Considering surgery

[Rycaitsmom 3]

I've just barely started on this journey. The mandatory seminar is next month at a hotel in St. Louis. I have been reading all I that I can on wls and I feel confident (at least for the moment!) that this is the best option for me. I have downloaded an app that is offered from the hospital that I will go to for the surgery and there was something on there that I was wondering someone could help me answer. Under the insurance section it talks about showing documentation of failed non-surgical wl attempts. I really don't have a lot of proof so I was wondering what you all did to establish failed wl attempts? Or was that a requirement for anyone else? Thanks innadvance for your input!

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[Pescador 1,374]

I would write down specific questions for the Seminar. All insurances are different. Our surgeon had a wonderful staff who always took care of insurance. We did nothing. Good luck! Would do this again in a heartbeat!

[sweettea 300]

I would also ask the surgeons staff. I remember putting slimfast, Adkins diet, portion control...

[katie09/21/2016 137]

I've just barely started on this journey. The mandatory seminar is next month at a hotel in St. Louis. I have been reading all I that I can on wls and I feel confident (at least for the moment!) that this is the best option for me. I have downloaded an app that is offered from the hospital that I will go to for the surgery and there was something on there that I was wondering someone could help me answer. Under the insurance section it talks about showing documentation of failed non-surgical wl attempts. I really don't have a lot of proof so I was wondering what you all did to establish failed wl attempts? Or was that a requirement for anyone else? Thanks innadvance for your input!

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This part had me frazzled in the beginning too! I didn't really have "proof"either, so I just had to get my medical records from the past 2 years (my surgery is next week, so I needed 2015 and 2014) where I had my weight recorded.

Everytime I go to my PCP they weigh me so that's all they needed. For 2014 I didn't have a PCP but I had couple of visits with an OBGYN doctor & they had also weighed me for those visits so I had those records sent to my surgeon too.

My insurance company accepted this as "proof" - that part was much easier than I anticipated.

Goodluck with everything

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[Rycaitsmom 3]

Thanks everyone! I wonder if Weight Watchers has record of all the times I joined them? I will also look into Dr's records. Hopefully the surgeon's staff will help me out as well.

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[James Marusek 5,244]

Many health insurance plans require a 6 month medically supervised weight loss and exercise program. In my case I contacted a doctor specializing in weight loss and met with her to begin the process. I attended monthly Bariatric Surgery Support Group Meetings. I monitored my daily caloric intake. I went cold turkey on my 6 diet coke a day habit. I kept a food journal. I did 30 minutes of exercise (walking) daily. I met with the doctor monthly, was weighed and discussed my nutrition, exercise and progress in weight reduction. At the end of the six months, the doctor forwarded a letter documenting my program and results. This went in with the package that the surgeon's office forwarded to my insurance company requesting surgery approval.

[KristenLe 5,979]

Thanks everyone! I wonder if Weight Watchers has record of all the times I joined them? I will also look into Dr's records. Hopefully the surgeon's staff will help me out as well.

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WW should have records. Do you have your weight tracking books? I wouldn't worry too much - especially if you have discussed weight loss with your PCP. I didn't have to show actual proof.

[Djmohr 6,965]

My insurance required that as well but what they took was my weights off my medical records and then I filled out a document that spoke to all the diets I tried over time. Luckily those diets coincided with my yo yo weights so apparently it was proof enough.

I would definately ask those questions at your seminar.

You have to jump through a lot of hoops that seem almost ridiculous but I promise it is worth it. Also I would say that even if it seems ridiculous, it makes sense down the road.

Having WLS is very very hard work and both the insurance company and the surgeons want to make sure that a patient is ready otherwise it just ends up costing lots of money and big health issues down the road if they don't follow the lifelong commitment that comes with living after WLS.

It is a lot of responsibility and I will say there has not been a single day gone by where I did not think about what I put in my mouth and what it might do to my weight. I am two years post op and I had a 9 month wait so nearly 3 years of being hyper aware.

That said, I am down 152lbs, My weight fluctuates between 158 and 162. I am very healthy with the exception of damage done to my joints and spine because I waited too long to make this decision.

I LOVE that I chose this for myself and would do it again in a heartbeat, I am also thankful for the long drawn out process that helped me get my head straight and prepare me for what was to come.

Best of luck to you and if you need anything feel free to reach out.

[laceemouse 631]

I've just barely started on this journey. The mandatory seminar is next month at a hotel in St. Louis. I have been reading all I that I can on wls and I feel confident (at least for the moment!) that this is the best option for me. I have downloaded an app that is offered from the hospital that I will go to for the surgery and there was something on there that I was wondering someone could help me answer. Under the insurance section it talks about showing documentation of failed non-surgical wl attempts. I really don't have a lot of proof so I was wondering what you all did to establish failed wl attempts? Or was that a requirement for anyone else? Thanks innadvance for your input!

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My surgeon had a check list in the paperwork, I checked off that I had tried Weight Watchers (many times), Jenny Craig, Slimfast, Medi-fast, etc. There was nothing else I needed as proof. WW MAY have records of past clients but most of the others would not, especially if it's something you buy and try at home like Slimfast.

My info has all gone to insurance and I am awaiting approval. I didn't have to do a monitored weight loss program or wait a certain length of time or anything. It just varies greatly from plan to plan.

Best of luck to you!

[OutsideMatchInside 10,166]

@@Rycaitsmom

I had my surgery in STL. What program are you going with?

If your BMI is high enough, that documentation might not be necessary.

[Pinkberry2 128]

Just do it like Nike

[Rycaitsmom 3]

@@Rycaitsmom

I had my surgery in STL. What program are you going with?

If your BMI is high enough, that documentation might not be necessary.

I'm looking at Dr. Eagon at Wash U. Bmi is 60. Don't know if that's high enough for them, but it's plenty high for me!

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[laceemouse 631]

@@Rycaitsmom

I had my surgery in STL. What program are you going with?

If your BMI is high enough, that documentation might not be necessary.

I'm looking at Dr. Eagon at Wash U. Bmi is 60. Don't know if that's high enough for them, but it's plenty high for me!

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The "norm" for almost every insurance is BMI 40 and above with no other health problems and they will pay. I am just at that threshold and my surgeon thinks I will have no problem getting approved.

For BMI 30-39 they usually require co-morbities, 1 or 2 other weight related health problems such as high blood pressure, diabetes, joint issues etc. I have mild high blood pressure but it is well controlled with meds so the chances of me getting approved if I were under BMI 40 would be iffy.

Of course some people self pay and then it is up to the doctor what he/she requires to do the surgery. That's why you see some low BMI people getting surgery, most are self pay. I would/will consider that if I don't get approval from insurance.

[KristenLe 5,979]

@@Rycaitsmom You may not have to provide any proof. I had my 6 month supervised diet waived because of a BMI over 50.

[OutsideMatchInside 10,166]

@@Rycaitsmom At 60 BMI you won't have to provide proof of failed attempts. Are you sure your insurance in MO covers surgery? Most plans don't.

At Wash U, you are going to have to wait 6 months or more for surgery and go through their program (which is world-renowned). If you want surgery faster, there are other programs that are faster.

Good luck