How to start the process

[cluelessgastricgirl 8]

Hello everyone, I am brand new to all of this and would like to know what I need to do to get the process started for weight loss surgery through my insurance bcbs tx. I had a sister that had the sleeve done a year ago and she said the surgery has transformed her life. I want this only as a tool to get me where I need to be after many failed weight loss attempts. I have a little over a hundred lbs to lose and I know my insurance covers some of the surgery but If any one could give me some advice as to how to get the ball rolling on this and what I need to do I would greatly appreciate it!

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[Babbs 14,681]

First, look up your insurance plan and see what the pre requisites are for bariatric surgery to be covered. A lot of insurances have certain requirements before they approve surgery, such as several months on a weight loss plan under a doctor's care, psychological evaluations and other tests. Then, look for a bariatric surgeon in your area, and they should be able to help you through the process. A lot of bariatric programs have some sort of orientation you can attend to get the basics.

Good luck!

[Djmohr 6,965]

I started with a phone call to my insurance company and asked specifically what the process was. They were extremely helpful and sent me via email a list of the qualifications and process.

That is how I found out I had to use a Bariatric center of excellence for the surgery and they also provided me with a list of those.

Just give them a call.

[James Marusek 5,244]

There are Bariatric Surgery Centers of Excellence in many states. These combine many groups under one umbrella, like a full meal deal. That includes specialized surgeons who only perform bariatric surgery, hospitals who dedicate a full floor to this type of surgery, insurance coordinators, psychologist, pre-op testing, sponsors for bariatric surgery support groups, training sessions and nutritionists. Because there are many steps to this process, it is good to have all of these together in one place. Generally these centers of excellence offer a free consultation session to kick things off.

The first step for me was to see my primary care physician. He then made the appointment for the initial consultation with the center of excellence.

[ppressey24 254]

I didnt call my insurance. I went to my primary care dr and asked if she thought i was a candidate for the surgery because of my arthritis in the back and knees, previous back and knee surgeries. She said yes and referred me to the dr.

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[Inner Surfer Girl 12,015]

I started with my PCP. Actually, he was the one who talked me into just exploring the idea. He referred me to an awesome surgeon at an awesome practice and they took it from there.

I never looked back.

[MissMellyMell 46]

Start with meeting with your primary care physician and let the doctor know that you have tried losing weight, but you're now interested in weightloss surgery. They will need to send the request to your insurance. Your insurance should then approve or deny the request. You should call them to see what requirements need to be met. Every insurance company has different requirements set for bariatric surgery. Good luck to you! ????

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[KristenLe 5,979]

Find out insurance requirements and information on Centers in your area. Most have informational sessions to attend first. They'll help with the details. I told my PCP but didn't need a referral.

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[inhiskingdom 39]

I called my insurance Blue Shield to find out if they covered bariatric surgery and at that time they gave me a list of approved surgeons. I called the surgeon made an appointment and at my first appointment we started the 6 month monitored weight loss program that Blue Shield requires. Make sure you ask about deductibles and copays/out of pocket costs so you can plan accordingly. Good luck to you!

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[Sajijoma 1,324]

I did things ass backwards because that's my style. LOL first I sought out the surgeon Google search, word of mouth, location to home, and everything I could find on this surgeon to see if he was a safe bet and then I looked to see if my insurance covered it. I have Aetna so I was able to look up my benefits online and see what all was covered and thankfully it was. They also fast tracked me to a 90 day prep for surgery program because I was well over 40 BMI even though I had no known co morbidities and because I went to a Center of Excellence, I only paid 10% of the cost instead of the standard 20% I would normally have paid. I made the reservation for the seminar and went in and got all my questions answered and really by the end of that night I had scheduled my first nutritionist visit and first surgeon visit because I knew it was the right thing for me. After that, I had 4 visits total with the nutritionist, 1 psych eval with the in house psych, and 2 visits with the surgeon over the 90 days and then it went to insurance and was approved within 3 days and I had surgery a week later. It all happened so fast I didn't have time to panic or obsess about anything, which worked out just great.

[cluelessgastricgirl 8]

Ok so I have called the insurance and basically I am going to contact the Surgeon of my choice since the surgery has to be done in a blue distinction center I have already found one that is 3 hours away and I would rather them do the approval rather than start off with a dr over here that may not have as much experience dealing with the insurance. Wish me luck guys!

[#BirdDog 604]

I got online and checked my insurance requirements and what surgeons in my area were accepted. My insurance had a form for me to fill out to make sure I met the requirements for them to pay. I then went to a seminar where they discussed the different types of surgery available and the differences between them. They had people who had been through the various surgeries there to answer questions. While at the seminar they had a packet for me to fill out and return to them. I handed it back filled out the same day. They called me a couple days later and said my insurance had sent them the requirements and made an appointment for me to meet the surgeon. Took my wife with me to the first appointment. They had a presentation that we watched and we both had long discussions with the nurse and the surgeon. When I left there I had a binder full of information that they had put together for me.

I started making appointments, first with a nutritionist from their list, then the psych, chest X-ray, blood work, and ekg. Got most everything out of the way but my insurance required me to see a nutritionist for 6 months before they would give the approval. Then one day my surgeons office called and said insurance had sent over the approval and they are ready to schedule my surgery. I scheduled it, had to go to another "class" at the surgeons office where they addressed things specific to my surgery, how my food intake had been in the last six months. They discussed the prep for surgery and what I would need to be doing afterward. Right after that I had another appointment with the surgeon where he basically went over how they do the surgery and he gave me an opportunity to ask all the questions I had. No rush he wanted to make sure EVERY question my wife and I had were answered. This made me feel excellent about my choice in surgeons. After that it was rock and roll, started the two week liquids and next thing I knew I was checking into the hospital for my surgery.

Now I'm on day 4, still recovering and having some pain from one incision but I know I made the right decision and am excited to see what the next year has in store for me.

[cluelessgastricgirl 8]

Ok everyone thank you so much! I took your advice and I just got approved for October the 17th everything went by so fast! Thank you for your advice!!!

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[MissMellyMell 46]

Ok everyone thank you so much! I took your advice and I just got approved for October the 17th everything went by so fast! Thank you for your advice!!!

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Awesome! Good luck on your journey! That's right around the corner!!!

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[cluelessgastricgirl 8]

I know the dr and I thought it would be mid November before we got the date so this was a great little surprise

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