I've made the decision to do this

[NorCalGuy 0]

After much consideration and research, I've decided to have a VSG. It seems like the best bet for me, after battling my weight for years. I'm 26, 6'2", and 370. Nobody else in my family is overweight, and I'm easily the fattest of all my friends. After I quit drinking a few years ago, I really began putting on weight (probably just switched one addiction for another) but even before that, I was heavy. It just wasn't until the last couple years that I really lost control with it. I have what amounts to a lifetime gym membership, and it feels like I'm dying after a couple minutes of cardio. Also, I have high blood pressure, but luckily no diabetes or elevated cholesterol (yet..). One new thing thats been scaring me is these weird, transient pains in my feet and legs; perhaps its just the hypochondriac part of me, but I keep getting the thought of blood clots and embolisms... I need to do something about this now.

Another impetus for getting this surgery is the fact that next month I start at a nearby university, which provides medical insurance. It'll be the first time in about 8 years that I've had it, so i figure I may as well take advantage of it while I'm there. Its some form of Anthem, though not sure if its different being through the school, I see that there is bariatric surgery coverage, and understand that Anthem now covers VSG. But I'm curious... can a regular doctor (GP, or whoever I first see at the university health center) refuse to refer me to a surgeon? What I mean is, even though I more than meet the criteria for surgery, can a doctor, by way of their own beliefs against these types of procedures (or that I need to keep trying the same stuff I have been in terms of dieting), deny my request for referral?

Also, anyone have good suggestions for surgeons in the bay area? I'm not sure which hospitals are "in network" for Anthem, until I actually get the insurance next month, but I think Alta Bates and UCSF are, and perhaps the California Pacific Hospital are.

[Shoppingbeemom 31]

Hi, Your Dr can refuse to refer. If you feel your Dr isn't fullfilling your medical needs, you may want to look for a different Dr. I don't live in the Bay Area anymore, so I can't help you with where to go.

[Nancy Rivers 24]

Congrats on making the decision. Yeah, the doctor could refuse to refer you - if that happens find a different doctor. Also, I would check to see if there is a "pre-existing condition" limitation since this is new insurance. I don't know if there would be with ones offered through the school, but when I switched from one insurance company to another, they had a pre-existing condition limitation - they would not cover treatment for pre-existing conditions for 6 months. So, my doctor visits for treating my diabetes and the meds for it were not covered for 6 months.

[Infernored 5]

Totally agree that if one doctor won't refer you, just find a another doctor. Way to go on making the decision to do this! My own health has improved drastically since the surgery, I just wish I did it sooner!

[GreginMI 76]

My previous doctor wouldn't even TALK about bariatric surgery with me and guess what? He was about 400 lbs himself! So I found a "fit" doctor who was more than pleased to refer me. I honestly don't see how a doctor can eat that unhealthy and then be able to help you with your weight. So if yours won't refer you, like everyone else said, find a new one! I did and my sleeve is awesome! I'm 55 lbs down (including 8 days pre-op diet) and 75 to go after 6 weeks post op!

[NorCalGuy 0]

Thanks guys. I'm fairly confident that whoever the doctor is, they'll do the referral, but I was concerned about that being a potential hold-up. Reading the insurance handbook, it does stipulate that weight loss surgery isn't covered unless its for morbid obesity, and since I meet that criteria, I should be alright. Also, if they refuse me, and try to say it isn't necessary, there is some CA state health board I can petition which will overrule the ins. company based on medical necessity.

What does it mean when they say they want documented weight loss attempts? This seems to be pretty common across the board, for both insurance and the surgeon. Does my stack of diet books, my gym membership, taking OTC things like Alli and Adipex from Mexico, and doctor's orders from a year ago (from this free clinic I was going to at the time) count?

[LVikingFan 14]

Thanks guys. I'm fairly confident that whoever the doctor is, they'll do the referral, but I was concerned about that being a potential hold-up. Reading the insurance handbook, it does stipulate that weight loss surgery isn't covered unless its for morbid obesity, and since I meet that criteria, I should be alright. Also, if they refuse me, and try to say it isn't necessary, there is some CA state health board I can petition which will overrule the ins. company based on medical necessity.

What does it mean when they say they want documented weight loss attempts? This seems to be pretty common across the board, for both insurance and the surgeon. Does my stack of diet books, my gym membership, taking OTC things like Alli and Adipex from Mexico, and doctor's orders from a year ago (from this free clinic I was going to at the time) count?

Most insurances require that you have 6 consecutive months of a doctor supervised weight loss attempt. That means that your doctor documents it in your chart each and every month that you are working on losing weight. I think that it has to be in the past year also to count. Once you actually start to do all the requirements it seems like almost a full-time job, but stick with it and you won't regret it. Good luck.

[GreginMI 76]

I didn't have to do any pre-op diet other than the 8 days low fat diet before surgery. What my insurance company meant was that I had to fill out a form in the surgeon's office and write down the years and types of diet attempts. i.e., 1988 Richard SImmons Deal-a-meal, 1993 Weight Watchers, 2001 Slim Fast, 2006 Nutri-system, etc. That's all I had to do for my insurance to approve me. I guess what it actually means varies from insurance to insurance. You should call your insurance person at your surgeon's office. She should know. They have to find out that kind of stuff. I would think if yours is like mine then all that stuff you mentioned would indeed count.

What does it mean when they say they want documented weight loss attempts? This seems to be pretty common across the board, for both insurance and the surgeon. Does my stack of diet books, my gym membership, taking OTC things like Alli and Adipex from Mexico, and doctor's orders from a year ago (from this free clinic I was going to at the time) count?