need advice.....

[tifaga3 0]

I jus tneed advice. My insurance covers the band IF medically necessary..... iver never had or seen a regular fam dr. I made an appt this month and I recently went to the ER for arthritis in my back. So now where do I go, what's the steps I need to take and do I ask my new dr on my first visit about helping me with a referral? Please all the advice I can get ill glady take

[eco 0]

Do you have any acid reflux problems?...that's I got mine done acid reflux,sleep apnea..sleep study done..and of course well over 100 pounds overwieght hyperrtension,and borderline diabetes...

[tifaga3 0]

Do you have any acid reflux problems?...that's I got mine done acid reflux,sleep apnea..sleep study done..and of course well over 100 pounds overwieght hyperrtension,and borderline diabetes...

I'm well overweight, I have arthritus, I have fam hx of diabetes and hight BP but never myself so far. I did get told 2 yr ago I have acid reflux but I wonder if that dr still has her diagnosis on file.....I only saw her once and never again so I dunno. sleep apnea? I don't know....do I need psyc eval? Nutritionist? Ill start all that on my own now if I will have to in the future...

[JerseyGirl80 12]

Some insurances need a referral, some don't. You don't have a PCP? If not maybe you should get one. If you are seeing a pain doctor, I'm not sure if they'd write a referral after the first visit, but after a while they might, some of them even suggest weightloss surgery.

I didn't have a PCP . The first thing I did was I went to a seminar. My insurance didn't need a referral but they did need medical necessities. I already knew I was over weight by more than 100lbs, and I have PCOS, which would have been enough for my approval. At the seminar I made an appointment with my surgeon, I didn't know him prior to the seminar. I met with him a month later and he gave me perscriptions for blood work, an ekg, a sleep, apnea test, a chest x-ray, and a psych evaluation, which revealed more co-morbidites favoring my approval.

If you find a good surgeon with a great staff they will tell you what you need to do for your insurance to get approved. My Doctors insurance case worker pretty much did everything for me, they made it so easy. Also, my surgeon has an in-house nutrition staff and referred me to a psycologist that all of his patients use, I don't know if all Docs are like that but it would have been annoying having to find doctors and nurtrionists that specialize in weight loss surgery.

Anyway, luckily my insurance at the time, Aetna, was pretty easy with their requirements. One of the big things some insurance companies look for is proof of you being over weight for at least 2 years (mine required it), if you have no medical records showing this they may give you a hard time, or just deny it completely. It's hard to really tell you where to start not knowing your insurances requirements, but it couldn't hurt to go to a seminar just to see what they tell you, that's what I did because I didn't know where to start.

[tifaga3 0]

The pain dr was an er dr. I have set up a primary dr as well as testing for chlesterol and thyroid. I can prove my obesity for yrs through any er visits, my obgyn, ect I'm sure... I am going to get the paperwork from my acid reflux diagnosis and I have my back pain and arthritis er discharge paperwork too. Clearly I've been over weight for about ten years now. I had joined curves before and la fitness..... so I have tried. I just want to go to this first visit and get tested prior to setting up bariatric appt. I did attend a seminar already and plan to attend again to decide which surgery I'm aiming for. Thanks for the help. And anyother adive much needed

[happygirl65 5]

You should call your ins co and find out what their specific requirements are because they do differ.

Mine required BMI of 40, proof of obesity for 5 yrs, medical documentation of diet attempts such as self directed, physiscian directed, programs like weight watchers etc. Some require 3 to 6 months of physician supervised diets, and they are changeing requirements all the time. Make sure that your policy doesn't specifically exclude weight loss surgery.

I would go to a seminar if you can, it's free, and loads of info.

Definitely talk to the dr each time you go and make sure they note it in the progress notes on your chart that you discussed weight loss options, even if it's as simple as them recommending you try exercise and south beach diet or something like that. It shows that you are trying and the insurance co needs to see those notes.

Some are easier than others so really, call them they will send you a checklist and make things a lot easier on you. Some of the things on the list are taken care of by the surgons office like the nutrition classes and psych eval. Some require sleep study, some do not. It is all variable depending on your insurance and your surgeon's requirements.

Don't get discouraged, I think the paperwork can be the hardest part of the whole venture.

I wish you every bit of luck and happiness on your journey!

[tifaga3 0]

Thanks. I did a seminar already so that's done. I have no exclusion so they just told me if a dr refers it as medically necessary then they cover it......so I don't know if that's it our I should ask again if I need anything else......