Taking the Plunge - Questions?

[MissKay 329]

Hi all! I just started this sort of journey about a month ago when a very inspirational blog (Simone's Journey to Health) turned me onto and educated me on what the Gastric Sleeve was. Since then I've done a bunch of research on my own and stumbled upon this forum a few days ago. I finally made the appointment with my regular doctor to discuss this as an option and start the whole process.

The one thing I'm struggling with is questions to ask her, as well as advice on how to deal with if she pushes back on it. I'm 25, I'll be 26 in May and I'd really love to just start this now since from what I've found my insurance may require a 6 month monitored diet plan before covering the cost. So putting it off isn't really an ideal option. I'm really tired of feeling and looking the way I do. It affects me more and more each day.

So any advice would be wonderful!

[Bufflehead 6,358]

I would ask her if she has had other patients who have had sleeve gastrectomy or other wls surgery, and whether she believes it is a good option for you. If she seems positive about it, ask her if she has a recommendation for a surgeon and ask her if she will participate in any required pre-op diet or clearances.

If she seems opposed to surgery or uneducated, tell her thanks for her opinion and time. When you leave, find a surgeon and get a recommmendation from their office for a wls-friendly PCP and get yourself a new doctor. Good luck!

[newmebithebypass 713]

first call your insurance and see if you need a referal from your pcp to see the surgeon and if it needs to be a center of excellence if it neededs to be a center of excellence in my experince you can do your weigh ins with the nut because they will provide you with one thats what i am doing

[MissKay 329]

I do need the referral, my insurance requires a referral from the PCP for any specialists, or anything like that. I'm not even sure what a center of excellence is? From what I can see I'll have to travel to Seattle or Portland to have the surgery done. Where I live there is only a surgeon that does Lap band.

[newmebithebypass 713]

Ok so a center of excellence is a special designation a hospital gets for having a low complications rate with surgery. Some insurance requires you to use these hospitals because they are typically in net work and better than a standard hospital. I am getting bcbs anthem next year and they require a blue designation hospital so I am switching programs half way through

[psychprof 141]

Centers of Excellence are hospitals that meet certain requirements as determined by various boards and professional organizations, and that use the criteria for Bariatric surgery put forth by the National Institutes of Health (as I understand it). My insurer, Harvard Pilgrim, will cover the entire cost of a Bariatric procedure that is done in a CoE.

I learned all of this by logging into my health insurance account online and doing a simple search in the search bar for "Bariatric surgery" or "weight loss surgery."

I'm new here, just joined to make this post. I haven't even spoken to the doctor yet about this, but I do think I'm ready to make the plunge. Planning to call the insurance company today. :-)

[MissKay 329]

Ohhh, gotcha! Thank you for that information.

I have Premera Blue Cross, and I met with my doctor today and she's going ahead with referring me to a surgeon. But they're doing a sleep apnea test on me first since Premera has a multitude of hoops to jump through. Which admittedly is entirely overwhelming, but I'm determined to see this through. I know they did mention the 6 month supervised diet with a nutritionist before going forth. That's the part I'm super nervous about since a friend who had this surgery said that if you lose weight on that diet they will normally say you don't need the surgery since you can do it on your own. I know I'll lose some, but nowhere near enough.

[psychprof 141]

Ohhh, gotcha! Thank you for that information.

I have Premera Blue Cross, and I met with my doctor today and she's going ahead with referring me to a surgeon. But they're doing a sleep apnea test on me first since Premera has a multitude of hoops to jump through. Which admittedly is entirely overwhelming, but I'm determined to see this through. I know they did mention the 6 month supervised diet with a nutritionist before going forth. That's the part I'm super nervous about since a friend who had this surgery said that if you lose weight on that diet they will normally say you don't need the surgery since you can do it on your own. I know I'll lose some, but nowhere near enough.

That's interesting. Yes, it seems like most insurers and even some Bariatric programs require the six month nutrition thing first. The only one I've seen from reading through these forums that doesn't is Harvard pilgrim (which I happen to have). I'm grateful too because my BMI is 41 and if I lose any weight I could drop down easily to under 40.

I know what you mean--everything I've ever tried usually yields about 20-30 lbs loss, but that's about it.