Sleep study before being approved?

Oliviawashere
on 8/7/14 10:36 am

I just might be that person that needs her ducks in a row to form nicely and orderly. I need to complete the physican supervised diet of 6 months & get a psychological test for my insurance to consider to approve me. So why is it that, I am not even approved yet and am only on the 3rd month of this diet; I get a call from a sleep study place that says my surgeon notified them to make an appointment with me. Why would I go through this hoop, when I don't even know if i am approved? Should I? What if I am not approved, wouldn't it be all for naught?

jaxie77
on 8/7/14 11:09 am - Canada
RNY on 12/16/14

Hey Olivia, 

A sleep study is pretty standard for WLS , and yes it may be a hoop to jump through for Insurance purposes , but if you are approved(when not if !) , it's one less thing that needs to be done , which means less time to wait on the surgery !!

Also , if you have it done and find out you have Sleep Apnea , you are on your way to getting something done about it and feeling better , and if you dont have it then that's one less thing to worry about ! :) 

Honestly , it's nothing to worry about , very relaxed procedure , a bit weird sleeping with all the wires and stuff but its nothing like what you're imagining (if youre anything like me I had all sorts of weird visions of men in labcoats and me on some stretcher overnight in a padded white room !! 

Hope everything goes well for you , it will all be approved in no time ! Good luck xx 

Jax x

  

kathkeb
on 8/7/14 11:52 am

Since sleep apnea is a co-morbidity, being diagnosed will help with your approval (since significant weight loss alleviates most cases of sleep apnea).

It will also help your medical team treat you before, during and after your surgery if they know whether you have it or not.

Very standard to have this test as a pre op.

Kath

  
hollykim
on 8/7/14 12:06 pm - Nashville, TN
Revision on 03/18/15

because sleep apnea is a co morbidity that will qualify you for surgery. I don't know why you are complaining that your surgeons office is on the ball and trying to move things along as quickly as possible. 

 


          

 

poet_kelly
on 8/7/14 12:21 pm - OH

Some insurance policies require a sleep study before approval.  I don't know if yours does or not.

If it is something you will not need to do until if/when you are approved for surgery, then you can wait if you want.  But if you want to get things done as quickly as possible, I'd go ahead and do it now.

Even if you are not approved or decide not to have surgery, the sleep study will not be for naught because if sleep apnea is common in morbidly obese people and if you have it, it would be a very good thing to find out and get it treated.

Besides that, you probably already know if you meet/will meet your insurance policy's requirements for approval.  You know that you have to complete a six month diet, but you plan to complete that, right?  Do you meet their other requirements, in terms of BMI and so forth?  There really shouldn't be much of a guessing game about whether or not you will be approved.  If you meet the criteria in your policy, they  must pay for your surgery.  If you don't meet, they won't pay for it.

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

jessica1371
on 8/8/14 1:16 am - Elgin, IL
VSG on 08/29/14

I for one was ALL in when I made the decision to have the WLS... I was not going to let anything stop me.... I attended the Seminar on the 6/26/14.... they told me my insurance needed a Psych and Nut eval for approval... however my surgeons office had another set of requirements. I am glad my surgeon is so thorough!

I am in a hurry due to starting a new job. I asked the office if I can also schedule some of the eval needed, cause I KNEW I would be approved by insurance. Needless to say I had ALL MY evals done and insurance approved me by 8/7/14.

Yes when I did the pulmonary eval, I brought the results of my sleep study from 2 yrs prior.... According to those results I have sleep apnea, and in order to clear me for surgery I had to start using the CPAP machine.  

SO it's awesome that your office is helping you and preparing you for your upcoming evals/requirements. Some clearances are only good for 60 days I didn't know that... so It's good to have everything coming together at once. The longest wait for me  was trying to get appts for evals since the specialists are very booked up!!! So it sounds like your office is at least getting you on the books!

 

Good luck!

STATS: 5'7" HW: 424 (Jan 2014)   SW: 391 (Aug 2014)  CW: 323 (Jan 2015)

    

MegZorar
on 8/8/14 8:08 am
On August 7, 2014 at 5:36 PM Pacific Time, Oliviawashere wrote:

I just might be that person that needs her ducks in a row to form nicely and orderly. I need to complete the physican supervised diet of 6 months & get a psychological test for my insurance to consider to approve me. So why is it that, I am not even approved yet and am only on the 3rd month of this diet; I get a call from a sleep study place that says my surgeon notified them to make an appointment with me. Why would I go through this hoop, when I don't even know if i am approved? Should I? What if I am not approved, wouldn't it be all for naught?

I took a risk and DID NOT get the sleep apnea test. My surgeon recommended it, but it wasn't on the list of requirements from my insurance company. My BMI was high enough, based on the insurance requirement, that I didn't need to show comorbidities. I know it helps to paint as full a picture as possible when looking for insurance approval, but I also needed to consider out-of-pocket costs and a very high deductible. So in the end, I took a risk and passed on the sleep apnea. I was approved in less than a week (did months of visits with a primary care provider, nutritional consultation, psychiatrist eval, etc, as required by insurance. But no "extras.") Had surgery Tuesday. Good luck to you.

     

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