Newbie Here, Just Wondering...

[AKessler731 2]

Hi everyone. I first called about a consultation a few week ago after I finally made up my mind that I want/need to have this surgery. I was told that the dr requires me to go to an information siminar first. The first one is Sept 1st (this wednesday). I asked if there is anything I need to do in the mean time to get the ball rolling, she said the dr requires me to do atleast 2 support groups before surgery. I did one on 8/21 and I'm doing the second one right after the information session on 9/1. So I will have both of those done. I have already called to get my medical record from my dr (which they want to charge me almost $50 for!). I have already called my insurance and I have UHC Choice Plus and I had just had a baby in April so my $500 deductible and my $2,000 out of pocket max has already been met. If I can get this surgery done before 1/1/11 It will be covered 100%! The only requirements from my insurance was a BMI over 40 of a BMI over 35 with 2 co-moralities. Well my BMI is 44 so thats covered. I asked if I was required to do any lenght of a supervised diet and she said no. I guess my question is what is your opinion on whether I might be able to get this done before the first of the year? I'm so ready to get this done, Ive been fat my whole life and I have never really experianced being slim. I have two daughters and a loving husband who I need to be healthy for. I have PCOS also and that just makes it harder. So what are your opinions?

[honk 780]

One thing to consider is many doctor's require you to loose a percentage of body weight. Mine required 10%. So depending on how much they might require you to loose could affect how quickly you have surgery. I had to loose the weight before they would schedule the surgery. I know some doctors include the require weight loss in a presurgery liquid diet which means they set a date before the weight is lost. I would ask about these items at your sugeon consult.

[bambam31 168]

Share these concerns with your doc at consultation. I was in the same position as we had a baby the same year so deductibles were already met. It took me about three months to get through the process but everyone/doctor is different.

Brad

[vdavenport 0]

Like Bambam31 said, all doctors are different. I have UHC also and it took about 2 weeks for them to approve my surgery. The hardest part for me was before July 1st I had Cigna who required a 6 month doctors visit before approving it. My company changed insurance carries and UHC doesn't require that. Otherwise, I could have been banded in April or May. But got approval on my birthday July 30 and I am being banded Tuesday. My doctor did tell me if I gained any weight during that time they would not do the surgery and they put me on a liquid diet for the last week. Good luck.

[AKessler731 2]

Thanks everyone. Do you all know does the dr usually require anything that the insurance doesnt? Like the psych consult and the losing a percentage of body weight...are those usually things the insurance makes you do or do just some dr's do it on their own?

[vdavenport 0]

My doctor required a psych eval and I had to take 3 classes. The first was a support group meeting, the second nutrition and exercise and the third was basic what's going to happen during and after the surgery. I am doing a week long liquid diet and they talked about that in the 3rd class. The classes really helped me a lot and I'm glad it was a requirement.

[mom05 0]

Thanks everyone. Do you all know does the dr usually require anything that the insurance doesnt? Like the psych consult and the losing a percentage of body weight...are those usually things the insurance makes you do or do just some dr's do it on their own?

My doctor had me do the seminar which I did May 5, 2010, then I had to do blood work and a gall blader ultrasound once that was done I had 3 appt (all on the same day) that my surgeon required (consultation with the internest, psych and with the surgeon him self) this was on 06/28/10.. My insurance required a one time consultation with a dietician, which I am so grateful they did because I learned lots of things this was on 07/22/10. The surgeon's office submitted the paperwork to the insurance probably around 08/05/10 and I got approved 08/13/10.. I too wanted it before the end of the year because I have met my deductable and out of pocket... My BMI is 40.5 and I don't have any other issues so I think as long as your BMI is 40 with no other issues it should be ok... But your doctor will tell you more. I wasn't put on a pre-diet but I was told if I gained the surgery could be delayed (by my dr. not the insurance) so I am still going to do a pre-diet 2 weeks before the surgery which is 09/22/10.. Good luck...and glad you joined:thumbup:

[Supporting Spouse 0]

The doctor will make you go through a series of test regardless if you are paying with insurance or cash. It is to cover them just in case... The only thing I can think of is follow up with your doctor's coordinator that is taking care of your application. Just make sure you do not get lost in the loop and they are submitting a complete package. That was the longest part of the process for us. Our file was not complete and no one informed us. So, once I stayed on top of it we were approved the next month :0) Good luck.

[PrincessErin 64]

I have UHC Choice Plus, too and I'm only required to have a BMI of at least 40 or 35 and greater with co-morbidities. No supervised diet and no Hx of being overweight. I think my Dr does require a psych eval but I'm not entirely sure on that. I think it really just depends on your surgeon, etc.

Maybe once the ball is officially rolling, you can talk to your Dr about the fact that you've already met your deductible for the year so you'd like to have it ASAP. I hope they schedule you quickly! GOOD LUCK!!

[Bella Luna 1]

I also had to have a sleep study, which was required by the surgeon, not by insurance.

[rockstar 0]

My surgeon also requires the nutrition meeting, psych eval, and informational seminar... but my insurance required a 6 month supervised diet with a BMI of 40. So a lot of factors contribute to what you'll have to do.