New Here, called insurance and No requirements before hand?

[hernandez776 56]

Hello! First I'd like to say thank you for reading! I've been looking into WLS for over a year and finally with the support of my family have decided it is the right option for me. I called my insurance company to ask what the requirements for approval are thinking I'd have to see a nutritionist for a few months etc... but the only thing they told me was if I had a BMI of 40 or more all I would need is a referral from my doctor. Has anyone else experienced this? Seems to good to be true. Plus I rarely ever get sick so I don't have a regular physician I'd be making an appointment with a doctor for the first time to discuss weight loss I don't have a "medical" history of seeking dr's help to lose weight. Maybe this will count against me?? I've been extremely over weight for the last 12 years and nothing I try, no program, no pills, no exercise regime will keep the weight off. I managed to lose 45 pounds once and it all came back plus some. I'm 230 lbs and 5'2 with a BMI of 42.2. So in that regard I know I meet the requirements but with no past history I wonder if that will hinder this process. Anyone else have a similar experience?

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[clc9 644]

It's never a bad idea to have a regular doctor. Then you have them if you do get sick instead of having to try to get in with someone new when you don't feel well. Plus there are things that don't have noticeable symptoms that can be caught through routine blood tests, physical exams and things like blood pressure testing, etc.

That said, I wonder if the referral for surgery can come from your surgeon?

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[ThinJenne 187]

Most Dr. Dont have a problem with refering you if you are morbidly obese i hate that word. But my dr did want me to try and lose the weigh before she referred me but some surgeon offices does it all mine didnt but i didnt need a dr referrel to go to them i needed my dr to refer me to everyone else like for my lungs and heart and such. So i say go to your sergon office and find out what they need from you but i would still get a PCP because it good to have

The Losers Bench

[The New Kel 1,312]

What is your insurance? It does sound too good to be true. Usually there are lots of requirements.

Sometimes you have to read the policy to get into the details.

But like others said, it is good to get a regular primary care doctor. Someone who can see you through and after surgery for regular stuff.

[hernandez776 56]

What is your insurance? It does sound too good to be true. Usually there are lots of requirements.

Sometimes you have to read the policy to get into the details.

But like others said, it is good to get a regular primary care doctor. Someone who can see you through and after surgery for regular stuff.

I have Cigna.

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[dodlbug 23]

Hello! First I'd like to say thank you for reading! I've been looking into WLS for over a year and finally with the support of my family have decided it is the right option for me. I called my insurance company to ask what the requirements for approval are thinking I'd have to see a nutritionist for a few months etc... but the only thing they told me was if I had a BMI of 40 or more all I would need is a referral from my doctor. Has anyone else experienced this? Seems to good to be true. Plus I rarely ever get sick so I don't have a regular physician I'd be making an appointment with a doctor for the first time to discuss weight loss I don't have a "medical" history of seeking dr's help to lose weight. Maybe this will count against me?? I've been extremely over weight for the last 12 years and nothing I try, no program, no pills, no exercise regime will keep the weight off. I managed to lose 45 pounds once and it all came back plus some. I'm 230 lbs and 5'2 with a BMI of 42.2. So in that regard I know I meet the requirements but with no past history I wonder if that will hinder this process. Anyone else have a similar experience?

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It really depends on how strict or lenient your insurance is.

I was OKed for the band procedure before I even started classes and probably would have been able to get it done right then and there. I waited, went through the hospital recommended steps, and landed up with the sleeve instead because my endoscopy showed gastroparesis. The band wouldn't have worked as well for me and I would have had issues.

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[Syaniya 319]

Your insurance may not have requirements, but most surgeons will...mainly because they want you to be successful after wls.

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[ladygg1967 171]

Yes, the referral can come from the surgeon you've chosen. I do recommend getting a PCP......just good to have someone you can see outside of bariatric issues. I have a PCP, but didn't discuss my plan for WLS until last week (started the ptocess back in June 2016 though). My insurance also just required a BMI of at least 40-without co-morbidities-and a referral from a doctor. I also just found out they'll pay for the surgery at 100%; no worries about deductibles!

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[Montana Gal 448]

My Insurance had no requirements, but my surgeon had many!

[jack morris 122716 39]

It's good to set some requirements on your self this is not a small step you take its best to prove to your self you can beat the beast of food I've been on the long road had to wait six months to even set a date but I was able to beat the odds and set goals for myself I lost 80 lbs before and it has made the after surgery so much easier best of luck it will pay off in 5 days out and it's been a lot better than I thought

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[rosestara 48]

My surgeons office had a lot of requirements that everyone had to do even if they were self pay.

[Vinasu 621]

I had Cigna. They required 90 days of diet and a referral from my PCP.

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[Newme17 3,444]

What is your insurance? It does sound too good to be true. Usually there are lots of requirements.

Sometimes you have to read the policy to get into the details.

But like others said, it is good to get a regular primary care doctor. Someone who can see you through and after surgery for regular stuff.

I have Cigna.

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I have Cigna too. Here is their medical coverage for bariatric surgery.

https://cignaforhcp.cigna.com/public/content/pdf/coveragePolicies/medical/mm_0051_coveragepositioncriteria_bariatric_surgery.pdf

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[hernandez776 56]

I already knew my surgeon has many requirements, I was just surprised that my insurance company did not. I will be going and seeing a doctor next week and going from there. Thank you everyone for your time and advice, it's very much appreciated.

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[tamirn 90]

All I had to do was get a referred by my pcp.. Then I had meet with a nut and do 4 bariatric classes that took me 3 weeks to do.. My surgeon gave me a goal weight of 10 pounds to lose.. I'm almost there..once I meet my goal weight and get my psych cleared I get my surgery date! This whole process has taken or will take about 2 months.. I meet with my psych Dr.. In a few weeks.

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