So Many Questions About Gastric Sleeve Surgery..

[snoah 0]

Ok, so I have been on this site since the middle of last year, I think. Anyway, I started researching VSG last year & decided that it is the way to go for me. My former employer's insurance did not cover any bariatric surgery & self pay was out of the question for me. As of right now, I do not have health insurance but I start a new job on 1/2/12 and am hoping that this company's insurance does cover the VSG. It is a large company over many states (Kindred Healthcare) and I believe that my insurance will be through United Healthcare.

Anyway, one of my questions is can my referral for surgery come from my OBGYN? I haven't been to a PCP in almost 3 years because I haven't been sick or needed to go. I have talked about weight loss with my OBGYN & she even prescribed Phentermine for 3 months to help me kick start the weight loss (which did not work). I'm trying to get a head start on everything that I will need if the surgery is covered. Any information or help regarding this would be greatly appreciated.

Sorry for such a long post..

Thanks!

[jasleeve 440]

welcome!! this place will be ur bestfriend for awhile!!!

from research that ive done, you may have an issue. ive read before that u would have to be working for the company for a year to get the option to have bariatric surgery. now, that was that persons case so you should check that out. also, you will def need to start seeing ur pcp & as far as referral, u can have ur gyn release ur medical history & have ur primary write the letter. i believe it needs to be from ur primary dr.

Ok, so I have been on this site since the middle of last year, I think. Anyway, I started researching VSG last year & decided that it is the way to go for me. My former employer's insurance did not cover any bariatric surgery & self pay was out of the question for me. As of right now, I do not have health insurance but I start a new job on 1/2/12 and am hoping that this company's insurance does cover the VSG. It is a large company over many states (Kindred Healthcare) and I believe that my insurance will be through United Healthcare.

Anyway, one of my questions is can my referral for surgery come from my OBGYN? I haven't been to a PCP in almost 3 years because I haven't been sick or needed to go. I have talked about weight loss with my OBGYN & she even prescribed Phentermine for 3 months to help me kick start the weight loss (which did not work). I'm trying to get a head start on everything that I will need if the surgery is covered. Any information or help regarding this would be greatly appreciated.

Sorry for such a long post..

Thanks!

[snoah 0]

OMG.. I really hope that I do not have to wait another year. That would devastate me. Thank you for the information! As soon as my new insurance starts I will make an appointment with him. Thanks again!

[MyVSG2012 15]

That's right, as I get closer and closer, this place is becoming my best friend!

Once your insurance kicks in at your new employer, go to their website or call them to find out specifically what their requirements are and which surgeries they will cover. I recommend calling every month or so until you are "in the process" because they can change their policies. My WLS center gave me a handout of things to accomplish before even seeing the surgeon and calling my insurance company to check the requirements is on there at least 3 times. When I started my insurance only covered RNY or Lapband, now they cover the sleeve which is what I wanted all along. I will be the 2nd person from my company/insurance that will have this process through my WLS center.

welcome!! this place will be ur bestfriend for awhile!!!

from research that ive done, you may have an issue. ive read before that u would have to be working for the company for a year to get the option to have bariatric surgery. now, that was that persons case so you should check that out. also, you will def need to start seeing ur pcp & as far as referral, u can have ur gyn release ur medical history & have ur primary write the letter. i believe it needs to be from ur primary dr.

[Lissa 2,631]

I was self-pay, but, from what I've read, it seems that the most important thing is to stay in touch with the insurance company and their benefits coordinator. Some doctors claim that their office staff will "handle" all of that for you, but being proactive seems to be the way to go.

Good luck! I know you hate the thought of another year before you can have the surgery, but if that's what the requirement is, at least you're moving closer to your destination! Don't let that get you down, please!

Here's hoping things work out for you to be sleeved quickly!

[jasleeve 440]

im praying thats not your case!!! im sorry to have scared you but im not one of those "tell you what it is you want to hear".. i like to be honest and fwd and let people know about things ive seen since maybe u havent. if you know what the insurance company is, go ahead & give them a ring & see what they say! if it is another year, take that year to prep yourself for whats to come. i had a 6 month process and i thought to myself, "omg 6 months is 1/2 a year!!!!" but it fleeeeew! i was sleeved dec 20th. hang in there <3

OMG.. I really hope that I do not have to wait another year. That would devastate me. Thank you for the information! As soon as my new insurance starts I will make an appointment with him. Thanks again!

[snoah 0]

@jasleeve - you didn't scare me. Its good for me to hear everything do I can be prepared. Thank you everyone for all of the information! January 2nd can't get here fast enough so I can find out about the insurance!!

[grannyk 58]

You definitely need to find a new PCP. Specialists are great, but they are specialists. I work for an oncology clinic and many patients want to use us as a PCP, but there are reasons why there are family medicine docs. They can take care of a broad range of care needs and then refer to a specialist when there is a necessity. I wouldn't want my gyn to try to take care of stomach issues, or my GI doc to make decisions about my female parts. Does that make sense?

I was self-pay in Mexico because my insurance won't pay for any bariatric surgery and I didn't want the ins co making my decisions. Insurance is a necessary evil as far as I am concerned and I hate dealing with them in my personal and work life. Best wishes for a speedy and "painless" process.

Kathe

[longer-life 139]

Insurance companies are so different it is difficult to answer your questions and to get a head start. I have a PPO so I didn't need a referral per say. However the insurance and my surgeon required a letter of necessity from my PCP. I also did the 3 month diet and exercise plan required with my PCP.( I could have done it with a nutritionist though). Hopefully you were weighed when you went to see your OBGYN, because that will count as proof of obesity, if your insurance requires it.

As soon as you get your insurance it would be a good idea to set up an appointment with a PCP that is bariatric surgery friendly, to do a physical, get weighed & establish a relationship . (I would call and ask the receptionist how the PCP feels about bariatric surgery before I even bothered to set up an appointment. ). It will be beneficial to have a PCP post op as well.

Lastly, I remember when I first spoke to my surgeons office they asked me if I had already started the required diet. I hadn't, but that means you can probably complete the 3 or 6 month diet BEFORE the weight loss surgery clause kicks in (if there is such a clause). This way you can get surgery as soon as the year goes by, NOT start the 3-6 month diet at that time. Good luck!! Keep us posted.

[GonnaBHotMama 18]

Lastly, I remember when I first spoke to my surgeons office they asked me if I had already started the required diet. I hadn't, but that means you can probably complete the 3 or 6 month diet BEFORE the weight loss surgery clause kicks in (if there is such a clause). This way you can get surgery as soon as the year goes by, NOT start the 3-6 month diet at that time. Good luck!! Keep us posted.

This is very true. I need a 6 month non medical diet, like supervised diet plan with a doctor, so having to wait the yr wouldnt be as unproductive as you think. By that time, you could complete your diet stuff, and save up for any fees you might have. I will still be out of pocket a max of about $4000. I'll be finding out more exact numbers tomorrow, but I know the max they can charge me. You'll figure it out! Good Luck!

[snoah 0]

All of this information is great - thank you everyone! I have actually found a doctor today that has been recommended by 3 people that have all had the VSG done. As soon as my insurance kicks in I'm making the appointment. I can't wait to get the process started!!

[jasleeve 440]

yay!

All of this information is great - thank you everyone! I have actually found a doctor today that has been recommended by 3 people that have all had the VSG done. As soon as my insurance kicks in I'm making the appointment. I can't wait to get the process started!!

[GonnaBHotMama 18]

Congrats! The time will fly and you are already on your way! Good Luck!!

[Catie 0]

I am the Director of Compensation and Benefits for my company and I can tell you that there is a world of difference from insurance plan to insurance plan as to requirements and if WLS is covered at all. If your new company is "fully insured" than they buy insurance from a carrier (I think you mentioned UHC). Depending on the rider they purchase, WLS may or may not be covered and UHC may have its own, sometimes stringent, hurdles to overcome (6 months of diet, 5 years record of morbid obesity, co-morbidities, etc). You'll just have to see what the plan says.

If your company is "self insured" that means that the company itself pays the bills and UHC would simply process claims. The employer decides whether or not to cover WLS and criteria for approval...not UHC although many self insured employers are guided by carriers in establishing approval criteria.

I lucked out. My company is self insured with UHC, and I just had VSG on Tuesday. I have only worked there for 6 months, was not required to do a supervised diet and only had to provide 5 years of medical records showing BMI over 40. That was it. I got approval within a week of submitting records. But I know I am the exception rather than the rule. Most insurance approval is a lot tougher.

Good luck and one final piece of advice you can do now...ask your HR person for a Summary Plan Description (SPD) of the medical plan you will be starting in January. In that SPD, you will find the plan's inclusion or exclusion of weight loss surgery and if allowed, what criteria for approval exists. You'll know before January where you stand.

[snoah 0]

Catie - thank you so much for your information! It just goes to show how little about health insurance. I emailed the coordinator that I've been talking to since I've been hired & she said that the company is changing insurance with the new year & they haven't received their new cards yet & she wasn't sure company it would be. I haven't emailed anyone in HR but I start on Monday so I can try & wait until then to find out who the insurance is with. I do know that my insurance will not start until March 1st so I still have a little time to figure everything out. I don't know if it matters regarding the size of the company to whether they choose self insured or fully insured but it is a large medical company over 3 states. I'm hoping that since it is a rehab company that they do cover the WLS since they are in the business of improving quality of life. I know all I can do is be paitient but I have wanted this for so long and for so long I just kept hitting walls - so I'm really hoping my luck is changing..