Today I got the news that my insurance has approved the surgery! Cutting it a little close, eh? But it’s done, so I just have to sit back and wait for next week to arrive. I wanted to go over my experience with the consultation and insurance process in case it’s helpful for any of you.
Most insurance companies require a 3 – 6 month medically supervised diet as the first step of the approval process. I was fully prepared for this step, which is why I initially assumed my surgery would be in August or September. I called my insurance company to verify coverage and pre-requisites, and the rep confirmed that I did, indeed, need 3 months of a supervised diet in addition to a psych consultation, nutrition consultation, and surgical consultation.
The more I looked into the various weight loss surgeries, the more interested I became in the SIPS procedure – but I didn’t know if it was covered or not. I hated the idea of calling my insurance company again, so I did what any semi-internet-savvy person would do: I Googled. That’s when I found this document that outlines exactly what my insurance (Blue Cross & Blue Shield of NC) covers and what the eligibility is. And curiously, there wasn’t a single mention of a medically supervised diet!
I went over the requirements over and over again to make sure I understood them, and then since they were different from what the rep had told me… I had to call again. And again, I was told there was a diet requirement. When I mentioned that I had found the eligibility requirements online and it did not include that requirement, I was put on hold. Eventually she came back and apologized – I was right and they were wrong. There used to be a diet requirement, but that eligibility criteria had been removed in 2014! That bears repeating.
The requirements changed two years ago and the reps were still giving out the old information.
Moral of the story? Always ask questions and do your own research.
In the end, I only needed 4 things:
- I had to meet the physical requirement. Having a BMI over 40 or a BMI over 35 with comorbidities.
- I had to have a consultation with a surgeon.
- I had to have a consultation with a psychologist.
- I had to have a consultation with a nutritionist.
So I made the appointments. I would complete of my insurance requirements by May 2nd, so I was suddenly dreaming of a June surgery date instead of August or September. And while it was touch and go for a few days, I did get my June surgery date (I decided on the sleeve gastrectomy – SIPS is still experimental). But they wouldn’t submit my paperwork until I had the surgeon mandated endoscopy. That appointment was this past Monday. My pre-op appointment is tomorrow. My surgery is in one week.
That’s cutting it just a little too close for comfort to me. But – they did submit it on Monday afternoon, and today I was approved. BCBSNC has a 48 hour turnaround time for approvals – and with me at least, they stuck to it.
But if I hadn’t called – both my insurance company and my surgeon’s office – multiple times, it wouldn’t have happened so easily or quickly.
Don’t rely on the system to get things done.
Countdown to Surgery: 7 days!