Starting my Journey- contacted insurance step 1

[GigiLane 19]

Hi everyone! I am very happy to be joining this forum and looking to all the information and seeing everyone's transformations.

I'm currently 30 yo woman and have struggled with weight all my life. I was born 10lbs and suffered really bad asthma as a child that definitely contributed to my weight gain. At the age of 18, Im 5'3.5" and weighed 301.

I worked out for 2-3 years and changed my diet and managed to get down to 190. I still wasn't satisfied.

Today, I'm currently back at 237. I finally decided it's time to consider weight loss surgery (WLS). At the age of 18, my doctor did not recommend WLS because I was too young.

I realized that a healthy diet and exercise are going to be a part of my forever. However, it would be a dream come true if I can have VSG to finally be able to feel comfortable in my body.

I have UHC and I live in Florida. Bariatric surgery is covered and I am required to do the following:

40 BMI or greater

A psych evaluation

6 months of a supervised diet by a physician

notification from my dr.

I am having lab work done this week and I am looking forward to getting started.

Can anyone share what the psych evaluation is like and what the 6 months of the supervised diet is like? Thanks in advance.

Gigi.

Sent from my iPhone using the BariatricPal App

[Calla 0]

Hi Gigi

I'm on the other side of the country from you in California. I think the 6 months of supervised medical diet parameters change with each insurance provider. I just spoke to my insurance today and the medically supervised weight loss program means "active participation in non-surgical forms of weightloss". I am going to my PCP to discuss my weightloss. This way I only have the 20 dollar copay cause it's not like I haven't spent my life trying it the non surgical way.

[GigiLane 19]

Hi Calla! That's a good recommendation. I'm going to talk to my PCP. I tried every weight loss program out there shots, pills, low carb, no carb, and I lose weight but then I end up gaining it back plus some. I'm concerned about doing another "diet" bc my BMI is at 41.3 and I can't go under 40 to be approved. It's a catch 22.

Sent from my iPhone using the BariatricPal App

[GranadoM74 41]

Hi!

I'm 27, from Texas and in the pre-op VSG process. I am on my 6th month of my 6 month PCP supervised diet. At first I was a little bummed because of the wait, but it went SO much faster than I thought it would.

I have UHC and I had to also have a phone "meeting" with the Optum Bariatric Services Center through UHC. They assigned me a nurse to help me along the way with any questions I may have.

For my Supervised Diet, I didn't have to lose weight and won't be penalized for gaining. That was one of my first questions. I meet with my PCP and discuss weight loss.

My psych eval was quick and painless. We just discussed the choice of having surgery and my eating habits. Don't stress it! They won't ask anything deep and dark.

Good luck!! I'm so excited for you!

Edited March 30, 2016 by GranadoM74

[ChickenChick 30]

I started my journey today.

I also have UHC (Choice Plus) through my husband's employer and I'm in Texas.

I was told by the staff:

I'll have to have a physical (scheduled for Monday 4/4)

6 visits, one month apart with a nutritionist (on staff) and my first is considered on Monday 4/4

Psych eval (which will be done during a visit and they have one on staff)

No diet

No weight loss

They said my insurance covers 90%. Worse case scenario out of pocket will be $3400, best case $1200. I'm at 37BMI and on medication for high blood pressure and for high cholesterol. Although the patient advocate said my insurance only requires one comorbidity with a BMI of 35..in which case mine would be blood pressure, they may not count it since it's 'controlled' with medication and they also said my insurance didn't consider high cholesterol. Having said that, he said he was 95% sure I would qualify for the surgery, so that was a little odd. Possibly they hated to be too positive.

However, when I spoke to UHC to start the process I was asked:

How tall are you? Almost 5'4"

How much do you weigh? 210

Do you have high blood pressure? Yes

-Are you currently taking medication? Yes

Do you have high cholesterol? Yes

-Are you currently taking medication? Yes

Do you have diabetes? No

I was under the impression I need two comoridities if I'm below 40 BMI but above 35. I haven't read anything yet about if they are controlled with medicine then it doesn't count, yadda yadda yadda. The other stuff about 6 months visits, physical, psych eval - none of that surprised me. At this point I'm not 100% sure if that's the facility's requirements or my insurance, or a combination of the two.

A nurse from OptumHealth will be calling me later today so I'll hope to know more then.

[GigiLane 19]

@@GranadoM74 OMG you're almost at the finish line. Please share once you get your date! Everyone's stories and result keep me so motivated. I know the 6 months will fly by! The weight gain or loss is a good question that I will ask my dr, thank you for brining that up.

Do you know if you'll have to pay any money for the surgery? I'm not sure if I should my plan to low deductible VS the high ded that I'm on now w UHC. I may need to look into that more or search the threads.

Seems like the evaluations are easy peasy I feel much better now after everyone's encouragement. Thank you so much for taking the time to respond. Wishing you the best and looking forward to seeing your progress!

Sent from my iPhone using the BariatricPal App

[GigiLane 19]

@@ChickenChick looks like you and I may end up having surgery around the same date since we are starting the process so close together. Looking forward to see your journey too! and wishing you the best of luck.

Sent from my iPhone using the BariatricPal App

[clerkstar841998 18]

@@GigiLane I am also just starting out in my weight loss journey. I have UHC and have to do the 6 month supervised diet with a Bmi of 41.

Sent from my iPhone using the BariatricPal App

@@GigiLane I am also just starting out in my weight loss journey. I have UHC and have to do the 6 month supervised diet with a Bmi of 41.

Sent from my iPhone using the BariatricPal App