How Long For Insurance Approval?

**Twodogfox** · 06-26-2016 11:42 PM

Hi there. I will soon be going to the informational seminar for Gastric Sleeve. I'm one of those people who makes up their mind, researches the heck out of it and then wants to get it done! All except dieting, sigh. I have Blue Cross Blue Shield through United Airlines and my biggest fear at this point is how long it will take to get approved (and if). I've heard up to 3 years!!! Anyone have any quick approvals to share? Do they all make you go through yet another 6 month supervised diet program? Face it, we've all been that route several times! I've done Nutrisystem, Jenny Craig, Weight Watcher online, doctor supervised, phen-fen, just fen. I've done it on my own, dedicated to the gym and good diet for 6 months and only lost 20 lbs and couldn't budge another pound. I've lost a lot of weight over the years and can't keep it off. Like I have this set point my body wants to return to. Anyway, I should get my package of forms and info in the mail tomorrow or soon. Seminar the 20th for sure but am hoping for a cancellation the 7th. I have to drive 4 1/2 hours to get there but its the closest one approved for facility and doctor by the insurance. Wish me luck as I do all of you.,

**KariVSG** · 06-27-2016 08:00 AM

im hoping not to long.

**luckygirl** · 06-27-2016 08:15 AM

HI,
I hope your approval goes quickly,however don't rule Mexico out.I had thought about surgery and knew my insurance carrier wouldn't pay,and if I picked up insurance where I worked I'd have to have a higher BMI.I made up my mind in late April,had surgery in June.Total cost 5,000. with airfare.Best birthday present to myself. I'm 3 weeks out and doing fine.I'm losing very slowly and I'm quite happy about that. Theres not a lot of pain with this surgery,my incisions are about the most painful part. I'm babying myself probally a little too much but I just want smooth sailing. Good luck on your journey.

**Kevin_Sly** · 06-27-2016 09:31 AM

I have Healthcare New England and my prerequisites were...
6 month waiting period
Nutritionalist attendance
Support group attendance
Psych Evaluation... Diet tracking... Exercise tracking...

Plus, at 6 months, the paperwork goes in and 4 weeks for approval.

For me, it's been an anxious wait but I'm really glad I went through the process. I feel completely ready (as ready as can be). If you have a serious problem (weight is causing a heart problem or diabetes etc.) check to see if you can bypass the waiting period with doctors approval...

Just my two cents.

**RehabNurse** · 06-27-2016 09:42 AM

I had a Blue Cross/Blue Shield of Texas PPO plan at the time I was qualifying for the surgery. My initial consultation took place in October 2014 and the insurance company granted their pre-approval for the sleeve in December 2014. My paperwork was submitted in November.

A friend currently went through the pre-approval process with Blue Cross/Blue Shield, but her plan was slightly different because it required six months of nutritional visits. Her paperwork was submitted at the beginning of this month (June 2016) and she was recently approved by the insurance company.

Generally, insurance pre-approvals for bariatric surgery are processed more quickly during the summer since people generally want to enjoy their summer without being operated on. Since less people have surgery during this time of year, the process moves faster.

On the other hand, everyone is bum-rushing to have surgery before the end of the year (Oct/Nov/Dec) before their insurance plans change on January 1st, or because they do not need to pay as high of a deductible at year's end.

**Twodogfox** · 06-27-2016 12:02 PM

How were you sure you were getting a quality doctor and facility? How do they handle the after care?

**Twodogfox** · 06-27-2016 12:04 PM

What gets me is that lets say they require you to work with a doctor assisted weight loss, or nutritionist. So you loose some weight, making you ineligible for the surgery, but not enough to be in the healthy range. Cause I've lots anywhere from 20-60 lbs by myself or through a program, then you put it slowly back on. The older I get the harder it comes off and the quicker I go back to my "set point". I hate to sound bitter but if this was a male sexual enhancement surgery, it would get done ASAP

**ready16** · 06-27-2016 12:22 PM

I just got denied

I'm waiting for one more attempt by my physician. Can you tell me more about the Mexico option?

**RehabNurse** · 06-27-2016 12:43 PM

Originally Posted by ready16

Can you tell me more about the Mexico option?

There's one option in Mexico that's $2,999 (all inclusive):

http://longtermvsg.com/gastric-sleev...ijuana-mexico/

**PleaseSleeveMe** · 06-27-2016 05:20 PM

My mom had RNY in 2005 after a 1-year waiting period (Medicare/Medi-Cal).

I had my sleeve last week after a 5-month waiting period, and I was a cash customer (no co-morbidities, so insurance wouldn't cover me). I went through UCLA medical center and they typically require 6 months. Even as a cash customer, they made me go through most of that, although I was able to get them to cut it short one month through lobbying them relentlessly.

In southern California, Torrance Bariatrics will do the procedure a week after seeing you if you are a cash customer ($20,000). They do it as an outpatient procedure at a clinic in Beverly Hills.

I have heard mixed reviews about the Mexico options, but I'm afraid I don't know much more about that. I would understand going that route, but definitely do your homework and ask around (do not just rely on faceless people on the Internet). After all, this is a decision meant to enhance your health, not endanger it! I believe there are a number of sleevers on these forums who got their surgery in Mexico and I'm sure they will be a great starting resource for your research.

Best of luck to you!

**freeme** · 06-27-2016 08:53 PM

I have Blue Cross PPO. I went in for a consultation in March. I had to show that I tried (to them) either 5 or 6 differen't ways to loose weight on my own. You also have to bring in from your primary proof of your weight I think last 3 months and last year. They said you can also bring OBGYN records. My BMI was 37. I had to have a psych evaluation too. This location had quite a few employees from where I worked so I think either they knew how to get paperwork in because I had a date for surgery when I left after that initial workup. My surgery was 5/31.

**Twodogfox** · 06-27-2016 09:13 PM

One thing I am learning is that it widely varies how long it takes to get approved! I guess for now I'll rely on the staff at the Deaconess Bariatric Clinic in Spokane to start the process. I don't have a lot of records for methods I've tried. Been years or the facility is closed. I have my current doctors records however. I called today and there was a cancellation for their July 7 seminar which is earlier than the July 20th I was registered for. I often feel if things are too hard, maybe they aren't meant to be. Sometimes things fall together. However, there is the belief that that things worthwhile are worth fighting for. Sigh. I often read that doctor recommend the full bypass (more invasive procedures). Hopefully that isn't because they get paid more.