NEW! Starting the process and am a little confused.

[dandylion_23 5]

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!

[marbelvsg 132]

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!

[della street 213]

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.

[dandylion_23 5]

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?

[MrsRoboto 370]

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

Good luck!

[dandylion_23 5]

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.

[pstock911 12]

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!

[BLERDgirl 6,417]

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.

[dandylion_23 5]

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.

[sharob 3]

Has anyone here used dr. Alvarez?

[BLERDgirl 6,417]

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

[dandylion_23 5]

My dr is out of Salt Lake City, Utah.

[Stephanie Stroup McIntosh 157]

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.

[perk4756 259]

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

[mclorrie 219]

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!