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

NEW! Starting the process and am a little confused.



Recommended Posts

Hi all! After several attempts to lose weight with pills, insane diets, clean eating and thousands of dollars later spent on beachbody products, I have decided to get help. I feel this is my only option left. I am 5'3 and 268lbs (my heaviest) at 33yrs of age. I have done my research and I'm ready to change!

I have PCOS and I'm sure I have type 2 diabetes. My bmi is at 44 or so. Both sides of my family have a history of diabetes. About 3 1/2 yrs ago I was on the verge and was put on metformin for the PCOS. I was at least 40lbs lighter at that point. Anyways, my insurance covers bariatric surgery but has to be submitted for authorization. So therefore, they can't tell me exactly what requirements have to be met. I've heard some insurances make you wait 6months to make sure it's necessary? Am I right on that? Are there any cases where the insurance doesn't do that? My consultation with the surgeon is May 21st. How long has the process been for others as far as from the day of that first consultation to surgery?

Any and all info is appreciated!

Share this post


Link to post
Share on other sites

Hello. I also have PCOS and am currently two months post-op. Each insurance company has their own rules and someone in the company should be able to tell you what they are. Each surgeon also has his/her own pre-surgery requirements. In my experience, the surgeon's office coordinated everything with my insurance company, submitted all of the required paperwork, etc. My first meeting with the surgeon was early November, 2014 and my surgery was on February 16, 2015. So my entire process took about three and a half months. I hope this information helps. Good luck!

Share this post


Link to post
Share on other sites

Your insurance plan should have a guide, probably online, that should detail its requirements. Some do, indeed, require 6 months of weigh-ins, nutrition visits, etc. Mine did, but it also said if I had proof of 6 months of weigh-ins and following a doctor-supervised diet within the last two years, that that would 'count'. I had that and had all the paperwork, so gave all that to my surgeon's office.

First surgeon visit: 11-14-14. Surgery: 1-29-15.

Share this post


Link to post
Share on other sites

Thank you. It does. I've talked to 3 people and 1 girl told me where to look at our benefits but I couldn't find it. Another lady told me she couldn't give me the info and that the office needed to send in for authorization to get the info. That didn't make sense to me. We have GREAT insurance so I hope it's good enough with just my bmi without having to show proof of my failed attempts. Is PCOS a valid reason along with a high bmi?

Share this post


Link to post
Share on other sites

Who do you have insurance through? Maybe someone else with the same insurance can point you in the right direction.

Good luck!

Share this post


Link to post
Share on other sites

Anthem Blue Cross Blue Shield. My husband's job has an amazing plan. We had them privately before and through another employer and it was the worst insurance ever! Not through this company though.

Share this post


Link to post
Share on other sites

I have BCBS through my husband's employer and they were great. Call back! You're paying for the policy, so you have a right to know what it covers. I called and spoke to a guy and he gave me all the info I needed. I began the surgeon's program at the end of November and had my surgery February 2nd. Keep calling until somebody answers your questions!

Share this post


Link to post
Share on other sites

You might want to start by searching in your area for bariatric programs/surgeons. As mentioned each program has a different set of protocols. Most program hold informational seminars. These are a good place to learn about the programs requirements and occasionally meet the surgeon. If it's an option in your area, I recommend looking at at least 2 programs. You really want to find a program that suits your needs & personality. If they have support groups, attend 1 or 2. You can get good recommendations as to what surgeon is popular this way.

Share this post


Link to post
Share on other sites

I am confident in the surgeon I chose. I've already done the seminar and filled out their "survey". He has agreed to see me and in our area he's the best. He is also in our network as far as insurance goes. I understand everything I have to do on the Dr's end. It's the insurance I can't seem to get a clear answer from. They do cover bariatric surgeries but I can't find out what their requirements are that I need to meet. The clinic I'm going to has an insurance coordinator so I'm sure she can find it all out. My appointment isn't for another month and would rather not wait that long just to find out my insurance requirements, you know. I'll call them again tomorrow. Maybe I'll get someone interested in helping me this next time.

Share this post


Link to post
Share on other sites

They have to give you specifics. If the person you speak with isn't clear, ask for a supervisor.

Share this post


Link to post
Share on other sites

I have a similar story to you,PCOS and all. I had my consultation exactly 6 months prior to my surgery. At my 6th weigh in, my doctor submitted my info and I was approved by the end of the week. It was 3 weeks later when my surgeon had an opening. Make sure you have all required testing done at the beginning of the process. You have to have the chest xray and ekg within 6 months of the surgery, so you could wait a little while for those. Do the psych eval. as soon as possible. My surgeon's office said that that is the item most likely to cause someone a denial. Your surgeon's office should also have an idea what the insurance requirements are for surgery.

Share this post


Link to post
Share on other sites

I have BCBS and mine is great! I called them. They tell you anything u want to know. My cost is only my $250 yearly deductible

Share this post


Link to post
Share on other sites

Welcome dandylion_23!

I have United Healthcare, and they require me to do the six month doctor supervised visits. I'm almost done! When I met with my surgeon, she gave me a list of requirements to complete before she approves me for surgery. I had to make an appointment with a cardiologist - who ordered a chest x-ray, Calcium score, and an electrocardiogram. I passed all three, and received clearance from him. I was also required to have a psych evaluation - (two appts. later and he cleared me for surgery). And I also had to attend at least one group session that's offered by my weight loss clinic. Done that!

Next week I'll have my fifth supervised visit, and next month will be my last, and they'll submit it to insurance for approval.

Every surgeon is different, but he will probably give you a list of items that will have to be completed prior to your surgeon scheduling your surgery. Good luck with everything!

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

    • rinabobina

      I would like to know what questions you wish you had asked prior to your duodenal switch surgery?
      · 0 replies
      1. This update has no replies.
    • cryoder22

      Day 1 of pre-op liquid diet (3 weeks) and I'm having a hard time already. I feel hungry and just want to eat. I got the protein and supplements recommend by my program and having a hard time getting 1 down. My doctor / nutritionist has me on the following:
      1 protein shake (bariatric advantage chocolate) with 8 oz of fat free milk 1 snack = 1 unjury protein shake (root beer) 1 protein shake (bariatric advantage orange cream) 1 snack = 1 unjury protein bar 1 protein shake (bariatric advantace orange cream or chocolate) 1 snack = 1 unjury protein soup (chicken) 3 servings of sugar free jello and popsicles throughout the day. 64 oz of water (I have flavor packets). Hot tea and coffee with splenda has been approved as well. Does anyone recommend anything for the next 3 weeks?
      · 1 reply
      1. NickelChip

        All I can tell you is that for me, it got easier after the first week. The hunger pains got less intense and I kind of got used to it and gave up torturing myself by thinking about food. But if you can, get anything tempting out of the house and avoid being around people who are eating. I sent my kids to my parents' house for two weeks so I wouldn't have to prepare meals I couldn't eat. After surgery, the hunger was totally gone.

    • buildabetteranna

      I have my final approval from my insurance, only thing holding up things is one last x-ray needed, which I have scheduled for the fourth of next month, which is my birthday.

      · 0 replies
      1. This update has no replies.
    • BetterLeah

      Woohoo! I have 7 more days till surgery, So far I am already down a total of 20lbs since I started this journey. 
      · 1 reply
      1. NeonRaven8919

        Well done! I'm 9 days away from surgery! Keep us updated!

    • Ladiva04

      Hello,
      I had my surgery on the 25th of June of this year. Starting off at 117 kilos.😒
      · 1 reply
      1. NeonRaven8919

        Congrats on the surgery!

  • 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

    ×