Seminar is not for a month....I got ?'s though.

[MsJen 2]

Such as, I have read where you are required to see a couple of different types of doc's beforehand, to get approval. I'm freaking out cause what if one of them says no? Do I just find another one until someone says yes? My GP said no last year, he's not really cool about 'easy out's', as he calls them. Also, I've seen where people have to wait at least 6 months before their insurance will approve them. I have BCBS of AL, does anyone know if I would have to wait?

Can anyone tell me anything else they think I should know? I'm just so excited, it's going to be a long month for me! Thanks y'all!

Edited July 8, 2015 by MsJen

[reree6898 1,164]

I would suggest that you call your insurance company and make sure that they cover it and find out from them what their requirements are. All insurance companies have varying requirements and copy's etc. it's best to know that up front because your policy may or may not cover it. I had BCBST a few years ago with my old job and it was an exclusion even though my bmi was 59. I have BCBST now with my new job and it's covered I just have to meet my deductible.

[Babbs 14,680]

No offense, but your GP sounds like an ignorant fool. Find another one that understands the benefits of WLS.

And yes, as @@reree6898 said, you will get better answers if you call your insurance company for the exact requirements.

[lauraellen80 855]

It will depend a lot on your surgeon and your insurance. You can try giving your insurance company a call and asking them if they cover weight loss surgery, and if so, what if any requirements they have. Some require a 3-month supervised diet, some a 6-month one, some don't require anything besides a BMI of over 40 or a BMI of over 35 with co-morbidities, it varies widely. Most insurances, though, do require a referral from your primary care doc--if your PCP is really anti-WLS, you may see if you can change to a new PCP before you start the process. My PCP just had me come in for a physical before I started with the pre-surgery visits, as I hadn't been to the doctor for a couple of years.

The approvals that you have to get before surgery will mostly be dependent on your surgeon. Mine required a chest X-ray and EKG to make sure that I didn't have any underlying heart or pulmonary issues that might cause problems during surgery. I had to have a bunch of bloodwork done, again for the same reason. Some people also are required to do a sleep study to check for sleep apnea, and an endoscopy to look for hernias, GERD, and other abnormalities. If they find a problem, this doesn't mean that you can't have surgery, just that they may need to deal with the problem beforehand or adjust your surgery to make it safe for you.

Then you typically have to get clearance from a nutritionist/dietitian and from a psychologist. The NUT works with you to make sure that you understand the pre- and post-op diet and are willing and able to comply with it. The psychologist evaluates your mental and emotional readiness for surgery and makes sure that you have a good support system (whether that's your family, friends, a therapist, support group, etc) and that you don't have underlying mental/emotional issues that indicate you wouldn't be able to comply with the post-op directions from your surgeon and NUT. The psych eval is the one that worries a lot of people (myself included). But really, they want you to succeed--they just want to make sure you're prepared for this huge life change. The NUT and psychologist may be a part of the bariatric team, or you may have to go to outside practitioners, but your surgeon's office can probably recommend someone.

[MsJen 2]

Thanks for the quick reply!

BCBS of AL does cover it. However, I did find this Documentation must support participation in the program for six consecutive months. The following criteria must be met for this participation: Documentation of participation in a physician supervised program of nutrition and increased physical activity (including dietitian consultation, low calorie diet, increased physical activity and behavioral modification). Documentation of program participation must appear in the medical record by the attending physician. Documentation should include comments by the physician regarding patient progress or lack of progress. A letter does not meet this requirement. There must be medical records to document medically supervised weight loss attempts; OR Acceptable with medical record documentation of medical supervision are: Weight Watchers, LA Weight Loss, Jenny Craig, EatRight etc. Not acceptable are self-directed programs such as joining a gym, Atkins’ diet, calorie counting, low fat, cutting back, internet programs, etc.

So, if I'm reading this correctly, I do have to wait 6 months AND join a weight loss program?! Drat! That's why I need this surgery, cause I've tried all the other programs

[MsJen 2]

Am going to call after work. My GP has his own weight loss program/support group thingy so that's why he's not on board with anything else. It's just the "eat right/exercise" program, which never worked for me. I need something more tough than that. Thanks everyone!

[Babbs 14,680]

@@MsJen

I understand you being anxious to get this done asap, but the truth is, unless you are going to do self pay, most of us had to jump through the hoops of the insurance requirements. Most of us waited 4,5,6 months and even more. I suggest you take that time to learn healthy eating habits, read WLS forums and books, watch YouTube videos, etc.. so you can be as prepared as you can be for the huge life change coming your way. That will make the time go by faster!

Keep us posted!

[slvarltx 332]

My first appointment was in September 2014...that started the clock on the 6 month waiting period through BCBS of MI. Finally sleeved in 5/15...so a total of almost 9 months after submittal to insurance company and scheduling for the surgeon.

[MsJen 2]

@@slvarltx

78 pounds down! I'm so happy for you! And thanks for the input.

[slvarltx 332]

The sleeve is a wonderful tool. The week before and the week after surgery are pretty miserable, but a very small price to pay. 2 months after surgery I feel pretty much 100%.

[MsJen 2]

Another thing I'm concerned about: I understand you have to join a weight loss program for 6 months. If I lose more than 30 pounds in that time, then my BMI will fall below the minimum allowed and they most likely won't do the surgery. All that time I would have spent going to doctors and getting all this paper work and stuff done and then they wouldn't do the surgery?! It's not the 30 I'm worried that I can't lose, it's the 100 past that!

[Babbs 14,680]

@@MsJen

My understanding is that most insurance companies go with the beginning BMI. But another good question for your insurance company!

I believe I was under the required BMI when I got approved.

[Sharon1964 2,530]

I think you're misunderstanding the nutrition/program requirement. You have to have some sort of physician-involved program for six months. I went to my pcp once a month for six months and he did all of the documentation and nutrition/exercise counseling. At the end, he faxed his visit reports over to the surgeon who included them in the package to insurance to get auth.

Instead of seeing an MD once a month, you can see a registered dietician that is part of a medical practice. You can also join a program like Weight Watchers, with medical supervision.

You don't have to wait six months and THEN join a program (you don't actually have to join a program at all).

[The Candidate 3,215]

I had to wait a year, plus lose 10% of my excess weight. 24 weeks of classes too. Just got my date of 07/29. And I actually started with a 45 BMI, finished with a 39 and was still approved.

It's perfectly understandable that the wait seems unbearable at the beginning. We all felt that way. But once you jump in you'll find that it will definitely go by faster than you can ever believe right now.

As @@Babbs said unless your willing to self pay, you're going to have to jump through your insurance's hoops.

Good luck.