Can someone explain the process?

[MICHELLE LEE 19]

Hi all,

I have United Health Care Choice Plus for railroad employees. Ive already called insurance and they do not require diet beforehand. I am scheduled to attend a seminar Nov. 13th. My questions were....

1) Do you have to wait until after seminar to start all required testing? Does the Bariatric center dictate what testing is done?

2) How can I speed up process of tests?

3) If my insurance does not require a referral from PCP, do I even need to see my PCP?

tHANKS.:cursing:

[Mommyto1 1]

I don't have United Health Care, but at my initial meeting with my surgeon I was given a prescription with all the tests I needed to have done. You will probably have to go to you PCP to obtain a letter of medical necessity to be submitted to your insurance company (most companies require this) and then you'll have to get medical clearance from your PCP.

Good Luck!

[jguttery 0]

I have found that each surgeon has different requirements. I went to a seminar held ny one surgeon, received their packet (45 pages), which included a PCP letter, attending one additional seminar, full history of diets, then found out he was out of network with my insurance company. They also required attending one support group a month, and one office visit a month for 18 months after surgery (out of pocket exspense). Called my insurance company and they gave me the name of the only in-state in-network surgeon. Called their office and they mailed me a 4 page package, they called my PCP, no additional seminar, no mandated follow-up support group meeting, no requirement for a monthly office visit..

so after a lengthy answere the short answer is it depends on your surgeon of choice and your insurance company

[honk 780]

If you have a PPO you probably don't need a referral from your PCP. I did'nt ask, I told my PCP's office I was having surgery. My surgeon does not make appointments until after the seminar. I was able to get in about 3 weeks later (the first seminar I went to there was a 8 week wait for an appointment. Thus the need to find another doctor. A better one at that.) At that first appointment I met with a Nurse Practitioner, Psych, and Nutritian. Three hours but done all in one day. Your tests are going to depend on your doctor and personal medical issues. I had to have recent blood labs (which I had just done), EKG, and clearance from the neurologist regarding a blood clot. My doctor did not have a required "support" group but I did have to attend three group session with a psychologist regarding eating habits. It was a lot more informative than I had thought it would be.

One thing to consider is that many doctors require weight loss presurgery (I know if I could I would have done it already right?) I was told to loose 30 pounds before surgery. So depending on your doctor you may have a weight loss goal that does not include the 2 week liquid diet you've probably read about. So the timing of surgery could be affected by that. How long would it take you to loose 20-30 pounds? I don't want to be a downer I'm just telling you my own situation.

[Amanda1982 142]

I have united Health Care choice for city employees. They didn’t require anything other than a letter of medical necessity from my doctor and a BMI over 40 or 35 with co-morbidities. But the surgeon Central Carolina Surgery wanted 5 years notes showing my weight, letter from my doctor, sleep study questionnaire, two letters from friends and one from myself. Once I turn in my packet with all the information (which I did yesterday) the will call the insurance and get pre approval, then will they’ll schedule me to meet the surgeon. That day they will schedule all my other appointments. But they wouldn’t even talk to me until I went through the seminar. I think every surgeon is different.

[Bella Luna 1]

I never had to see my PCP, in fact I don't even have a PCP. I have BC/BS Federal. My surgeon did require I attend a seminar to begin the process (which I could complete online). Then I submitted an application to them and they contacted me with all the required tests. These were based on their requirements. Good luck!

[viking_girl 0]

Yes, I think the center will dictate what tests they want. In my case, I lived an hour and a half away and they were going to let my primary physician do the tests, but then they wanted the results sooner, so in the end, they did them anyway, which was fine.

I think it would be premature to do testing before the seminar, because every center seems to require something different.

Also, something else to think about.... it seems like you are in a hurry to get this done, but having been there already, do you really want to be on a liquid diet through the holidays? I know I would have had a really hard time sipping on a shake while my family eats turkey.... or having mushies for Christmas dinner. I think early January is a great time for surgery.

I actually had mine in early October last year.... I waited until all of the fun summer things were behind me, and I had plenty of time to get back on real food before the holidays. It worked like a charm for me.

OF course, I do understand if there are financial issues that dictate the date of surgery... just wanted to give you something to think about.

[AKessler731 2]

I have United Health Care Choice Plus, my process was fairly easy. But I was so anxious to get my surgery done before the end of the year because my deductible and out of pocket was already met for the year so it will be free. So I wanted to make sure everything was covered. I called the center and asked them what I could go ahead and do and the girl told me the dr requires two support group meetings before surgery. I Did one before the info session. They schedule them like every two weeks or so and I didn't want to have to wait for another one. So I did one of those, then the info session and the other support group before I even got to meet the surgeon. After the support group i went to see my PCP and got a referral, even though it wasn't required, got my letter of medical necessity (even though the ins only required the letter of medical clearance) and I got the letter of medical clearance. My PCP required me to do labs and a sleep study to get the clearance. Then I had to do nutrional counseling and a psych exam (both required by the surgeon) and an information class (also required by surgeon). And I think that was about it. My paperwork was submitted to ins on last Thursday, I called today and they are on step 3 of 5 so he said give it a couple more days. Ins only required: BMI of 40 or 35 w/two comorbidities, letter of medical clearance. And thats about it. No supervised diet, no history. Good luck! I have heard UHC is the easiest to work with!

Oh Ya, and the surgeon required an upper GI

[MICHELLE LEE 19]

Thanks all for the awesome responses. I am calling the surgeons office today to find out what all I can complete early.

As far as eating throughout the holidays , I am so ready to change my eating lifestyle thatI would rather just get this done, and fully enjoy next years holidays as a new thin healthier me...

[misery4499 0]

Every surgeon and every circumstance are different. I had to follow a monitored diet from a nutritionist (surgeons rule), attend 2 support group meetings, a battery of test from psychological tests, ekg, chest xrays sleep apnea test, blood tests. Some people need to loose weight before surgery depending on your BMI to make sure it is a safe procedure. Luckily I did not need to. You should not want to speed the process it really is for your own good to make sure u can stick to the diet and are in top notch health before your surgery. So really everyone is different hope this helps, and good luck!

[Dave_NW 92]

Hi all,

I have United Health Care Choice Plus for railroad employees. Ive already called insurance and they do not require diet beforehand. I am scheduled to attend a seminar Nov. 13th. My questions were....

1) Do you have to wait until after seminar to start all required testing? Does the Bariatric center dictate what testing is done?

2) How can I speed up process of tests?

3) If my insurance does not require a referral from PCP, do I even need to see my PCP?

tHANKS.

There seems to be a lot of different processes and requirements, depending on who your insurance is with, who your surgeon is, and your medical condition. It is possible to "fast track" things, if you're persistent, and your surgeon has his/her act together. But there still seems to be specific requirements most everyone needs to meet.

In my case, my surgeon refused to even schedule to see me until I'd attended one of their weight loss seminars. He has an on-staff bariatric nutritionist, physician, psychologist, and nursing staff. I was able to see everyone needed on the same day, during a marathon back-to-back appointment day. So I think my journey has been pretty short. Here's my timeline:

Referral from PCM to WLS Center approved by Insurance: 8/19/2010

Attended Mandatory WLS seminar at Surgeon's Center: 8/25/2010

Surgeon's office consult and marathon appointments: 9/29/2010

All Lab Bloodwork done (14 tubes of blood): 10/1/2010

Endoscopy: 10/14/2010

Surgery Request submitted to Insurance: 10/15/2010

Surgery Request APPROVED by Insurance (YAY!!!) 10/20/2010

Surgeon consult, to sign surgery consent documents: 11/16/2010

Surgery Day: 12/6/2010

Things could have gone even faster, except my surgeon had scheduling conflicts, and I had to wait a month after the seminar before I could get in to see him. We were going to plan surgery during the second week of November, but I wanted to be sure my support people will be available to help after my surgery. We elected to wait till after the Thanksgiving holiday, which I suppose is weirdly appropriate. Even with the scheduling delays, from date of PCM referral to the WLS Center to my Surgery day will be about 15 weeks. That's pretty fast, I think.

Once you've seen your surgeon, you'll have a better idea of what you're facing. Don't try to short circuit the system - things exist for a reason. Take your time, do your research, start gathering the pieces and parts you'll need for pre- and post-op life, and get ready for your big day.

A word of polite caution: You didn't get fat overnight, so don't expect to lose it overnight. This is a process, not a magic bullet. If you get too impatient, you're setting yourself up for severe disappointment. How does the old saying go? "Slow and steady wins the race."

Good luck!

Dave

[spoiltmom 44]

I have UHC Choice Plus. There was no previous dieting required and I didn't need a referral from my PCP. My whole process was done and I was banded within 2 months of calling the surgeon for the initial consult. I was approved within 5 days.