Taking the first step.. I need advice

[Jarod Erb 0]

Hey everyone

So I am pursuing bariatric sleeve surgery and enrolled today in my insurance companies bariatric program. The case manager I spoke with gave me the requirements I need to get approved for the surgery and part of the requirements are providing a 5 year history of morbid obesity and proving a 6 month doctor or weight loss expert guided diet and exercise plan. I have been overweight for over 10+ years but it wasn't until less than a year ago I decided to start seeing a doctor about this. I was diagnosed with obstructive sleep apnea a year ago but I don't have 5 years of recorded doctor visits discussing weight loss and I don't have 6 months of a physician recommended diet plan.

I was just curious If anyone has ever found a way past this or I guess lied somehow to get the approval process moving a little faster? My family doctor has suggested this surgery to me so do doctors sometimes help grt around this.

I'm just trying to get info from others who have been through this before. Any information or advice would be great!

Thanks

[Quest4TheNewMe 225]

Have you been to the doctor over the last 5 years, even if it wasn't specifically to discuss weight loss? As long as they recorded your weight, that is likely what insurance is looking for.

[Ethomas15 22]

I didn't have health insurance until this year actually so I feel your pain. Like the other person said just check any history of doctors visits even like an immediate care walk in clinic 9xs out 10 they take ur weight at those and my nurse advocate suggested I just scrounge up any and all visits I had in the last five years to make up for never having a primary physician. For the physician followed diet the program you get involved with May have a bariatrician to help with that the center I am using has an in house bariatric physician that does group monthly weigh ins and discussions to get us our 6 month supervised "diet" as long as the only thing talked about during the visit is weightloss ur fine 6 visits then u can submit to insurance! It is going by faster than I thought so don't fret lol! U don't want to lie though and get denied and risk not being able to do this at all!

From what I've read there really isn't any way around the six month diet if ur insurance requires it unfortunately but.....that will be the time that u can use to educate yourself for after surgery start excercising so u can recover easier and get all of the other hoops and things that u will have to do to grat approved ...so look at it positive! I've recently started my journey as well so I'm in the same boat I've had one diet appointment and I actually end up having to do 8 vs 6 so I've had the same thought as you...I'm just thinkin I've been overweight basically my whole life 8 more months is nothin lol

[woo woo 872]

You will do the 6 month diet before they submit to insurance. They'll set you up with that.

As far as the weight history, as mentioned you want to get in touch with any and all docs you have seen in the past 5-6 years and get the records as most do take your weight when you go in and it's recorded.

I have also heard of people using pictures as proof, but I don't know exactly how that works.

[alwaysvegas 702]

Not to alarm you, but you may be denied for not having an official record of your weight history. So you can't just make up weights...they have to be taken by an organization. The history can be taken by schools, weight clinics, etc. in addition to a doctor, although what is acceptable can vary by insurance.

My insurance only required a two-year history and I was totally freaked out because I was sure there was one year I did not see a doctor at all. Turns out I did have two weight checks that one year, but I also had three co-morbidities due to weight, so maybe that got me through. Every insurance operates a bit differently in what they deem important for approval/denial.

If you are denied, you and your doctor can fight the insurance denial to try to get it overturned. Check the insurance forums (or your insurance website) if that happens or even before to read up on the process.

Edited October 29, 2014 by AlwaysVegas

[Jyoyonomore 319]

Hey everyone

So I am pursuing bariatric sleeve surgery and enrolled today in my insurance companies bariatric program. The case manager I spoke with gave me the requirements I need to get approved for the surgery and part of the requirements are providing a 5 year history of morbid obesity and proving a 6 month doctor or weight loss expert guided diet and exercise plan. I have been overweight for over 10+ years but it wasn't until less than a year ago I decided to start seeing a doctor about this. I was diagnosed with obstructive sleep apnea a year ago but I don't have 5 years of recorded doctor visits discussing weight loss and I don't have 6 months of a physician recommended diet plan.

I was just curious If anyone has ever found a way past this or I guess lied somehow to get the approval process moving a little faster? My family doctor has suggested this surgery to me so do doctors sometimes help grt around this.

I'm just trying to get info from others who have been through this before. Any information or advice would be great!

Thanks

@jarodErb My insurance company did not require 5 years But the 6 months & could not be any early then 25 days apart or later than 30 days apart continuous appointments with my primary was required and lots of PreOp tests. If you are having any Cardio or sleeping issues you'll need a Cardio workout and a sleep study. My surgeon required a Psychologist eval, and a Nutritionist eval, a endoscopy . I got on my own a sleep study proved I had sleep apnea, a colonoscopy and a Cardio work up just because I wanted to know the status of my body before surgery. The 6 month went by quickly and though I was inpatient at times it helped me get 90 percent of my questioned answered and help prepare me for the forever of PostOp.