Pre-Surgery & Insurance Approval

I researched bariatric surgery procedures through my insurance company. I found out that my insurance company covers the majority of the procedure at 100%. (I asked the insurance company to send me the detailed benefit information and criteria for the surgery.) I spoke with my family about the surgery, they weren't real supportive at first. They believed I could lose weight on my own. I did have one great supporter, my sister-in-law. She was interested in weight loss surgery also.

I went to the informational seminar on January 13, 2009 with my husband and sister-in-law. The information shared with us was great! This is when I decided bariatric surgery WAS for me.

I had my first initial visit with Dr. Slikkers and Mary Kay (the nutritionist) on March 12, 2009. I told Dr. Slikkers that I was thinking about the lap band. He said that was a great choice for me, that he could see me being very successful with the lap band. That day I was scheduled for an endoscopy since I had such bad heartburn at that time. The dr. thought I may have a hiatal hernia. The procedure was scheduled for April 10, 2009. I had the procedure and no hernia was found.

I had my psychiatric evaluation on April 21, 2009. The first portion of the evaluation was a psych test which was 580 questions. I was having a hard time staying awake for the test. :) The next day I returned to meet with the psychologist. She asked me about my family, my job and eating habits. The only thing I had left to do is get an approval from the insurance company.

Grand Traverse Surgery sent my pre-op requirement that were met to Blue Cross of Minnesota (my insurance company). On May 15, 2009 BCBSMN sent me a letter stating that coverage was denied and it was not medically necessary for my condition. I had not met the criteria for the lap band procedure for the following reasons: 1. My BMI must be 40 or greater for 2 years or between 35-40 with documentation of a co-morbid condition. 2. I must participate in at least one medically-supervised attempt to lose weight within the past 2 years. This attempt must include 6 consecutively monthly visits with a doctor. Luckily I asked the insurance company to send me the criteria back in March and still had that information. The criteria had changed to the above since then. I appealed the decision and sent the previous criteria into the insurance company along with all other criteria required. On July 20, 2009 I was sent a letter stating that the original decision to deny coverage was reversed and determined that BCBSMN would pay for laproscopic banding. YAY!!! I opened the letter and broke down into tears. I was SO HAPPY! It was real now!

I called Dr. Slikkers office and they said they did receive the approval and it would be 4-6 weeks before I would receive a surgery date because the surgeon would need to look over my file and make sure everything as far as lab work, EKG, X-Rays were in order. Six weeks later, August 26, 2009, I received my surgery date of September 17, 2009. I would need to get clearance for surgery from my PCP and have a pre-op appointment with Dr. Slikkers and the nutritionist Mary Kay.