did you have to do a 6 month diet?
Just call the customer service number on your card and explain you need to know the prerequisites for bariatric surgery and which procedures are covered under your plan. Usually they call this either a sleeve gastrectomy or a vertical sleeve gastrectomy. If you just say sleeve there is another procedure that is similar, an older one where they literally put a sleeve over the stomach, and you may get bad info.
You can ask them to either email or snail mail you the pages so you have them in hand and know what you are up against.
I have harvard pilgrim. I had to prove I'd tried on my own and used my online records from Atkins and my Weight watchers check in book. But at my high bmi and proof i had sleep apnea and arthritis they didn't seem to much care about that. I paid my surgical copay of $1000, and copays for the other visits for a total of about $1425 (so far, it's a 5 yr thing with a center of excellence)... The docs office had their own rules as well though. I had to lose 10% of my excess body weight before I could even see the surgeon.
Best NSV - fitting on a kid's amusement park ride with my 4 yr old grandson!
CFIDS =Chronic Fatigue Syndrome) Also dx with post-bariatric reactive hypoglycemia; and chronic gastritis (both sleeve complications). Permanently disabled.
Start weight 335, down to 218, up during gastritis. Have accepted there is no way to lose it with my hypoglycemia. Current weight 260. Currently doing 10 day sleeve reset and determined to get back down to my post surgical weight or close to it.
I have medical mutual and they covered my surgery. They did require 6 months of supervised weight loss and psych evaluation. I do have really good. Insurance since my husband is a public employee. They just needed to see that the surgery was medically necessary and not just cosmetic.
Many of the people in my nutrition class the other day who have insurance as federal employees say that the sleeve is not covered but by-pass surgery is covered. I agree with everyone who said you can have the same company insuring you and have different coverage based on what your employer is willing to pay for.
I have BCBS of Texas as I am employed by a TX company and mine will be covered by insurance minus the items that are not covered.
Well I met with Dr. John Gonzalez June 1, 2012, immediately I connected with the doctor and that made me feel really good. Not only has he operated on people that work in the same company I work for but he also knew my primary care doctor. My insurance BCBS was accepted and they did cover the sleeve surgery. My total pay out was $700.00 ($200 deductible). They only require I take a nutrition class (already did the same day) and a phsycological test which I will do this week. There was NO 6 month pre diet required which I was happy to hear. Did not get a surgery date till the confirmed approval from my insurance was recieved but he did tell me that my surgery could very well happen with in 1 month. I am very excited and surprisingly I'm not nervous, at least not yet. Thought I would share this info. with all of you that responded to my thread, thanks. Will continue to post my journey to a new life. str672
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