Where do I start?

[RNY-Gal 40]

Hello, I'm 31 female 5'8 with a BMI of 50. My insurance company covers surgery. But I don't know what to do to start the whole process. My IC requires a 6 month program. I got a referral from my PCP for gastric bypass. I called the surgeon, but the nurse set me up with a free information session. She was going to send me a packet in the mail about it. I called them on Dec16, 2015. The free information session isn't until Jan, 27th 2016. It just seems like a very long wait just for a information session. That month could be used to start my 6 months of lifestyle changing program.

So really my question is, am I going down the right road here or is there any shortcuts to get me going faster? I have UPMC insurance.

[catwoman7 11,212]

you should be able to start your six-month supervised diet at any time. I decided I was going to get the surgery in the summer (2014). To do it I had to switch insurance carriers, which couldn't happen 'til January (2015). So I decided to go ahead and get started with the six-month diet right away so i'd have it out of the way before I started up in the program. My insurance company didn't care where or how I did the diet - they just wanted documented evidence that I'd been on such a diet within the last year (or two?). So if you know you're going to go for the surgery, you probably don't need to wait for the info session to get started on the diet. I went to some info sessions before and some after I started the diet (because I wanted to check out several different surgeons and programs).

Edited December 26, 2015 by catwoman7

[RNY-Gal 40]

Well, I decided to go to my insurance website to read about everything, and I found something I didn't see before.

http://www.upmc.com/Services/bariatrics/approach/Pages/default.aspx

It seems that it's the first step. So I have to do it.

[WLSResources/ClothingExch 3,444]

The information seminar is only a month off, but if you want "credit" from your med plan earlier, make an appointment with your primary now. It's absolutely necessary that it be documented, hence being in your medical record at the primary's office. I believe monthly visits are required in general; you'll have to be sure of your plan's requirements. (I was not required to undergo a supervised diet.)

[Kelly1121 26]

You could definitely start your 6 month supervised weight loss with your PCP now, just make sure it's all very documented so that it'll count. It took me a few months to get up and going between the mandatory seminar with my surgeon's office, and some other hoops, and it definitely would have been nice to be further along in my own 6 months at this point. Good luck!

[newmebithebypass 713]

my best advice for you is to see if your hospital has an online info session. mine did and it was a half hour video that i watched and then took a short quiz to make sure i paid attention. also i am going thru a center of excellence and i do my monthly weigh ins with the nut. its good because we can talk about all the dietary changes for after surgery

[glitter eyes 1,398]

I had a six month wait also. I started in January with my PCP and wasn't able to get into my hospitals information seminar until the end of February. By then I had already been to my PCP for the month of Jan. and Feb and those months were counted. So for me it was six months from my first PCP visit not from the informational seminar.

Good luck to you, the months will eventually pass and it will be your turn!!

[jj7481 363]

Insurance is a major driving force for many people. Unfortunately, modern health care in the USA leaves medical providers making decisions based on what insurance will approve as opposed to what they feel is best for the patient. (sorry, just my little soap box).

Several insurance plans will require you to jump through many hoops before you actual surgery. This is the norm for many bariatric surgery patients. Informational sessions are usually required to start the process (mine was). From there you go to the next step which your weight loss team will guide you through.

I first decided on bariatric surgery almost a year ago. I was referred by my PCP to a local bariatric surgeon and accredited weight loss team. After going through their informational session and filling out their paperwork they called and advised my insurnace didn't cover them as a primary bariatric surgery center (calling it only Tier 2 coverage). So....onto the primary recommendation of my insurance. I waited another 2 mos for an informational session then 2 mos later I had my first appointment with my surgeon, nutritionist, etc. Only then could I start the mandatory 13wk wellness program required by my insurance company. Once that was completed I could then schedule my surgery and pre-op stuff. After 10 mos I finally got my surgery.

It is a process. My recommendation would be to follow your insurance directions to get started and the weight loss team should guide you from there. Try not to start a diet or program on your own until you have started and confirmed you will be with a specific surgery center (as all surgeons have their own program they want you to follow).

Edited January 4, 2016 by jj7481

[RNY-Gal 40]

Insurance is a major driving force for many people. Unfortunately, modern health care in the USA leaves medical providers making decisions based on what insurance will approve as opposed to what they feel is best for the patient. (sorry, just my little soap box).

Several insurance plans will require you to jump through many hoops before you actual surgery. This is the norm for many bariatric surgery patients. Informational sessions are usually required to start the process (mine was). From there you go to the next step which your weight loss team will guide you through.

I first decided on bariatric surgery almost a year ago. I was referred by my PCP to a local bariatric surgeon and accredited weight loss team. After going through their informational session and filling out their paperwork they called and advised my insurnace didn't cover them as a primary bariatric surgery center (calling it only Tier 2 coverage). So....onto the primary recommendation of my insurance. I waited another 2 mos for an informational session then 2 mos later I had my first appointment with my surgeon, nutritionist, etc. Only then could I start the mandatory 13wk wellness program required by my insurance company. Once that was completed I could then schedule my surgery and pre-op stuff. After 10 mos I finally got my surgery.

It is a process. My recommendation would be to follow your insurance directions to get started and the weight loss team should guide you from there. Try not to start a diet or program on your own until you have started and confirmed you will be with a specific surgery center (as all surgeons have their own program they want you to follow).

This is very informative.. Yeah, my information session is the required first step. So I really can't start anything until I do that. Two more weeks to go! I actually can't wait until I really get started I've been waiting for this to happen for YEARS!!