male only 3 more months?

[SpeakerSpeaking 6]

So I have just recently started this journey. I did the webinar last week and had my first apt with the surgeon on Monday. They originally told me that I was going to have to do a 3 months of pre-op diet and meeting with the dietitian. They just talked to my insurance company and found out that I have to do SIX MONTHS! UGH!!!

It just seems like such a long time! What did you guys have to do to get pre-authorized by insurance?

[goblue9280 481]

Insurance required only a letter from my doctor and a psych evaluation. My surgeon additionally required 1 nutrition class and an upper endoscopy. I also had to do a stress test and a cardiac ultrasound, but I'm not sure if that was insurance or surgeon required.

I have BCBS of TX and bariatric surgery is a covered procedure with a $5000 deductible... no diet/waiting period required.

[Pillar2butterfly 391]

I had to do 6 months. Honestly, it goes by so slow and fast at times at other times. I was glad I had to wait that long, because it took me that long to get my mind prepared for the lifestyle change. I don't think I would have been prepared with less than that. It took me so long to mentally absorb the eating changes and mental obstacles. You need to think of it like this...the insurance is paying a nice chuck of change to assist in your change..they want to make sure you are really ready and really healthy enough for this.

[defibvt 348]

Sadly, the day before my appointment with my surgeon, here in Texas, I received a call stating that my insurance policy specifically does not cover weight loss surgery (I am a nurse, working in a Hospital WITH a Bariatric Program). The self pay option would be over $12,000. After doing my due diligence, I found a surgeon and a team in Mexico, my surgery only cost $4,400 (add $220 for my round trip flight) and it was cheaper than here in the States. From applying, filling out the forms, getting accepted, scheduling my surgery and having my surgery done, was about 8 weeks. I did get an approval from my primary care doctor to have the surgery. Since my surgery, my nephew (who was in grad school and had no insurance - because he was over the age limit) had his sleeve done, by the same team I had mine done with, and as of January 2, this year, my brother in law had his sleeve done by the same surgeon/team I had mine done with (he has insurace, but didn't want to have to wait the 6 months to have his surgery done). I know this isn't for everyone, but it worked for me and my extended family. It is also an option for those that don't have insurance, their insurance doesn't cover it and those who feel they can't wait the required time or jump through all the hoops insurance makes you jump through.

[retzlpa 98]

My primary physician and the bariatric physician both submitted separate letters to my insurance stating the necessity for the surgery along with medical records of past weight loss attempts and I had a failed lapband that was eroded into my esophagus. They both estimated my life span without surgery at about 5 years. I was approved within 2 weeks. I still had to fast track through the meetings and psych evaluation though.

[trekker954 421]

There were so many hoops. For insurance, I needed the psych eval; the nutrition class, BMI over 40, evidence that past diets have failed, consecutive weight in for 3 months all done with my PCP who wrote the letter of necessity. Now my surgeon also required clearance from my cardiologist an pulmonologist who also required some tests before they would clear, tons of blood work, chest xray and an endoscopy. I will tell you this, all these co pays and some test deductible add up. At least after each test, i'm finding out I'm pretty damn healthy regardless what i may look like. But I was approved this week, so just have the endo left and scheduled for next Wed. Now if I could just get someone from that darn surgeon's office to return my call to schedule the big day. The initially wanted me to schedule the date as well as endo; but I wanted to wait until I was approved by BCBS. I was pushing and booking though, as I really want this done in January. I want a good 4 to 5 weeks at home, before my work travel schedule starts. Surgeon said I can fly internationally after 10 days. I wonder how many flights he's taken to China. I need want to be on pureed food by then. I don't like the food in China so its a win win. I'll probably live just on Protein shakes.

Edited January 7, 2016 by trekker954

[James Marusek 5,244]

I had to do a 6 month. The whole process from beginning to surgery was around 9 months. So hang in there. It will go by fast.

[Pinkgirl1234 761]

A lot of hoops! Time goes by fast as you are going through the process though.

[XxStephYxX 46]

So I have just recently started this journey. I did the webinar last week and had my first apt with the surgeon on Monday. They originally told me that I was going to have to do a 3 months of pre-op diet and meeting with the dietitian. They just talked to my insurance company and found out that I have to do SIX MONTHS! UGH!!!

It just seems like such a long time! What did you guys have to do to get pre-authorized by insurance?

i just had my first meet with he surgeon yesterday and first diet appointment today and for my insurance i have to do the dietitian for 6 months

it sucks but im sure if we dont think about it all the time it will go by in no time

[Pinkgirl1234 761]

So I have just recently started this journey. I did the webinar last week and had my first apt with the surgeon on Monday. They originally told me that I was going to have to do a 3 months of pre-op diet and meeting with the dietitian. They just talked to my insurance company and found out that I have to do SIX MONTHS! UGH!!!

It just seems like such a long time! What did you guys have to do to get pre-authorized by insurance?

i just had my first meet with he surgeon yesterday and first diet appointment today and for my insurance i have to do the dietitian for 6 months

it sucks but im sure if we dont think about it all the time it will go by in no time

This is a major surgery and you need time to be tested and get clearance.Also to prep.Time will go by fast but note this is major so get ready.

[Djmohr 6,965]

First I was told 3 months supervised diet, then my insurance at the time required the following:

6 months supervised diet with physician or qualified nutritionist

Had to use a Bariatric Center of Excellence

Phyche eval

sleep study or in my case latest history from bi-pap

EDG study

Cardiac Clearance

The whole process actually took 9 months and at the time I was told 6 months I was very ill with kidney disease. It did not matter and I can remember being both pissed and scared to death all at the same time. I wanted to do it right away.

I am so very glad that I had that time to prepare myself. The classes and research I did was instrumental in my success so far. I likely would have chosen the wrong surgery and would not have had the time to build excellent habits. It allowed me to focus on small changes and follow them through.

I still believe that the most important habit I built was tracking absolutely every thing I put in my mouth. I know exactly where my Protein, calories and carbs are from the moment I take that first meal in the am. I use myfitnesspal and I track it good or bad. It allows me the opportunity to know what is in my food and to make better decisions throughout the day. I definitely make better choices because of this and I also have such an excellent understanding of nutrition because of it.

People think it takes so much time, it literally takes just a moment or two and your food is logged. In the beginning I used to measure everything, over time you learn how much a couple of ounces of meat or a real 1/2 cup of cottage cheese.

Also, learning to pay attention to my body while eating was an important tool as well. I used to mindlessly eat and of course when you pay attention you actually savor the food you do eat and can recognize when you are full.

Many good habits to learn and you need the time to truly make them habits which will set you up for success.

Best of luck to you!

[jj7481 363]

I was required to do an orientation session. After that I setup a meeting with my surgeon to discuss options followed by a meeting with my dietician then a physical therapist. That afternoon I also met with a psychologist for an evaluation. I then setup a 13-wk workout schedule making sure to work out for 30 mins 3x wkly. After this I could schedule my surgery date. However, pre-op labs had to be obtained as well as an upper GI performed.

Only once this was completed could I pay my $5,500 co-insurance THEN have my surgery.

[SpeakerSpeaking 6]

Only once this was completed could I pay my $5,500 co-insurance THEN have my surgery.

OMG! I am realizing how lucky I am that my out of pocket limit is so low. There is no way I could afford that!

[jj7481 363]

Only once this was completed could I pay my $5,500 co-insurance THEN have my surgery.

OMG! I am realizing how lucky I am that my out of pocket limit is so low. There is no way I could afford that!

Yeah, it's a shock to the system for sure. However, if you continue to make all your appointments then complete a post surgery 13-wk fitness program you are refunded part of that. Hospital HR treats it as an investment and wants to make sure you're committed to it.

[Cape Crooner 589]

Hmm, my case was quite different.

I attended my orientation on August 10, first meeting with surgeon, psych, and NUT on September 2, got approved for surgery on October 1, surgery on October 6 - entire process under 2 months.

I live in California in the winter and Boston in the summer. My flight to California was booked for 11/7, so 10/6 was pretty much my go/no-go date.

There were multiple reasons why I was able to pull this off:

1. I have a very good Anthem CA policy (PPO) that was grandfathered from Obamacare. Before the ass-clown destroyed the US Healthcare system, I was paying $450/mo with an $6,000 deductible. Now I pay $1300/mo with an $8,000 deductible, but they approved my surgery in 5 days without question.

2. I went to Newton Wellesley and handpicked Dr. Partridge - the head of surgery. I told her that I had to be in California for Thanksgiving in the first meeting and she said she'd do what she could to make it happen if I did everything they told me to do. I did.

3. I'm in my 60's and I've been dieting for almost 50 years. I always kept weight and diet records. I attended the first meeting with a 2 page write-up of my diet/weight history along with a 2008 diagnosis from my PCP of obesity.

4. I think I impressed the psychologist with my conviction and my logical case for why I wanted a VSG. By the time I met with the surgeon, she said "everyone on my team is very impressed with you".

5. Given my relatively low BMI (38), I ate like a pig the day of my orientation and then convinced one of the assistants do an official weigh-in after the August 10 orientation. I came in at 281 (BMI 40.2). This cleared me through insurance for comorbitities.

6. Before my first meeting, I met with my PCP (mid August) and got a strong letter of recommendation.

7. From the day after the orientation on, I dieted like crazy. I was down to 266 by 9/2 and 256 by my final session before approval, and 251 on the day of surgery. I think the fact that I lost 30 lbs in less than 2 months helped my surgical team do a very minimally invasive operation. I went to every support meeting I could and actively participated - further impressing the staff.

8. I continued being a model patient for 7 weeks after surgery. Eating exactly what they told me to eat and walking/riding my bike at least and hour/day. By Thanksgiving I was down 65 lbs and resumed a new normal but healthy lifestyle.

Today I weigh 204 - down 77 pounds and 14 pounds from my goal - 5 months after my orientation and 4 months after my first meeting.

I'm eating what I want, drinking alcohol in moderation, enjoying a social life, and still losing 2-3 lbs a week.

The first 3 1/2 months was hell - a self imposed "biggest loser" contest (no social life, alcohol, coffee, or soda), but now I'm thoroughly delighted with the results.

You can do this if you totally focus on the endgame!

Edited January 10, 2016 by Cape Crooner