TN_Gal

I had my final visit for my three month multi-discplinary plan today to meet insurance requirements. I was told all of my info would be submitted tomorrow. My surgeon does not have a wait list at this point so my surgery will be scheduled as soon as approval is achieved. My husband would like to squeeze in a weekend getaway before all this takes place so I'm just trying to gauge the timeline. I was told today that Aetna has two weeks to approve. I'm looking for real-life scenarios. Nothing tricky in my file- weight loss the whole time- no additional tests required- documentation of 2 years of obesity....It's all there! Should be cut and dry in my opinion.

I only had a one day, full liquid diet prior to surgery. Everything went well and I'm 7 weeks post-op tomorrow!

I never gained any weight during my weigh ins- I was always able lose a pound or two from my previous weight. The only time I gained was AFTER I had received approval at my pre-op appointment. I should clarify that I gained weight in between the weigh ins but was always able to drop it right before I had to weigh in.

Don't get me wrong- I'm SUPER glad I only have a one-day pre-op diet but just curious why there is such a variance. Are there others that only have to do liquids for one day before surgery??

Surgery was Tuesday. Feeling a little like I got ran over by a truck. I am looking forward to feeling normal again.

I had my surgery on the 12th and asked my doctor about this afterwards. He said that in his time of doing this procedure, he has had people follow both protocols of pre-op diets (1-2 weeks vs 1 day of liquids). He said that most people find it difficult to be compliant with a week or two of liquids plus it makes little difference in the reduction of your liver if you do it for one day or one week. I personally only had the one day pre-op and my surgery went fine. To each his own I say!

May 12 here as well! I only have a one day liquid diet so will start that on the 11th. Pre-op is this Wednesday. So excited!!

Last appointment was on Wednesday, file submitted on Friday, approval the following Wednesday!! Yay! Surgery is scheduled for next Tuesday. Yippee!

I told my immediate family (husband, brother, sister, mom, and dad). Besides my husband, I really wish I had kept my mouth shut and let them assume I was following a strict diet plan as I lost. I have, however, prepped my co-workers and church members slightly by letting them know I have been seeing a nutritionist that is helping me make healthier choices. That way, in a few months when I am much smaller, I can give all the credit to my nutritionist.

I am almost halfway through my 3 month multi-disciplinary program for insurance to approve RNY. I have done everything required so far- just have to have the last two meetings with Nutritionist and Psych eval. I am very concerned as I have gained about 8 pounds since my last visit. I know aetna's verbiage says "no NET gain." I'm not sure if this means no gain from starting weight or no gain at all during the process. I would be devastated to be denied from gaining....My next weigh in is in a week. I am fully prepared to fast in order to meet weight if necessary. Anyone have experience with this??

What kind of questions did they ask? I haven't had any dealings with the nurse from the insurance company because they haven't submitted my packet yet. I am anticipating they will at the end of the month.

Thanks for all the replies- my appt was yesterday and I was down 1.5 lbs! Woooo! Now, I have one more appt for Aetna in which I will need to not gain any weight. Can't wait for this to be over! At least I am good for another month....

Does the history have to come from a PCP? I think the only history I have is from sporadic obgyn visits.

I have this exact requirement with Aetna. I hate the lingo and can't figure out what persistent obesity means. Does that mean all medical records would need to show a bmi above 40 or just that you have been in the obese category? So confusing....

Help!! I have my first consultation tomorrow at Vanderbilt in Nashville for Gastric sleeve. I just found out TODAY that I have a $15k cap for all bariatric surgeries. I'm so confused what this will mean for me. I've read several posts about some people who had doctors that negotiated the price down and didn't have to pay anything out of pocket and others who ended up with a $60k bill because of the cap on their insurance. Any insight or advice out there? I would rather pay out of pocket than end up owing a ton of money due to a cap. Thanks!

Echo everyone else- just had first consultation last week and went in with my mind made up to have the sleeve. My surgeon strongly suggested I reconsider RNY as it is proven and produces more effective results. After lots of reading and research, I have opted for RNY. I can't wait to get this done...will be another 3 months or so for me.

I actually had my mind made up that I was going to have the sleeve and my doctor was strongly trying to persuade me toward the RNY because of the long term research and proven results. He said you will lose weight much faster and in a greater amount after it is all said in done. My PCP also recommended RNY over the sleeve. She said if you are going to do it, then DO IT. Go for the gold standard if you have the option.

@@ai2 I met with an insurance specialists at vanderbilt and we talked for about 45 minutes regarding the cap. She said that the surgeons will write most of the fees off and showed me the bill of another person that had the same insurance as me. Her total out of pocket came out to be around $6000 after all the write offs. You might consider talking to the insurance person at the office you were going to use in the states.

I had back to back consults with my RE and then the bariatric surgeon the next day. I had my mind made up that I wanted gastric sleeve and my RE thought it was a great idea. When I met with the surgeon, he said I could have whichever one I wanted but he would recommend the RNY due to faster weight loss and more long term studies. Now I'm more confused than ever! I'm having this surgery to get healthy and attempt to have a baby. Been married 10 years with one ectopic 3 years ago- No pregnancies or babies since. Advice? Why did you decide sleeve over RNY? Did your dr prefer one over the other for fertility?

Got a quote from a dr in Murfreesboro, TN- $12300 for everything EXCEPT the insurance after the fact. Turn around time from first appt to surgery is only 3 weeks. I actually have insurance coverage for bariatric procedures but have a $6500 copay. I have considered going the self pay route because of my high deductible and avoiding the 6 month long process that comes with insurance. I'm still undecided. Advice anyone??

That's awesome...I'm actually at a crossroads right now as I have found a dr in Murfreesboro, TN (45 min from me) that will do all inclusive self pay for 12,300. He said he can get me in for surgery on Feb 12. How cool is that?!?! So now, I'm trying to decide if I want to pay the 12k and have it done in about a month or deal with meeting all the insurance requirements which will save me about $5k and have it done in June.....Trying to rational about saving the money but I'm ready to get this show on the road!

@@Beautiful Mess and @Gammy10 Do you mind me asking what your total out of pocket cost was for self pay? I read on their website the all inclusive price is $11,900 but sometimes those figures can be misleading. Also- What was the total time frame from your initial appointment to surgery date? I am in TN and dealing with insurance nonsense and would rather just bite the bullet and pay OOP if I can do it for under $12k.