mom2five

Ok, I decided to login to my husband's insurance account and actually look at the policy to see what they require. It appears as if the policy for bariatric surgery was reviewed last November, and as of Jan. 2012, the requirements have changed. Unless I am misunderstanding this, it looks like they have removed the requirement of the 6 month doctor supervised diet. I will copy/paste what it says, so I can get your opinions. Here it is: Medically Necessary: Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria: BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to: diabetes mellitus; or cardiovascular disease; or hypertension; or life threatening cardio-pulmonary problems, (e.g., severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); AND [*]The individual must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery; AND [*]The physician requesting authorization for the surgery must confirm the following: The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and The candidate's post-operative expectations have been addressed; and The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed. Sounds good, huh?

I called my insurance co. and asked about the requirements. The person I talked to said he didn't know what they are but my doctor will have a checklist. I looked it up online. I specifically googled BCBS WV bariactric surgery requirements and I found my checklist. I still have questions though. I'd say my doctor's office will be able to answer a lot of my questions though since I'm sure they deal with this all the time. I'm impatient though! height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!

Mine is BCBS WV PPO height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!

I've never done WW or JC. Never could afford it. But I've dieted my whole adult life. Hopefully I won't need detailed proof of that. Mgsmith72, I appreciate the encouragement. I had been hoping that since my BMI is so high, they would let me skip the 6 month diet but you have a high BMI too and you had to do it. Did you lose much weight on that? People really don't understand what it's like being obese... I am severely obese. I feel like I'm trapped inside a marshmallow. I can't physically exercise like people think I should. It hurts! But I do try. I have hypothyroidism too which doesn't help. My SIL had hypothyroidism but hers went away after surgery! How do you add people to your friends list on here? Or is that even possible? height : 5 ft, weight: 270, BMI: 53 Cant wait to get sleeved!

I might be skipping steps by going straight to the surgeon. I don't know. I just made the appt with him because that's where my SIL went. I believe he will put me on the right track though. I don't know how I'm supposed to prove I have attempted weight loss in the past though. I was prescribed phentermine for weightloss a few years ago. My old doc gave me diet advice. That was in a different state though. I hope I can get the documentation that they want.

Thank you both for the encouragement. I definitely plan to do it. I am getting impatient already! Thedogsmommy, you had surgery yesterday...how do you feel?