OregonBarbie

I Just got my first appt in Feb to meet with the NUT and the PT, and see the NP. I am reading about all the pre diets you are required to do before your surgery.. I am exactly at 40 BMI if I lost a bunch of weight prior to surgery, wouldn't the insurance deny surgery because you are not in the BMI catagory required for the surgery? I am not sure if my program will consist of the 6 month supervised diet yet, but that seems like a person would lose a bit of weight and possibly be denied because of it dropping their BMI, has anyone ever had that issue? Thanks!

We are close to the same stats?? did you already have your visit?

Well my insurance only covers it if you are diabetic. I have Barretts so they approved it because it's a pre cancerous condition and the gastric bypass would pretty much eliminate GERD. I am already outside the standard approval because I am only "pre" diabetic. But I will add something in my pockets just to be sure. As long as it isn't obvious I guess. My original doctor who referred me because I was 40 BMI, but my FIRST appt with the Bariatric clinic is not until Mid Feb.. I was not sure which weight they would use.. the original weight on my referral or the weight I am when I see the NURSE, NUT and PT and just since my approval to go into the program, I have dropped 5 lbs just because i am not eating all the holiday crap.. I gained 10 over the holidays.. it usually comes off when I stop eating junk food but this is going to put me under. I am also 5'5" and 3/4 so I just round up to 5'6"

I watched this too!! I thought for sure that clean diet momma coach was going to get a smack down when she started telling Latashas momma to stop enabling her and she is part of the fault.....Kristi Alley had WLS? I guess I missed that issue of People. I Know ROSANNE had it.. I think? Oprah is a dieting train wreck. But she can sell ice cubes to Eskimos. Most of the people on that show would be able to have WLS but like a previous poster said, it's not for everyone. But then a LOT of insurance companies won't pay for it or require you to be on your death bed to approve it.

That is what I am afraid of, I am just starting the program and my first appointment isn't until Feb 17th. I think I will go in heavy clothing too.. I am a member of Kaiser, but my insurance requires I go to a center of Excellence, so I have to use a different clinic and The new clinic has no records at all. So they will use what ever starting weight I have and then Expect me to lose some.. Since I am going through state insurance, it's already hard enough to get approvals.. I don't want to give them any reason to deny it...I was just wondering if anyone ever heard of someone being denied after originally approved due to a lower BMI

I finally got my new doctor to send my referral for Bariatric surgery. Insurance denied me, I was going to give up, but decided to appealed and got it approved because of Barretts, which originally they didn't have that information.. But My hospital can't do it, so they sent the referral to another one. When I called to make my appointment, they said 2 year wait list for non members.. UGH! Because of my Barretts and it's urgent for me to get the GERD to stop so I am not at an even higher risk for cancer. My doctor said 2 years is too long. So I called back the program and she said they don't ever get chart notes with referrals so they had no way to know. So I had to fax her over the biopsy results and doctors notes and she said she is going to present to the board to see what they can do.. I am keeping all my fingers crossed. So, hopefully I get to share a story soon too!

HI! Thanks for the reply.. I did get the approval and you are right.. It is a center of excellence. But because I am a NON member there was a 2 year waiting list.. My insurance gave me a 6 month approval. The program they referred me to is very well known and My doctor doesn't think it is a good idea to wait 2 years.. so I sent the center over the needed paperwork to hopefully be considered to start now and skip the 2 year waiting list. The first hurdle was actually getting the approval. My next hurdles from what I understand is passing all the evaluations which determine if you are even able to physically and mentally have the surgery... so hopefully the process goes smoother after this hurdle.

Partial Good news.. After my doctors appointment today, my doctor urged me to talk to the coordinator at OHSU and explain my circumstances. She did say they only get referrals and they don't have any chart notes. So I am sending those over. She is going to review my case and see if they can expedite my wait.. Keeping my fingers crossed..

Hi, I am new here. I am on Oregon Health Plan - My doctor sent in a referral for Bariatric surgery Dec 4th and it was denied because I didn't have Type II diabetes. I filed an appeal and it was approved! I was so excited. But the approval says I am approved for consideration for surgery. I am assuming I have to pass through all the other hurdles before they actually approve it? I am on Kaiser and then are sending me to OHSU Bariatric Progam and it says I am approved for 1 appointment.. ? I am calling in the morning but it will break my heart if I have to fight for each step of the process.. UGH! B

Yep! and I called this morning. OHP kaiser referral says I have medical approval for 6 months.. OHSU didn't have the referral yet but I was told this morning that it is a 2 year waiting list for state insurance.. basically she said they don't have enough room to serve THEIR patients and everyone else, so non members (state)are put on a long waiting list.. THIS IS BS.. I will be on the phone all day .. Isn't that discrimination? I have a pre cancerous condition and the longer I wait the more serious it is.. so the OHSU rep basically said to me this morning that.. if someone on their insurance doesn't have any co-morbidity they will get in before me... because they get priority...