Three Questions About Vsg...

[DeterminedGirl 53]

Okay. I'm reading through this site as much as I can every day. (I'm way pre-op--first appt in mid-Aug.) A couple of things have started bugging me, so I thought I'd ask the experts (namely, all of you!).

1. I see the there is a WIDE variance in what surgeons and insurance companies ask you to do pre-op. Which tests, what diet, how long, etc. So here's my question: is it possible to lose so much weight running through the pre-op hoops that the insurance company, which initially looked hopeful, now says, "Whoa, we think you can lose and maintain the your weight yourself?" I mean, is this pre-op diet ever a real hurdle to surgery down the pike?

2. What if you don't have the "standard" morbidities? Like, suppose someone had a life-threatening anaphylactic allergy to dust mites that is compounded by heavy weight? Or, suppose someone has had brain surgery for an aneurysm and was told that high blood pressure doesn't help in the possible recurrence of another aneurysm? I'm just sayin'..... What if it's other stuff? Does this, so to speak, weigh in with the insurance companies?

3. One of the things that really strikes me in this is that a) we're all pretty much powerless over food; we (at least I) hate being powerless; c) we decide on surgery (which is, like, a totally pro-active, life-affirming thing to do), and then, boom! d) the insurance company makes us, well, powerless again. Is anybody else really, really ticked off about this?

I should add that I haven't actually experienced any of the above--okay, I've experienced #2. But I'm asking because I am trying to get a healthy mindset for my appointment in August. I really want this whole process to be one of dialogue and decision--not too much edict. Are people--surgeons and insurance--generally willing to work with you?

I'd really appreciate your thoughts and insight on these. Thanks in advance. DeterminedGirl

[SophieJaneB 92]

Surgeons are VERY willing to work with you, especially finding your co-morbidities, etc. to try and help you qualify, after all, they WANT to do your surgery so they can get paid! My surgeons looked at my complete medical history and found 2 co-morbidities. They know what the insurance is looking for, and do what they can to help you qualify.

I had a really stressful period of time last year, my blood pressure spiked, I raced myself to the doctor, and bam, I'm diagnosed with high blood pressure. Do what you gotta do.

[MamaMelly 97]

I have BCBS, and I know that my insurance considers your weight from your first appointment and prior. They understand that once you begin the process you will probably lose weight.

As for the comorbidities, every insurance company is different. I know mine consideres osteoarthritis to be a comorbidity, and others do not.

Good Luck in your journey!

[prettysleeved1 173]

Okay. I'm reading through this site as much as I can every day. (I'm way pre-op--first appt in mid-Aug.) A couple of things have started bugging me, so I thought I'd ask the experts (namely, all of you!).

1. I see the there is a WIDE variance in what surgeons and insurance companies ask you to do pre-op. Which tests, what diet, how long, etc. So here's my question: is it possible to lose so much weight running through the pre-op hoops that the insurance company, which initially looked hopeful, now says, "Whoa, we think you can lose and maintain the your weight yourself?" I mean, is this pre-op diet ever a real hurdle to surgery down the pike?

Yes. I know someone that happened to. She had insurance that required a 6 month supervised diet and ended up being denied because in the course of the diet, her BMI dropped to 31.

2. What if you don't have the "standard" morbidities? Like, suppose someone had a life-threatening anaphylactic allergy to dust mites that is compounded by heavy weight? Or, suppose someone has had brain surgery for an aneurysm and was told that high blood pressure doesn't help in the possible recurrence of another aneurysm? I'm just sayin'..... What if it's other stuff? Does this, so to speak, weigh in with the insurance companies?

I don't know. I didn't have any co-morbid conditions; just plainly and simply fat. I had no trouble getting approved based on on BMI alone.

3. One of the things that really strikes me in this is that a) we're all pretty much powerless over food; we (at least I) hate being powerless; c) we decide on surgery (which is, like, a totally pro-active, life-affirming thing to do), and then, boom! d) the insurance company makes us, well, powerless again. Is anybody else really, really ticked off about this?

I get what you are saying. My insurance, although very lenient, considers this an elective procedure. I wonder how something that is used to treat a disease can be considered "elective" but that's the game you play when you deal with an insurance company. Even though you pay them for the insurance, their aim is to not have to pay. Go figure! Everytime I read on here that someone has to do 6 months of this, that and the other before even attempting to get approved, I thank my lucky stars that my hubby just happened be employed with a company whose insurance doesn't have that kind of run around.

Overall, get your list of questions together and just make sure that you are satisfied with the doctor and his/her answers to your questions and how the office is run and you should be fine.

[simply.torri 28]

Okay. I'm reading through this site as much as I can every day. (I'm way pre-op--first appt in mid-Aug.) A couple of things have started bugging me, so I thought I'd ask the experts (namely, all of you!).

1. I see the there is a WIDE variance in what surgeons and insurance companies ask you to do pre-op. Which tests, what diet, how long, etc. So here's my question: is it possible to lose so much weight running through the pre-op hoops that the insurance company, which initially looked hopeful, now says, "Whoa, we think you can lose and maintain the your weight yourself?" I mean, is this pre-op diet ever a real hurdle to surgery down the pike?

The pre-op hoops are annoying but I am starting to realized that it can be beneficial as well. We obviously have bad eating habits, so this time really helps to change those habits so that you experience optimal success from the surgery. I dont think its easy to lose so much weight on the diet that you are unable to have the surgery, unless you were already "not so big". Also... well my surgery center doesnt have a "Structured diet", just some tips to change my eating habits and only expect me to lose about 3-5lbs a month... that will do NOTHING for my BMI lol.

2. What if you don't have the "standard" morbidities? Like, suppose someone had a life-threatening anaphylactic allergy to dust mites that is compounded by heavy weight? Or, suppose someone has had brain surgery for an aneurysm and was told that high blood pressure doesn't help in the possible recurrence of another aneurysm? I'm just sayin'..... What if it's other stuff? Does this, so to speak, weigh in with the insurance companies?

I can't say much here. I didnt need to worry about this, because my BMI was 51.5 so i qualified instantly. However, im sure they will do what they have to do to get you approved.

3. One of the things that really strikes me in this is that a) we're all pretty much powerless over food; we (at least I) hate being powerless; c) we decide on surgery (which is, like, a totally pro-active, life-affirming thing to do), and then, boom! d) the insurance company makes us, well, powerless again. Is anybody else really, really ticked off about this?

I should add that I haven't actually experienced any of the above--okay, I've experienced #2. But I'm asking because I am trying to get a healthy mindset for my appointment in August. I really want this whole process to be one of dialogue and decision--not too much edict. Are people--surgeons and insurance--generally willing to work with you?

The surgeons and staff really do have open communication with you and support you wholeheartedly. Their goal is for you to be successful (imagine too many failures look bad on them so if anything, they want you to succeed! They really do put a lot into it and I think you will walk away with a different mindset.

I'd really appreciate your thoughts and insight on these. Thanks in advance. DeterminedGirl

[gelen's_change 157]

Q3 i hate that feeling ok i have sleep apnea and my bmi is 38 and i hve to do so much just to prove i need this isnt my weight enough. No they want 6 months weight in and so much more and its frustrating i want it NOW no matter fact Yesterday. We trying to get fit and prevent other conditions and they make it so hard.

[cantwaittolose 163]

I didn't have to jump through any insurance hoops. My BMI was very high at 50 when I met with doctors and insurance approved same day. The doctors I went to is a 1 stop shop. I went in for the consult and in same day did all tests, psych, insurance approval and scheduled my surgery date...which is now tomorrow! (it was scheduled 7 weeks ago) My dr. put me on 3 week pre-op because I have so much to lose. I have not had to supply my insurance.(Blue Cross PPO) with anything. I had to go back to dr. For more blood work, endoscopy procedure and then pre-op dr. Appointment. I think my experience has been easier than most in dealing with insurance...I've been very lucky.

Best of luck in your process!