Question, anyone from California?

[Carla viviana 0]

Hi I'm new to the group,

I'm not sure how this works, I have community health group insurance basically Medical and I went to my first seminar about 2 weeks ago and then the week after I had my first consult, I only met the nurse and that's the only person I talked too, I was told I had to lose 10% of my weight, and I need labs and to see the phsyc, I want to know if anyone had to do that too? And how was the process with Medical insurance, I guess I just want to know if this is actually happening.

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[RickM 1,753]

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Hello, welcome to the club - I'm in the LA area, though had my VSG in SF. Various labs and a psych eval is common if not outright standard. Dieting is quite variable. Some insurance companies require 3-6 months of physician supervised dieting with variable required results - most don't require a specific loss but don't want any gain, tho that too is variable. Surgeons' programs vary widely on pre-op dieting requirements - some like yours want 5-10% loss, sometimes variable depending upon BMI, while others don't: some impose a week or two (or more) of very low carb and sometimes liquids only immediately before surgery (notionally to "shrink" the liver, tho that point is debatable amongst the docs,) while others do nothing other than the semi-usual day before surgery liquid thing (if that). My doc's general philosophy is that if you could lose weight on your own, what do you need WLS for? And the liver shrinking thing doesn't help him any, so why put the patient through that (others take a similar tack, in that the last thing they want is for the patient to be fasting for weeks before surgery

Good luck!

[Carla viviana 0]

Okay I see what you're saying, thank you!

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[chele367 81]

Hi I'm new to the group,

I'm not sure how this works, I have community health group insurance basically Medical and I went to my first seminar about 2 weeks ago and then the week after I had my first consult, I only met the nurse and that's the only person I talked too, I was told I had to lose 10% of my weight, and I need labs and to see the phsyc, I want to know if anyone had to do that too? And how was the process with Medical insurance, I guess I just want to know if this is actually happening.

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Hi, Napa Valley here. Sounds pretty standard. Call and ask questions sometimes we can get lost in the shuffle of insurance and Dr. Requirements. Do not give up keep moving forward. Good luck

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[Carla viviana 0]

Thank you, I will sure do that

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[bigbit 99]

Requirements depend on your Insurance policy and the wording in the policy. I have Anthem Blue Cross (I'm in Southern California), and my policy dictated proving I participated in a weight loss program for at least 6 months in the past 2 years. I to had to have a minimum BMI of 40, or a lesser number if certain comorbidities existed. My pre-surgery BMI was 56+, so no issues there. I had to get Upper GI, Pulmonary and Cardio testing, psychological exam, approval from my primary care physician and specialists, nutritional consultation, and lots of waiting. I started working on getting the surgery in May 2015, and finally had the surgery in November. Since then, I am down 114 pounds, so it was worth the effort and wait.

[Carla viviana 0]

Oh wow congratulations! Im in San Diego I have medical but when to my first visit they told me that sometimes make it short to 4 months because the doctor is so far from where I am. They told me I had to lose 10% of my body fat

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[Clementine Sky 708]

I'm in Santa Monica and have Blue Shield of California, but knew from the start they wouldn't cover any of the costs because my BMI was below 35. I just zipped down to Tijuana and had surgery at a facility there that was actually nicer than the ones in LA where I've received other medical treatment. If I'd qualified I would have been required to submit documentation of continued obesity despite participation in a weight loss program, in addition to undergoing a psychological evaluation and nutritional evaluation. Since you're in San Diego you might want to explore having the surgery in Tijuana. I had a really positive experience with Dr. Fernando Garcia.

[Carla viviana 0]

Nice, my sister is actually getting hers done in Tijuana in Obesity not for me. Because her insurance didn't want send her to a biatric surgeon so I'm trying to figure out if I'm covered and I'm just doing the process, I'm calling to make sure everything is good. Thank you though

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