BigSue

My initial consultation was in February, so I did that in person. I also had an upper GI test at the hospital before everything shut down for coronavirus. My next steps were a nutrition consultation (one-on-one with a dietitian) and nutrition class (group class with the same dietitian), and both were changed to telemedicine. They were both changed at last minute -- the day before the appointments -- so I was nervous about having to decide whether to risk going to a major hospital where coronavirus could be spreading just to complete my pre-surgery requirements, but luckily, in the end, I didn't have to. As a bonus, I saved a 2-hour round trip for each appointment. One of my insurance requirements is a 3-month medically-supervised weight loss effort, so I have to go to my primary care provider once a month for three months to complete that. They changed the last appointment and the next one to telemedicine. They just asked me to weigh myself at home and take my own blood pressure and I talked to the nurse practitioner on Zoom for about 5 minutes. My next step is psych consultation, which isn't scheduled yet, but it would be nice to be able to do that by telemedicine, too.

I'm scheduled to have my nutrition evaluation next week at the hospital where the bariatric group is based. I checked the hospital's web site to see what restrictions they had in place for coronavirus, and it said that they would be postponing any non-critical appointments and encouraging people to schedule telehealth visits if possible. I called the bariatric group to ask if I could change my appointment to a telehealth visit, and they initially said no and insisted I had to come in for it, but they called back about an hour later and said they could change it to a phone call. My next hurdle is a weigh-in at my PCP for my 3-month weight loss effort. I hate going to the doctor's office as it is (always full of sick people!), but I'm REALLY wary of going now -- although I live in a rural area where there are currently no confirmed coronavirus cases. One would hope that the insurance companies would make some concessions for surgery approval given the world's circumstances, but insurance companies are notorious for denying coverage for any reason or no reason.

I'm at the beginning stages of getting weight loss surgery, and one of the requirements from my insurance is a 3-month medically-supervised diet with my PCP. My surgeon also wants me to lose at least 20 pounds prior to surgery, but the more, the better. I went to my PCP last week and told her about my decision to have weight loss surgery (which she supported) and the requirement for a 3-month medically-supervised diet, and she basically just gave me some pamphlets on healthy eating, which are, frankly, no help at all. I mean, I already know that kale is healthier than pizza. I've done a lot of fad/crash diets in my life, and as you can probably guess, they did not work in the long term, so I'm hesitant to go in that direction again. My surgery will probably be in July and I don't want to start regaining before I even have the surgery. I started intermittent fasting (16 hours fasting, 8 hours when I can eat) a few weeks ago, and that's going ok. I haven't had much trouble sticking with it, and I actually like skipping breakfast because it's one fewer thing to do in the morning. I also think it's helping me to get out of the habit of snacking, and sometimes I even stretch the 16 hours of fasting to 18 or more. However, I still have unhealthy eating habits during the times when I eat, and I'm not sure if I can lose enough weight through intermittent fasting alone. For those of you who had to lose at least 20 pounds before surgery (not counting the pre-op liquid diet), how did you do it?

Have you chosen a surgeon yet? I think the pre-op requirements vary, so your best bet is probably to ask someone at the surgeon's office. P.S. What part of Tennessee are you in? Just curious; I'm in Eastern Tennessee.

Yeah, it's a huge bummer. Maybe it's selfish, but I don't know. Many (most?) of us who are having this surgery really need it, and some of us have been waiting for a long time to get it. Many of us have serious health conditions and are counting on the surgery to help us lose enough weight to alleviate these conditions. Our health depends on it. Our lives could depend on it. I don't have a surgery date yet, but I was hoping for mid-July. I have a big work event from mid-October through the end of November, so I need to be fully recovered from surgery by then. If I get delayed more than about 6 weeks, I'm not going to be able to get the surgery in 2020, and that will also be a major financial blow. P.S. Part of the logic of naming the virus "COVID-19" and not "Wuhan virus" was specifically to avoid implicating a place or culture. The point was to prevent racist reactions that could result from associating the virus with a certain group of people.

Thanks for the advice, everyone! My insurance requires my medically supervised diet to be outside of the bariatric group. I do have to meet with a nutritionist in the bariatric group, but that's a few weeks from now and I get the impression that it's a one-time thing. I also have to take an online nutrition class and a pre-op surgery prep class. I switched from regular soda to diet several years ago, and I was kind of proud of that because it was hard (I loved regular soda and hated the taste of diet, but I gradually made myself switch and now I prefer the taste of diet, and even unsweetened flavored seltzer). I have a personal rule of no snacking at work, but that's not so easy at home, although the intermittent fasting has helped. I've been entering my food in MyFitnessPal, which is required in my bariatric program for the week before meeting with the nutritionist, but I went ahead and started early, so that is helping me to choose lower-calorie foods, but I am having scary flashbacks to my years of yo-yo dieting because I always do well at the beginning but I can never keep it up for the long term.

I had my initial consultation for weight loss surgery last week and I think it went well! For some reason -- and it seems silly in hindsight -- I expected to have to explain myself and justify why I need this surgery, but that wasn't the case at all. I had filled out a bunch of paperwork and sent it in ahead of time, but they still had a few more forms for me to fill out. A nurse took my vitals and asked me about a few things on my paperwork, and then I met with the surgeon. I was undecided about which surgery to get, and the surgeon said he thinks gastric bypass would be best for me because I have a BMI on the high end. He wants me to lose at least 20 pounds before the surgery. He told me that my insurance provider recently reduced their requirements, and now they only require a 3-month supervised diet instead of 6 months. Finally, I met with a surgery coordinator, who went over all of the requirements I will have to complete before the surgery. She said they want a 5-year weight history and I explained that I don't have it because I went 7-8 years without going to a doctor, and she didn't seem too concerned and didn't think it would be an issue for my insurance. She sounded very confident that they will be able to get insurance approval. The next thing I have to do is an upper GI barium swallow test, which at first sounded like no big deal, but the more I look into it, the more I realize that it is a little scary. I've been reading about other people's weight loss surgeries and watching YouTube videos, and not many people have mentioned this part of it. Overall, I am feeling good about this. I have a long journey ahead of me, but I've taken the first step and it's starting to feel real now.

I recently decided to start the process of getting weight loss surgery. I have an appointment for an initial consultation with a surgeon later this month. I’ve been trying to figure out the insurance requirements (BCBS of Tennessee) for covering my surgery, and I know the standard requirements of having a BMI over 40 and maybe having to do a 6-month supervised diet program, but I’m having a hard time finding any information on some of the other details. My biggest concern is that I’ve seen some people here mention a requirement for documentation of weight history. I have been morbidly obese all my adult life, but I rarely go to doctors. I went to get a checkup and bloodwork a couple of months ago, but before that, I hadn’t been to a doctor in 7 or 8 years, so I basically have no documentation of my weight history. I don’t even have many pictures of myself because I am careful to avoid being in pictures due to embarrassment about my weight. What is typically required for weight history documentation? Also, I’ve been on all kind of diets (Atkins, South Beach, Weight Watchers, Slimfast, Cabbage Soup, calorie counting, etc.), some of which were given by a registered dietitian, but they were a long time ago, in my teens/early 20s. I stopped doing fad diets over 10 years ago because I realized that yo-yo dieting always resulted in regaining everything I lost and more. So, I’m also worried that I won’t have sufficient documentation of my previous dieting efforts. It took me a long time to get to the point that I feel not only that I need weight loss surgery, but that I am ready to put in the work and make the changes that I will need to make, but I’m afraid that I’m going to have to wait years for my insurance to approve the surgery just because I don’t have official records of my weight and diet history. I know my surgeon’s office will have to get the details from my insurance company, but I’d really appreciate any info anyone can give me so I know what to expect. Thanks!

No, not on BP meds (or any meds) right now. PCP said my BP is borderline, not high enough to warrant meds yet. Work physical does not include any bloodwork (except the pre-employment physical when I started the job), and the only urine testing they do is for drugs.

My BMI is well over 40 so that will not be an issue. I have not had any preventive screenings and I am in my late 30s. If the surgeon is going to be concerned, is there anything I can do or say to alleviate his concern? I get an annual physical at work and they always said I was fine, until last year when they said my blood pressure was high and recommended I go to a doctor, so I went to the doctor then. I have gone to the dentist regularly for years -- does that count for anything?

Well, that's the potential problem -- until a couple of months ago, I hadn't set foot in a doctor's office for 7-8 years. I guess I should cross my fingers that the insurance takes my PCP's word for it...

Thanks for the info! That is really good to know about the follow-up appointments. AZhiker, can you tell me where on the BCBS web site I can find the requirements document? I have looked and looked and haven’t been able to find anything about specific requirements. The only thing I can find is that the surgery is covered on my plan. My BMI is well over 40 so that won’t be an issue, and I’m prepared to do a 6-month supervised weight loss program, but what happens if I do not have a documented weight history to prove I have been morbidly obese for at least two years? Will I have to wait until I have a two-year weight history before they will approve my surgery?