Advice and Suggestions for Gastric Sleeve

[Sergio_TX 15]

Specs:

Male, Age: 37, 5' 7"

Current weight: 386 / BMI: 60.6

My insurance: United Healthcare

Health Issues: I consider myself a very healthy person, just my weight of course.

My wife says that I stop breathing when I'm at sleep. So, I guess I do have sleep apnea... I do have a big problem with low back paid and headaches.

I checked my insurance benefits online and it says Bariatric surgery not Cover.

But from what a lot of people had told me is that it can be approve

Once I submit the appropriate documentation.

So, I search a bariatric Doctor in Dallas, Tx my consultation is Aug. 21st

Do I need to call my Insurance to know exactly what would I need to get approve or Is it better to wait for my doctors appointment?

Ive seen many post and videos that some "tests" are required.

Can I go ahead and start setting those up ? Get the appointment with a psychologist for the psych test ? Is that just an Adult Psychologist or behavior?

The sleep test ? Do I call myself to do that ? Or rather wait ?

I just want to have everything ready, if I could, all the stuff necessary if I can advance anything, so I can get it going ...

Diets I did the Adipex pills for like two months like 3 yrs ago.

Do I need to get on some kind of diet now? So i can have a record that I try?

I did the green juice for 10days but thats it No Dr appt or anything so, how do I proof that "diets" ? Or that I try weight loss on my own?

What y'all recommend ? To do first.

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Edited July 25, 2016 by Sergio_TX

[NeedaBreak4Me 1,755]

Unfortunately i can not comment on the insurance side of your question as i am in Australia and things work differently here.

But from my understanding is that you first meet with your surgeon to discuss the various surgeries suitable for your weight and lifestyle.

Depending on the surgeon, they all have different requirements.. some need a sleep study, most want a psych evaluation and a dietitian appointment... your surgein will advise what you need and where to get these done.

If you decide to go ahead with the surgery and you get approved, you will be required to do a diet for a time specified by your surgeon, they will book in your surgery and give you information regarding what to do after it.

Unfortunately thats all i know.... maybe someone else on the board from the usa can give you more information regarding the insurance and approval and the process, i could be wrong.

First thing you should do, is meet with your surgeon... he will be able to guide you in what you need to do... booking your own things could be a waste of time and money if he does not require them.

I hope this helped

Edited July 25, 2016 by AussieGirl81

[Clarevoyant 347]

I would def call your insurance to see what they cover, if it is indeed covered. Then i'd see the surgeon and their office will also call your insurance to confirm and will tell you what appointments you need to make and suggest docs they work with.

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Edited July 25, 2016 by Clarevoyant

[Bufflehead 6,358]

Don't do any tests until you find out whether you can actually be covered. Find a bariatric center of excellence and see if you can schedule an initial consult and have their insurance coordinator review your coverage. That is the person who needs to give you definitve information on whether you can be covered, and, if so, what kind of tests would need to be scheduled.

Even if bariatric surgery is not covered under your policy, there may be other options such as picking up secondary insurance from a spouse, or doing self-pay, whether locally or pursuing a cheaper option in Mexico.

[hobbes13rn 8]

I am going to Dr. Ayoola, in Denton Tx, he had several requirements for me.

A sleep study, a specific psych evaluation,abdominal ultrasound, upper EGD, and then my insurance had required several dietary consults that I had to complete before they approved me for surgery (8/3).

The surgeons office was great they walked me through all The requirements and made sure I got every thing done that I would need.

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[sc101071 398]

Please take your sleep apnea seriously. If you are not breathing when you sleep, you are not getting sufficient oxygen to your organs. It can lead to heart failure and kidney failure among other problems. My mom died at the age of 57 largely due to untreated sleep apnea.

[Armygalbonnie 643]

I just had my 1st consult this last Friday. I have Tricare Prime (retired military) and I anticipated my insurance provider would have their requirements for a Dr supervised diet. Fortunately, they do not; However, my surgeon and the weight loss clinic requires 3 visits with a dietitian (month between appts), a psych evaluation they schedule, 1 visit with a physical therapist and 1X support group. Even though my insurance doesn't have the requirements, it will still be November before I have the surgery. Even though I am impatient and I want the surgery YESTERDAY, their protocol is truly ideal. Not only do I have time to meet my surgeon's requirements, it gives me time to adjust to the future changes in my life. BTW, I have had several EGDs in the past and I have already been diagnosed with sleep apnea, so I don't have to have testing repeated.

As far as starting testing now, I would wait until your consult, to see what your surgeon says. Of course checking with your insurance before hand is a good idea. Don't always trust what you read online. That way you know what to expect.

Good luck!!

[Sergio_TX 15]

I am going to Dr. Ayoola, in Denton Tx, he had several requirements for me.

A sleep study, a specific psych evaluation,abdominal ultrasound, upper EGD, and then my insurance had required several dietary consults that I had to complete before they approved me for surgery (8/3).

The surgeons office was great they walked me through all The requirements and made sure I got every thing done that I would need.

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That's awesome, I'm so happy for you, time is getting closer!

One more question, so the surgeon is the one who's referring you directly with the psych Doctor, where to get the sonogram and the dietitian? Or they just told you what do you need for the insurance and you have to get it done by yourself?

What kind of Insurance do you have?

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Thank you all for all the replies! Awesome People! Thank you so much.

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[Sergio_TX 15]

@@sc101071 I know it's something that is a very serious matter and that's why I've decide to get the surgery done. I know that my problem is the weight.

Thank you so much for the concern.

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[Sergio_TX 15]

I just had my 1st consult this last Friday. I have Tricare Prime (retired military) and I anticipated my insurance provider would have their requirements for a Dr supervised diet. Fortunately, they do not; However, my surgeon and the weight loss clinic requires 3 visits with a dietitian (month between appts), a psych evaluation they schedule, 1 visit with a physical therapist and 1X support group. Even though my insurance doesn't have the requirements, it will still be November before I have the surgery. Even though I am impatient and I want the surgery YESTERDAY, their protocol is truly ideal. Not only do I have time to meet my surgeon's requirements, it gives me time to adjust to the future changes in my life. BTW, I have had several EGDs in the past and I have already been diagnosed with sleep apnea, so I don't have to have testing repeated.

As far as starting testing now, I would wait until your consult, to see what your surgeon says. Of course checking with your insurance before hand is a good idea. Don't always trust what you read online. That way you know what to expect.

Good luck!!

Perfect, I laughed hard with your comment "I am impatient and I want the surgery YESTERDAY" that's me 110% how you can see I want to go and get the tests done and stuff.

Thanks to y'all I understand much better the situation.... My appointment has been setup and I meet my Doctor August 21st. I'll definitely come back her and let you all know what happened.

Sent from my iPhone

I just had my 1st consult this last Friday. I have Tricare Prime (retired military) and I anticipated my insurance provider would have their requirements for a Dr supervised diet. Fortunately, they do not; However, my surgeon and the weight loss clinic requires 3 visits with a dietitian (month between appts), a psych evaluation they schedule, 1 visit with a physical therapist and 1X support group. Even though my insurance doesn't have the requirements, it will still be November before I have the surgery. Even though I am impatient and I want the surgery YESTERDAY, their protocol is truly ideal. Not only do I have time to meet my surgeon's requirements, it gives me time to adjust to the future changes in my life. BTW, I have had several EGDs in the past and I have already been diagnosed with sleep apnea, so I don't have to have testing repeated.

As far as starting testing now, I would wait until your consult, to see what your surgeon says. Of course checking with your insurance before hand is a good idea. Don't always trust what you read online. That way you know what to expect.

Good luck!!

Perfect, I laughed hard with your comment "I am impatient and I want the surgery YESTERDAY" that's me 110% how you can see I want to go and get the tests done and stuff.

Thanks to y'all I understand much better the situation.... My appointment has been setup and I meet my Doctor August 21st. I'll definitely come back her and let you all know what happened.

Sent from my iPhone

[Armygalbonnie 643]

My surgeon's office actually set up all the other appts I need and will get insurance authorization for those appts. I have Tricare insurance and it won't pay for the (3) dietitian visits but It will pay for the psych and PT. The psychologist they use specializes in food addictions/weight loss surgeries and that's why I am referred to him. I think you will find that at your initial consult, the surgeon and office staff are very informative and they will do all the paperwork, referrals and scheduling of appts for you. They really are your advocates!

[emme.vee 142]

I just had my 1st consult this last Friday. I have Tricare Prime (retired military) and I anticipated my insurance provider would have their requirements for a Dr supervised diet. Fortunately, they do not; However, my surgeon and the weight loss clinic requires 3 visits with a dietitian (month between appts), a psych evaluation they schedule, 1 visit with a physical therapist and 1X support group. Even though my insurance doesn't have the requirements, it will still be November before I have the surgery. Even though I am impatient and I want the surgery YESTERDAY, their protocol is truly ideal.

Thank you for your service! I too have Tricare prime. My ex and I separated but we never divorced so when he passed away I kept it for the kids. I have my own insurance thru work but I still stayed on with Tricare. I was under the impression you had to do a six month physician documented diet before they refer you to your surgeon. Do you think it's different for different parts of the country? I live in So. Cal. I see my doctor this Friday so I'm asking for a referral to a VSG surgeon but I do have Kaiser and I'm not sure what they will tell me. I'm glad that I have a back up insurance tho .

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[Armygalbonnie 643]

emme.vee

Every time I looked online and read Tricare's requirements, it appeared as though I would have to have a physician monitored diet. It doesn't say 6 months though. I'm in the medical field and I work at an Army hospital. One of my patients had WLS and I asked him if Tricare made him do the 6 month diet and he said, "no". When I saw my Dr Friday, she said "no" too. I'm not sure if it depends on which medical command you fall under. I know with Tricare though, if you have any other insurance, they will be your secondary. Tricare will pick up where your primarily insurance doesn't pay. If your primary won't pay, then Tricare will. You've got it made!!!! Let me know what you hear.

Bonnie