mspatches320

Hello I've been trying to get gastric sleeve surgery for about 2 years now. My PCP does not believe in the weight loss surgery she's put me on a couple of weight loss medications that have not worked because the side effects were bad. She has referred me to a dietitian which I will be seeing on Tuesday. The dietitian specializes in bariatric surgery help. Can a dietitian approve weight loss surgery, or does my PCP have to? I fit the criteria for weight loss surgery my BMI is currently 47.5 I have high blood pressure I have PCOS and a obesity family history.. my husband also thinks I have sleep apnea but I have yet to test that. My PCP is no help I am hoping this dietitian can help me any thoughts you can help me with

Yeah I was thinking about that to . Where I go it's a practice and I asked for her the other doctor at one time suggested that I get it so maybe I'll see if I could start seeing him again so I guess a PCP has to approve it?

Do i need to go to my primary care physician first or can i go to the Bariatic Clinic and start my journey ? IThank you

I went to 2 seminars and the last one i went to i made an appointment which i had to wait a month for. For them to tell me my ins doesn't cover it. That was a year or two ago. I guess my ins changed that is why i asked them before i started to ask any questions here.

I live in Northern NJ near NYC .

I read on it some more and i would have to go to a Bariatric Center of Excellence. Wonder if i could just contact them ? They would be able to help me correct ?

I have Anthem Blue Cross Blue Shield. I contacted them today and they sent me this Bariatric/gastric bypass surgery is covered if deemed medically necessary. You or your provider can view our medical necessity guidelines for this kind of surgery at the following web address: http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm Pre-certification is required. Your provider may call 1-800-690-0512 to request an authorization. Your plan provides coverage for surgery based on medical necessity. Surgery that is considered cosmetic, investigational or experimental will not be covered. Referrals are not required. In-network coverage is at 100% of the maximum allowed amount, with no co-payment or deductible. In-network providers are required to accept the maximum allowed amount for services covered by your policy. If services are rendered inpatient, the facility will charge a $300 admission co-payment. Out-of-network coverage is at 70% of the maximum allowed amount, subject to the out-of-network deductible of $750 per person or $2000 for the family. Please be advised that an out-of-network provider can bill you for any difference between the maximum allowed amount and the actual billed amount. Anesthesia rendered by an out-of-network provider at an in-network facility will be covered at the in-network benefit level based on the provider’s total charge. The out-of-network out-of-pocket maximum is $2500 per person or $7500 for the family. These totals include the coinsurance, but not any charges over the maximum allowed amount, penalties for non-compliance, deductible, co-payments, or non-covered services. Using an in-network provider gives you a higher level of coverage. When using an in-network provider, please verify with the provider, at the time of service, that they are still contracted as PPO participating. This will ensure you receive the in-network level of benefits for your date of service. Your deductible and out-of-pocket maximum can be viewed on our website. Please click the “Claims” tab at the top of the page. Now click the “Deductibles & Out of Pocket Amounts” tab. This will display the accumulations for your current benefit year. To view previous benefit year accumulations simply change the date range in the coverage period box on this screen.

Hello I am new to this forum. I have been thinking about getting the sleeve procedure done for the past 2 years now.I have gone to a seminar with new jersey bariatric but noticed that there hospitals and offices are quite distance from where I am located. I found another bariatric group called advance laproscopic in hackensack new jersey and have made my appointment to go to the seminar. Can anyone tell me what happens after I go to the seminar?