Alisa_S

Yea. I’m sure you would’ve thought about it once you calmed down a little. You just have a lot on your mind. This process can seem like a lot at times. You've got this though. Schedule if all now since some of them specialists take a while to get into so you have it as early as possible and double check with Dr that you won’t have to follow up for any Of it because that will mess up your timeline a little but hopefully it will all fall right into place. ❤️

Oh thank you! I didn't think of that and you're really talking me off of a ledge right now! That's what I'll do, knock out the 6 month diet, then have the tests done in January and hopefully surgery soon after!

Sigh 😩I told her all that & gave her my weight chart from Dec 2022 to present and she still said "Mmmmm....I'm still going to need to see you monthly for 6 months."
Then added sleep study, EDG, and cardiac appt to the 6 month supervised diet with documented failure of weight loss.
Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life."
Psych eval & Nutritionist counseling that I already have to do.

Sleevetobypass2023 - I've mentioned it a little & I have months and months of weight charts on my Carb Manager account. I used to track all my meals there when I was doing Keto & Low carb. I got tired of tracking all the meals and started just tracking my weight on there a couple times a month. I think I'll print that out and take it to my PCP. Can't hurt I guess.
I did hCG diet back in 2010 (too long ago). In the 90's I did fenphen / phenfen - whatever it was, & dang near got a divorce because I got really mean. Tried just the phentermine about 6 years ago & it affected the same (my boss finally asked me if I wanted to work somewhere else-I quit taking it that day). Been fooling with keto or low carb off & on for the last 8 years. sigh. Through it all I just keep losing and gaining the same weight, over & over. Gosh I'm tired of it.
WEIGHT LOG.pdf

Oh thank you! I didn't think of that and you're really talking me off of a ledge right now! That's what I'll do, knock out the 6 month diet, then have the tests done in January and hopefully surgery soon after!

Good luck with your PCP today!

Have you ever mentioned to your doctor, in the past, the things you did to try and lose weight? I have BCBS and they had the same requirement. But I had mentioned to my pcp that I did Keto, weight watchers, calorie restriction, and the mediterranean diet. When I mentioned this, she put it in the notes that went to the insurance company and they accepted it and that took 6 months off the process.
My pcp was very supportive and was happy for me to do the surgery. I gave her all the requirements from my insurance company (I needed to pass a ekg, her form stating what I've tried to lose weight, my comorbidities, etc...) he jumped right on that and got it done asap.
By the time I went to my 1st appt w/ my surgeon, she had already sent all of this to their office. So I was 3/4 of the way finished on day 1 of seeing my surgeon. All I had left to do was the psych eval, blood work the surgeon needed, and then waiting for it all to be submitted and approved by insurance. My first appt with the surgeon was Feb 28th, 2022. My psych eval was March 7th. Everything was submitted to my insurance on March 10th and I got my approval on March 14th 2022. The longest part of this was honestly actually getting to the surgery date because I couldn't have it until May 3rd due to the surgeon's schedule.
So honestly, the better prepared you are, the more you do behind the scenes, the faster the whole process will go.

I have an appointment with my PCP tomorrow to let her know that I want bariatric surgery & get a referral for my surgeon.
Are there any certain things I should bring up to my Dr? I have no doubt she'll be on board with the surgery. Anything in particular I should say, or ask for?
I've been told that I have sleep apnea by other Drs after having gall bladder surgery & colonoscopy, so I will ask for her to get a sleep study scheduled. I just assume I'll need one.
I spoke to my insurance, United Healthcare Choice Plus, and was given their list of requirements for approval 😕 & I will provide her with that list. I don't want to forget or miss anything that I should discuss. I appreciate any tips/suggestions. Like everyone else, I just want this to go as quickly & smoothly as possible.

Yes, it's requirement.
6 month supervised diet with documented failure of weight loss.
Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life."
Psych eval
Nutritionist counseling
sigh

Sleevetobypass, thank you! I am relearning what I previously knew about bypass.

OK - opinion from the other side of the track.
I have had reflux for 20+ years and was always tied to a PPI. When I lost a lot of weight it always receded. When I regained it recurred.
I took the chance and had a sleeve procedure. I wanted to maintain my anatomy as far as possible. I took a gamble that my reflux would not worsen and I won.
The sleeve does work out for some people. Also it doesn't work out for others. I really hope you can weigh up all the experiences we have to share here and find the right path for you.

that's not why some insurance policies require a six-month supervised diet. They require it because they want to see if you're able to stick to a diet long-term, because they don't want to fork over thousands of dollars for patients to have an elective surgery only to blow it big time by not following their clinic's plan. On top of that, some surgeons require that you lose a certain number of pounds before they'll let you have surgery.
I lost 56 lbs on my six-month supervised diet, and no way were they going to tell me I couldn't have surgery because I could obviously "do it on my own" (and honestly, fewer than 5% of people who lose a lot of weight can maintain it for more than a few months. Bariatric surgeons are well aware of this fact)

I was worried about losing too much weight too The thing is that they can suggest changes all they want but we already know how we are supposed to eat. If we could do it we wouldn’t be where we are now. Chances are you are not going to be able to stick to any diet for a full six months. I know I couldn’t. Also, the surgeries are known to help with sleep apnea and GERD depending on which one the dr feels is appropriate for you. I can’t imagine that being a reason to disqualify you. I have heard of a lot of people getting a hernia repair done at the same time as their surgery.

I don't know how other programs do it, but my 6 months of supervised diet was basically just a logbook of what I was eating, when, how much. My team didn't have me on any restrictions until 2 weeks before the scheduled surgery. They certainly followed up with me consistently, but it was more to suggest how I could adjust my food after the surgery -- ie, "I see you had 2 cups oatmeal for breakfast! After the surgery, you'll probably start at half a cup and go from there, you'll want to make it with either a higher Protein milk like fairlife or even a Protein Shake, you'll want to use thicker oats rather than instant or minute-oats," etc

I did lose about 20 lbs total pre-op -- just because having to measure my food made me more aware of how much I was eating.

I don't want this to come off the wrong way, but I don't think losing too much weight before the surgery will be an issue for you -- or for most people approaching it as an option. If your BMI is high enough to qualify you starting the program, it's highly unlikely you'll be able to lose enough on your own to drop your BMI to a point that it would disqualify you.
(I'm not saying it's impossible! But most people turn to WLS as a last resort after so many other methods have failed -- if we could successfully lose a big chunk of weight by ourselves just by being on a supervised diet, we would have done it without turning to WLS.)

Now that I've made the decision to have WLS & am waiting for my appt with my PCP my mind won't shut up! I know my insurance requires a 6 month supervised diet, but what if I lose weight on the diet and my insurance decides that I don't NEED to have WLS to lose weight since I was (theoretically) able to lose weight for this requirement? I was told after a colonoscopy that I have sleep apnea and need to have a sleep study done & that I should really be on a cpap, but what if sleep apnea is a reason to deny me the surgery? I take omeprazole for acid reflux because I have a hiatal hernia. What if that prevents me from having the surgery?
What if they just say NO? After making up my mind to do this, I just don't think I could take it. I'll be 60 in Oct & I'm 5' 8" - used to be 5' 9" - & I weigh 338 lbs. On my own I have fooled with hCG diet, Keto, low carb, etc, etc, etc for sooooo many years. I lose weight & gain it back. I know what I'm supposed to do, but can't stick with it. I need this. Period.

After many years, I finally decided to have wls.
I made an appointment with my primary care physician to talk to her about it and get set up for a sleep study for sleep apnea. Other than that, I have no idea what I need to do to get the ball rolling.
Does anyone have any experience with United Healthcare Choice Plus insurance and using it for wls?

Ooh yea as @NickelChip just stated and reminded me that they may want an upper GI and/or endoscopy if you have suspected or diagnosed GERD or prior abdominal surgeries. Or some doctors just require them for everyone (I think to look for hernias before they go in there). I have Mild GERD from the sleeve so he wanted those two tests as well as a gastric emptying study prior to my deciding on which surgery is best for my revision (bypass or SADI). That was a pretty complex decision though, since I had already have the sleeved stomach and GERD. I wouldn’t expect all three for a virgin surgery.

In my case, I was referred by my primary care doctor to the weight management center that is affiliated with the hospital and everything else was done through them. But I know it can be different depending where you are. In my case, my surgeon, dietician, and behavioral therapist were all in one office and I went to the hospital to have my labs drawn and my barium swallow and EKG. I did not have to do a sleep test or endoscopy based on whatever criteria they use for that. My insurance required a certain number of visits with the dietician and surgeon, but I'm not sure now what the requirement was because I had been going to the center for a long time on medically supervised weight loss before switching to surgical, so I had long since met those requirements.

Thanks! I think my insurance requires 6 months supervised diet, psych eval, and nutritionist too. I do have a surgeon in mind.
My PCP appt is the 19th.

After many years, I finally decided to have wls.
I made an appointment with my primary care physician to talk to her about it and get set up for a sleep study for sleep apnea. Other than that, I have no idea what I need to do to get the ball rolling.
Does anyone have any experience with United Healthcare Choice Plus insurance and using it for wls?

Thanks! I think my insurance requires 6 months supervised diet, psych eval, and nutritionist too. I do have a surgeon in mind.
My PCP appt is the 19th.

After many years, I finally decided to have wls.
I made an appointment with my primary care physician to talk to her about it and get set up for a sleep study for sleep apnea. Other than that, I have no idea what I need to do to get the ball rolling.
Does anyone have any experience with United Healthcare Choice Plus insurance and using it for wls?