Information Session Down, Now Surgeon Appt./rd/psych Friday

[DreamsOfSkinny 53]

Well I found a Dr. that I really like that is in-network for UHC and doesn't charge any stupid program fee----thanks goodness people posted on here and another board about him. He seems much more patient friendly and is the Director over WLS/GI surgeries at a local hospital. I lucked up and they were able to fit in all my needed appts. this Friday since I'll be out of town for 2 weeks coming up---finally graduating (well at least walking across the stage) for Bachelors degree...I'm just starting my last 2 courses today--so I have my appt. with surgeon, RD, and Psych. I also will start getting all my medical history information collected tomorrow and hope to get most of it to coordinator by next Tuesday (the day before I leave the state). My goal would be to be able to get everything submitted and done so that she can send off to insurance ASAP. The coordinator over the phone didn't mention any real tests needed for surgery besides x-ray and blood work done day of. I've recently has colonoscopy, ultrasound on stomach, endoscopy, etc. -- wonder if that made a difference? What tests did your doctor run?

I'm also a bit confused by my insurance. The coordinator said with United that there are 2 different plans she's come across... 1) that requires 6 month weight loss classes/Dr. and 2) one that only requires 5 yr. weight history and any health issues related to being morbidly obese---yes, that's what I'm considered now with a BMI of 40.??? How many of those with UHC didn't have to do 6month plan--what type of UHC plan did you have? (I have PPO called HRA Plus by my HR Dept.)

I hope to find out more answers to my questions come Friday, but I definitely am excited to find a Dr. that got me in right away, seems much more willing to work with my insurance, has great bedside manners, is highly qualified, and doesn't charge extra thousands of dollars for things that will be covered by my insurance PPO plan. I only have $2,200 left OOP for my max until June 30, 2013 Can't beat that!!

My husband suspected something tonight when I went to the information monthly meeting... I said it was at the hospital and by a Dr. and RD for weight loss. While I wasn't technically lying I feel really bad. Now I have to figure out how to explain needing to go to the Dr. for 4 hrs. on Friday..... :- /

Any suggestions on explaining to a spouse that has never really been overweight?

I'm scared to death to say anything until the insurance approves it because I feel like I don't want him to know unless it's really going to happen because I don't want to be judged. We've been together over 5 yrs., so he knows I've always struggled with losing weight and keeping it off and the health issues now arising because of my increased weight, but I still feel like he's going to respond with-- why in the world would you get surgery? Just eat right and go to the gym.

Sorry so long -- thanks my new WL family.

[Heyher 581]

I have UHC and had to have documentation that I was at or above 40 BMI for at least five years. Well I was hanging out in the mid 30's for the past 8 years. And they denied me. Now the surgeon and neurologist are submitting a letter of medical necessity and I had a sleep study which determined I have moderate sleep apnea. These were the things my surgeon was told to provide when he did the peer to peer with the medical director. So fingers crossed once all the new information is sent in they can approve me.

Six month diet is non negotiable. If that's the plans requirement then you have to do six months. 5+ years of BMI of 40+ is also non negotiable. Unless you have any comorbitities. Like Diabetis, high blood pressure, sleep apnea. Those are the three main comorbitities.

I would call the number on your card and ask for your plans exact requirements for approval.

[Heyher 581]

Also I have the HDHP Choice Plus. My MS meds put me at my deductable January every year. So if the surgery happens in the next two months it will cost me $100.

[DreamsOfSkinny 53]

Well I've now requested all the 5 yr. documentation, comorbities (sp??), tests results the Dr. Wanted and hope to get everything by Monday.... One more thing down. I'm already thinking I'll have to do the 6 month diet but read on UHC that you can do 2 3 month weight records with Dr. Within last 2 yrs., which I should have. But I'll just take it step by step. I'm already off of work on leave until beginning of Feb. so I am really wanting to get surgery end of Nov/Dec. I'd hate it if I got denied bc wasn't 40 BMI for 5 yrs or no 6 month diet.

I did tell my husband today, and he didn't really say much besides you know I'm not on you about your weight. Let me know how I can support you because since you researched this then it must be important.

[Heyher 581]

My advice is be honest and candid with him about why you are taking this journey. It helps so much to have support both pre and post op. I told my fiancé about it and he went to the seminar so he could better understand the surgery and what most of us are dealing with. That insight gave him the confidence to support my decision 100%.

[Heyher 581]

Also some plans will work with people if they don't have the 40 BMI for over 5 years. If you have any comorbidities use those to get letters of medical necessity. I have sleep apnea. So the surgeon and my neurologist wrote letters stating I needed surgery. It would improve my apnea and help with quality of life dealing with my ms and arthritis from a massive knee injury.

[DreamsOfSkinny 53]

Also some plans will work with people if they don't have the 40 BMI for over 5 years. If you have any comorbidities use those to get letters of medical necessity. I have sleep apnea. So the surgeon and my neurologist wrote letters stating I needed surgery. It would improve my apnea and help with quality of life dealing with my ms and arthritis from a massive knee injury.

Yes, even though I'm over 40 now the coordinator did say she's been doing the packets to insurances for several years and knows what UHC is usually looking for to approve. I've asked medical records for asthma, high cholesterol, etc. as well as some Dr. Restricted weigh ins monthly and weight loss plans, so I'm going to ask her tomorrow to include those within letter so at least the ins. Sees to begin with so they don't have to come back denied to have to appeal it :-/ Hoping the coordinator is right.......

[Smokey12 71]

I have UHC, and the surgery is not covered with my plan. I am refinacing my house so I can have this surgery. Any thoughts, My bmi is 44.

[Heyher 581]

I have UHC' date=' and the surgery is not covered with my plan. I am refinacing my house so I can have this surgery. Any thoughts, My bmi is 44.[/quote']

A lot of people who are self pay have the surgery in Mexico. There is a whole topic on self pay and Mexico surgeries. There are some great starting points for who is reputable in Mexico and a lot of other information.

Good luck!!!