First step?

[TnT 0]

I'm a newbie. My husband and I are both hoping to be sleeved fairly soon...we just aren't sure how to get the ball rolling! We live in rural Ohio so it's not like we have a bariatric center around the corner.

Do we see our family doctor first for a referral?

Do we contact a bariatric surgeon in a near by city?

Do we contact our insurance carrier (Aetna) first to see if it's even covered?

Should we both have it done at the same time? If not, how long in between?

We aren't even sure how long the process is from right now to a surgery date.

ANY advise you can offer would be awesome! Thanks in advance!

[Frankie 0]

I would contact your insurance company first to see if WLS is covered and it should be able to tell you all the requirements and steps you would need to take if covered.

Good luck!

Frankie

VSG 3/22/10

[KabinKitty 11]

I agree your first step is to call Atena to see if "Bariatric Surgery for the Morbidly Obese" is covered under your policy.

If it is excluded, you have no hope of getting them to cover it. You must pursue the self-pay option.

I found this post from February 2010 (I talked with a lady on OH who gave me the downlow. I also spoke with an Aetna patient rep and she also said yes they are approving but not until all the legal paperwork is complete, sometime mid April. Okay, there is hope and a light at the end of the tunnel. Be patient.

Sometimes surgeons don't need a refural from your PCP. They just require that you go to one of their seminars.

I'm a fellow Ohioian. To search for a bariatric surgeon, go to www.obesityhelp.com and you can search for a surgeon by state.

Good wishes and blessings to you and your hubby on your journey!

[TnT 0]

I called today and found out that Bariatric surgery IS covered, subject to precertification. Not sure what that means exactly, but Yay!! I got the ball rolling!

I was referred to this information and also was given a phone number to call for precertification. I was told that we are covered for 85% of the cost of surgery until our ded. and out of pocket is met, then it's 100%. Ded. is 250.00 and out of pocket is 2500.00, I think. (per individual)

So, now I just figure out what the heck all of that info means and move forward!

[KabinKitty 11]

Looks like Aetna does not considering VSG "inverstigational" any more. Good for you! I would choose a surgeon and they can guide you through all the steps. Some give you all the info you need at the surgical consult visit, and you are responsible to get the required tests done. Looks like you will need to meet with a nutritionist (mine is in my surgeon's office) for a required time (mine is 3 months).

Have you checked you BMI's? That's the second step. If you don't meet the 40 or 35 (with comorbidities) then you aren't going to be approved.

[TnT 0]

Looks like Aetna does not considering VSG "inverstigational" any more. Good for you! I would choose a surgeon and they can guide you through all the steps. Some give you all the info you need at the surgical consult visit, and you are responsible to get the required tests done. Looks like you will need to meet with a nutritionist (mine is in my surgeon's office) for a required time (mine is 3 months).

Have you checked you BMI's? That's the second step. If you don't meet the 40 or 35 (with comorbidities) then you aren't going to be approved.

My BMI is well above the requirement...:blushing:

So, chose a surgeon and they will guide me through the rest of the steps? My husband and I both want to get sleeved. I don't know if we should try to do it at the same time or if he should wait a bit after me...and how long after me? I can't imagine still cooking for him while I'm strictly on liquids and softs...

[KabinKitty 11]

I know there are some bariatric surgeons in Columbus Ohio. There is a Barix Clinic there.

You must check with your insurance company to make sure the surgeon and the hospital are within your network. If they aren't your costs go WAY up!

There is a Barix Clinic there (they were not in my network) and I know of another surgeon named Stephan Myers. He operates at Riverside Hospital. The way I understand he charges each patient about $3000 out of pocket for follow up visits and he sets you up with a nearby gym or you go to their gym after surgery. He's the only one I've heard of that does this.

I know some people who have had RNY's at Barix and they have done very well. I don't know anyone that's been sleeved there.