed up afterwards and to ensure the report was sent to the surgeons office. I made sure they had the results of my lab work. I followed up on the results of my upper endoscopy to make sure they had this information. Once all of the requirements/documents were in I asked my surgeons office for a copy of the "packet" they were sending to my insurance company to ensure all of the i's were dotted and t's were crossed. I also felt I had a jump start on the appeal if one was needed since I had all of the information they were sent. In my case it is a black & white process, either you met the criteria or you did not. It took about a month for me to get all of the testing done and 2.5 days for my insurance company to approve it. I kept on top of all of the moving pieces and followed up with each person along the way. For example, when my surgeon's office said they sent the "packet" to the insurance company I called the insurance company to make sure they had received it. I actually found out I was approved before my surgeon's office did. The only class my insurance required was a nutrition class. I have read on the site where some companies require a 6 month series of classes. I did not have that criteria to meet.

In my experience the 2.5 day approval process is NOT typical and insurance companies generally have any where from 1- 30 days for the approval process. My husband's employer has a dedicated department within the insurance company which helped move the process along. I would ask your insurance company what the time frame is according to your Summary Plan Description Guidelines.

I would check with your surgeon's office and insurance company on the timing of when the surgery must take place. The reason being that some of the testing may become "stale" or old and need to be redone. This could impact how much you out of pocket expenses will be. Best of luck to you on your journey and please feel free to ask questions. I have found the folks on this site are extremely giving and want to help others.

[DHB]

Congratulations & great advice! You have to drive the process. I had so many glitches along the way between the coordinator in my surgeon’s office & my insurance company. You absolutely have to stay on top of things. One delay & your tests become out of date & need to be redone. Check to make sure the insurance company actually receives everything.... If I hadn’t followed up on everything I’d still be waiting!

[Fredd]

Thank you for the well wishes! One item that helped me is getting a copy of the Summary Plan Description from the employer where our health insurance is through. This is where all the specific detail is on what your benefits are. I knew exactly what the insurance company needed to be sent in to them for the approval process. You can also get this information by calling your insurance company. Each insurance company/employer is different. I needed a 5 year medical history with a certain BMI, along with other items.

I became the "driver" of the process. I contacted my doctors and made sure they sent the information to the Weight Loss surgeon's office. I only had me to worry about and the surgeon's office has 100+ people they are following up on. I made the appointment with the psych office and followed up afterwards and to ensure the report was sent to the surgeons office. I made sure they had the results of my lab work. I followed up on the results of my upper endoscopy to make sure they had this information. Once all of the requirements/documents were in I asked my surgeons office for a copy of the "packet" they were sending to my insurance company to ensure all of the i's were dotted and t's were crossed. I also felt I had a jump start on the appeal if one was needed since I had all of the information they were sent. In my case it is a black & white process, either you met the criteria or you did not. It took about a month for me to get all of the testing done and 2.5 days for my insurance company to approve it. I kept on top of all of the moving pieces and followed up with each person along the way. For example, when my surgeon's office said they sent the "packet" to the insurance company I called the insurance company to make sure they had received it. I actually found out I was approved before my surgeon's office did. The only class my insurance required was a nutrition class. I have read on the site where some companies require a 6 month series of classes. I did not have that criteria to meet.

In my experience the 2.5 day approval process is NOT typical and insurance companies generally have any where from 1- 30 days for the approval process. My husband's employer has a dedicated department within the insurance company which helped move the process along. I would ask your insurance company what the time frame is according to your Summary Plan Description Guidelines.

I would check with your surgeon's office and insurance company on the timing of when the surgery must take place. The reason being that some of the testing may become "stale" or old and need to be redone. This could impact how much you out of pocket expenses will be. Best of luck to you on your journey and please feel free to ask questions. I have found the folks on this site are extremely giving and want to help others.

Fantastic advice! I will definitely make a concerted effort to be more proactive in this process...and the more I think about it, the more I realize, "Uh, yeah! This is MY surgery, MY life, MY time, MY money...heck yeah I should be the 'driver'!" Great advice! Congrats again on securing your surgery date! 3 weeks and counting! Sending good vibes your way!