New here :)

[MsLauren180 3]

Hello. I'm Lauren. A little about myself ... If struggled with my weight my entire life, but it never really became a serious problem till the end of high school. I graduated weighing 230. At the time this was the highest I had ever weighed, depressed and hating myself I began trying diet after diet. Losing the weight, but always gaining it back plus an additional 10 lbs. I currently weigh 285 but my highest is 303 which was my weight this time last year. I was able to get myself down to 260 through diet and exercise, and am back climbing the weight ladder yet again. I'm 5'9 so my BMI is in the 42 range.

I've recently began doing a lot of research on WLS. I'm switching my insurance to Kaiser come January 1st and my previous insurance (Blue Cross) wouldn't cover the procedure (there's a specific provision in my particular plan that excluded it).

So I'll be meeting my new primary care physician hopefully in January and will be trying to convince him/her that I need the surgery.

Any advise? Best way to get my doctor to see I need the surgery? To get my insurance to approve it? Tips for the process along the way? Any regrets or complications from the WLS you had if you've already had it? Anything would help! Thank you!!

[kelseycakes20 110]

I'm surprised blue cross didn't approve it, I have blue cross ppo and had no problems. If your new primary care physician is still against it, go to the hospital you want to have your surgery at, go to their bariatric program and ask them to refer you to any of their primary care physicians that they recommend. They usually work along side some that are all for the surgery. That's what I did and had absolutely no problems regarding that.

Tips for the process, stay on top of the scheduling for all appts and when it comes time to get your insurance approval, stay on top of that asking if its been processed and what not. Sometimes they lack in getting things done, it depends on the insurance. Your insurance will look at the qualifications to get approved for the surgery, there's technically not much you could do except fight it if they deny you lol.

I had mine done the 18th of November so I'm almost 2 weeks out. I have had no complications, very little pain, no gas pains, and have been feeling totally normal again, like where I can go out and walk a lot and do stuff instead of having a hard time getting around. I maybe had a little regret like my first full day home because I didn't have my pain meds but that was my own fault lol the regret didn't last long and its totally normal to feel that little regret just getting out of surgery haha

I have to say healing is different for everyone and I've noticed that age sometimes has a factor in it too. I'm one of the younger wls patients, 19 years old lol but I've also seen a few older patients that I know personally have a very easy recovery like mine.

Good luck and keep us posted!!

[MsLauren180 3]

Thank you so much for your response!! They normally cover it, but for some reason my specific plan excluded it so I had to switch insurance companies and the only other option I had was Kaiser. It seems their process will take some time. From what I read it looks like I'll need to take 3 months of nutrition classes and then pass all of the normal tests they require along with a psych test. My insurance goes into effect January 1st and I'll need to find a new primary in Kaiser. Just hoping whoever he/she is will be a doctor who's pro surgery

[MisforMimi 760]

Believe it or not, employers place the clause that excludes weight loss surgery most of the time....insurance companies don't care one our another

[cindyh95 21]

Your surgeon may have their own list of pre-op procedures. I had to have a sleep study and an EGD. My insurance didn't require those or even the nutrition or psych. My experience with my insurance was a piece of cake. Approved within 2 weeks of submission. If you haven't done nutrition in the past, take advantage of it. I feel everyone should use a nutritionist. My primary had no say in the surgical decision. He told me I'd be a good candidate and sent med records over to my bariatric surgeon but that was it. The surgeon made the decision if I should have it or not. Good luck to you!

[anaxila 501]

Four years ago when I asked in passing, my primary care physician said she would not support surgery for me. Once I got serious about it, though, she changed her mind. I think the fact that I have developed co-morbid conditions (diabetes, high blood pressure, etc.) made a difference, as did my firm resolve to proceed. I went straight to the bariatric surgery program (which happens to be within the same clinic / health care system) and started working with them directly. Once I'd made the decision to proceed, she supported me with a letter of recommendation.

My insurance was a breeze. The surgeon was the one with the requirements - nutrition counseling, pre-tests, psych eval, letter of support, classes / seminars, evidence of long-term weight problem (5+ years), etc. I'm glad he made me jump through the hoops because it made me more prepared for surgery next month.