Jump to content
×
Are you looking for the BariatricPal Store? Go now!

So Frustrating!



Recommended Posts

So I have done almost a year of Nutritionist visits. I have lost 26lbs. I went Wed for my psych bariatric eval and passed. Then yesterday I went for orientation and my consultation with the surgeon. Everything went well, they said I should be able to be approved. They gave me a checklist of things that both the doctor and possibly my insurance would require.

Nutritionist eval and documentation 6-12 months

^done

Psych bariatric evaluation and recommendation

^done

Letter from me outlining why I want surgery and what I am suffering from

^done

Cardio clearance- EKG, stress test

Gall bladder Ultrasound

Blood work

Endoscopy

sleep study and pulmonolgy clearance

^need referral and scripts for the above from PCP

My surgeon is in Ocala, my PCP is in Clermont and I live in Orlando. I decided to stop in my PCP office on my way back to grab the referrals and scripts (he works in a walk in clinic) and he asked that I get written documentation from my INS company of what they wanted to have submitted for approval of surgery before he sends me for clearances to have the surgery.

Called insurance company and NO one will give me written info because the procedure is only done in times of medical necessity and each case is decided on a case by case basis.

I go back in with the PCP and he says he will not give me any referrals or scripts for tests until I am approved for the surgery through my INS company.

INS company verbally said I had to have "6-12 months diet documentation from a nutritionist/physician, Comprehensive pre/post op plan with a Bariatric program, clearance from Cardiologist, Gastroenterologist, Documentation of No Endocrine issues that could be causing the morbid obesity and a BMI of over 40, documentation of any co-morbidities". They said if all the appropriate documentation is not submitted it is an AUTOMATIC Denial.

I told the doctor this. I showed him the emails between me and a supervisor at my INS company with telling me that "There is no written procedure to follow for a MAGICAL approval".

I have the option of changing my INS plan with a good enough reason. Should I just change it, find a new PCP and INS? I already checked with my surgeon and they take all of the other insurance options I have to switch to.

Ugh I am so frustrated. I feel like no one wants to help me.

:-(

Share this post


Link to post
Share on other sites

How crazy is that. You are right to feel nobody wants to help you cause that is how it feels. It is like nobody wants to be the one to have their name tied to a decision. Why will the baratric doctors not order these tests?? I know that they keep referring us back to our PCP and then PCP refers us back to surgeon. Nobody will just take the whole picture. I feel your frustration. Makes me want to scream.

I am going through a little bit of this with sugery scheduled for Wed, but need a Gyno doc to clear me (which i don't think he will) and don't see him till tues.

I want to scream for all of us.

I am not sure what to advice you to do. Hope somebody else has a good answer.

Changing insurance and PCP may be the answer.

Share this post


Link to post
Share on other sites

Oh no! Can you see another Gyno? I would really want to cry if I was that close!

The Endoscopy and AnX test is being done by my Surgeon. He said my PCP can do the 12 lead EKG. But I need a referral to the Cardiologist to get approval for a Echocardiogram and a script from my PCP for the GallBladder ultrasound.

My PCP says he doesn't want to waste $$ on those test that I need for surgery clearance before my INS company says yes.

In his opinion the Ins company should make a decision based upon the Nutrition, Psych, Bariatric doc and The info from the PCP and say yes or no based on that info and THEN the INS company should say to get clearance from the specialist And the Clearance tests.

Which I understand what he is saying, but the insurance company wants it all done then will give approval.

I'm trying to find out now, what the requirements are for the other insurance companies I can choose, so I will know if I can use all the info I already have or if I have to start all over.

I really, really hope they Gyno give you clearance!!!

Share this post


Link to post
Share on other sites

Tuesday was the soonest I could get in to see any Gyno. This one isn't mine, he was just in the practice when I had my boys nearly 30 years ago. My family doc is all I have seen in several years for paps and stuff. So I find out last tuesday that I have to do this and start calling around and even this doc's nurse didn't think I could get in, but she put me on hold and came back with this coming tues at 11. I just can't see how someone who doesn't know me could say it was ok to have the surgery on Wed. Even with the ultrasounds and an exam.

I understand your PCP and he is right, but it just doesn't work that way it seems. Nobody plays by the same rules, PCP, Surgeon, Insurance and then all the other specialists in between. It is crazy.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • vsg.with.sharon

      Hey everyone!
      I’m new here! Looking for some friends! 🥰
      · 0 replies
      1. This update has no replies.
    • LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    ×