What Were (or Are) Your Pre-Op WLS Requirements?

[Alex Brecher 10,512]

Some patients need to jump through hoops to get weight loss surgery. You are especially bound to the requirements if you are hoping for reimbursement from your health insurance plan or if your chosen surgeon has strict requirements. A long weight loss diet or liquid diet are some of the better known requirements, and others include a sleep study, cardio testing, lab testing, and psychiatric evaluations. The purpose is to make sure you are dedicated to weight loss surgery success and properly prepared for it.

However, these requirements are not just annoying for some patients. They may actually be counterproductive! In fact, a recent study showed that having more requirements leads to patients deciding not to get surgery. This means people who need it might be left out of bariatric surgery.

What do you think about pre-op requirements? Are they helpful? Were you required to have a long pre-op diet and go through a variety of tests? Did you think they were useful, or a barrier? Would you consider going self-pay just to avoid the hoops? Share your thoughts here!

[Berry78 4,261]

I had insurance that would cover it, but there were too many hoops. I chose to self pay in Mexico. Had I not had the ability to afford Mexico, I would have gone through the hoops, probably. Would have delayed the surgery by a year.

As it was, I just had a two week diet, and chose my date.

[4TheHealthOfIt 32]

I honestly didn't mind the pre-op requirements. I had the basics....nut, psych, extensive blood work, chest xray, ekg, endoscopy (due to a history of heartburn/reflux). I had a 6 mo wait through insurance and had to see my primary dr each month. I was motivated and focused and ready to do whatever I needed to do for the surgery. As for pre-op diet, I only had 2 days of liquids and a bowel prep. I was asked to lose 15 lbs pre-op and did just that through my 6 mo weight management program, diet and exercise. Self pay was not an option.

[Meryline 546]

First doctors visit on Jan 5th. BMI over 40, high cholesterol, bad back with one back surgery behind me already at age 37, and indications of high blood pressure. Got the date 4 days later, April 18th. Then my whole process began. Nut, psych, and a session with a physical therapist to get a workout program that I have to star 3 weeks post op (today actually). All done on the same day at the hospital. Extensive blood work, chest xray, EKG, Ultrasound, endoscopy, had everything with me to see the surgeon 6 weeks before my op date at the hospital again. I then took all my papers to my insurance, was there for 15 min, got approved. I had asked to be on a waiting list for an earlier date once I got approved. And I got a new date which was March 20th, so I'm 3 weeks post op today. They wanted me to loose 7-12 lbs before surgery, how they didn't care. Soft food only, 24 h before surgery.

Admitted the day before surgery, stayed for 2 days after, so really 4 days in the hospital.

I think it's been the least amount of hoops I have seen around. I'm in Austria.

Edited April 10, 2017 by Meryline

[gryffen 176]

In Scotland we have to jump through a huge weight management course first before surgery is even considered and if we lose more than 11lbs during that course we are out of the running for surgery.

Starts off with a class every fortnight for 12 classes, followed by a repeat of 4 monthly classes if you didn't lose weight. Repeat that with orlistat if weight not lost

Surgery is only considered if you pass a psych consult and surgeon has last say on it.

My preop required a OGD, blood work and weigh in tomorrow as its one week before surgery - also on a liver shrink diet for two weeks now

I read some US peeps surgery requirements and am honestly shocked and annoyed at how easy it it's covered there, not their fault but jeez - it's taken me ten years to get approval here.

[VSG4Mag 106]

Initially I was going to Mexico for self pay because my BMI was 36 and I had no co-morbidities. But I figured, why not give it a shot through insurance first, that way I can justify spending out of pocket when I have good insurance.

My first appointment was 2/7 and my surgery was 3/23 here in the US fully covered. Most insurances only give you the very basics when calling for the criteria. Either 40 BMI or over 30 with co-morbidities of severe sleep apnea, high blood presssure, cardiac problems, diabetes, athsma, high cholesterol and maybe one other. I didn't have any of them and I'm thinking to myself, I'm trying to PREVENT that! And WHY would you want to wait until they are developed and THEN perform a surgery on a sick patient!?!

So I went to my Doc in NY in HOPES of having sleep apnea. My requirements were blood work, check up and clearance from pulmonary doc, cardiologist, primary doc, NUT, psych doc and endoscopy. It was a PAIN to find a nutritionist and psychologist who dealt with weight loss surgery but I called some local weight loss practices and was able to find local people. my doc is an hour away because I didn't want my family/friends to know my plans, they so have all of the specialists in house at their main office, but none are covered by insurance and it was more inconvenient due to the distance for me.

I left that first appointment and literally scheduled the cardiologist, pulmonary, nutritionist, and endoscopy in the parking lot and all within 1 1/2 weeks. The psyc took me 2 weeks and I had just seen my primary doc for extensive blood work. I did a sleep study at home and had the results about 2 weeks after the first appointment. I was not hopeful when the results were mild-no sleep apnea.

I called my insurance company and was told that those are just the basic guidelines, and if the doctor could articulate why the VSG was medically necessary (I.e. Mild apnea interfering with my rest, I DO have a host of documented orthopedic issues that were exasperated by my weight gain over that past few years and mild reflux) that I could be approved. And 2 days later I WAS approved. You would have thought I won an all expense paid vacation when I got the call!

I guess technically I did! I'll take my Mexico self-pay money and go to Mexico for some fun!!

BTW, my insurance did require 6 months of weigh-ins, but somehow i got around that (I wasn't going to call and ask why) Not sure how.

My doctors office took care of all of the insurance approvals so I had minimal dealings with them.

so all in all there were definitely hoops, but I was on such a mission to get this done, I used it's a motivator. It also felt good knowing I had been examined and had minimal health problems going into surgery.

I had a required class just before surgery with a bariatric nurse at the hospital (going over the diet, the procedure, and what to expect, etc.) and the pre-op blood work and the rest is history.

from start to finish, just over 6 weeks from first appointment to surgery. I'm 2 1/2 weeks post op and I feel great.

[Sweet as peaches 759]

On 4/9/2017 at 7:32 PM, Alex Brecher said:

Some patients need to jump through hoops to get weight loss surgery. You are especially bound to the requirements if you are hoping for reimbursement from your health insurance plan or if your chosen surgeon has strict requirements. A long weight loss diet or liquid diet are some of the better known requirements, and others include a sleep study, cardio testing, lab testing, and psychiatric evaluations. The purpose is to make sure you are dedicated to weight loss surgery success and properly prepared for it.

However, these requirements are not just annoying for some patients. They may actually be counterproductive! In fact, a recent study showed that having more requirements leads to patients deciding not to get surgery. This means people who need it might be left out of bariatric surgery.

What do you think about pre-op requirements? Are they helpful? Were you required to have a long pre-op diet and go through a variety of tests? Did you think they were useful, or a barrier? Would you consider going self-pay just to avoid the hoops? Share your thoughts here!

I believe going through the requirements are beneficial because some people rarely see the doctor and to get clearance is important so you know what lies ahead. Taking risk with something happening is not good when have a family to think about.

Edited April 11, 2017 by Sweet as peaches

[violetisle 62]

I have Kaiser, and the requirements were a history of unsuccessful weight loss attempts (check!), a high enough BMI (can't remember what specifically since I for sure qualified at 50), completion of a 12 week educational course, psychiatric clearance, chest x-ray and EKG, and a lot of labs. They also want you to lose 10 percent of your body weight but I learned from the surgeon they're not super strict on it, my surgeon said to just lose 10 or so pounds to shrink my liver and that was it.

All the requirements make sense, though it's been frustrating how long everything has taken. I first made the decision to move forward with it last June; my surgery is (finally!) scheduled for 5/22/17. The longest delay was between my initial surgical consult in January until the end of March, which is when they finally got around to scheduling me.

[Ronnie0422 11]

Started my process in October and had surgery March 23rd. Had to have 4 consecutive months of weigh ins, had to see a psych, get an endoscopy and see a nutritionist. Didn't mind the process. The time helped me get mortally prepared. I know some people habe to go through a longer process but I'm sure insurance make you do that because only those who want it will go through it.

[chynadoll619 247]

Started my process in October and had surgery March 23rd. Had to have 4 consecutive months of weigh ins, had to see a psych, get an endoscopy and see a nutritionist. Didn't mind the process. The time helped me get mortally prepared. I know some people habe to go through a longer process but I'm sure insurance make you do that because only those who want it will go through it.

How is recovery coming along? And congrats!!

[emoji813]2017 could it be, a new me? yaaaass please![emoji813]

[Shell ???? 224]

In nz insurance won't pay they may contribute a tiny amount if you fit certain criteria which is hard to do

I was self pay as public hospitals don't do many a year and you have to be very very very large and be half dead to qualify. I chose self pay it was fast and I had no issues if I'd had to jump through hoops in order to get surgery it would have put me off if I'd had to wait I'd probably have talked myself out of it.

Self pay all the way best thing I ever did you can't put a price on healthy & happy

[Ronnie109 5]

18 hours ago, chynadoll619 said:

How is recovery coming along? And congrats!!

2017 could it be, a new me? yaaaass please!

Some days are better than others. The surgery wasn't that bad. Didn't experience a lot of things I read on here. Like the gas and pain. At this moment I'm dealing with figuring out what my sleeve can and can not tolerate. Getting my Protein in is hard even after being moved to the next stage of eating I still find myself only drinking shakes. Have you gotten the procedure yet??

[passion4film 44]

I just got my packet in the mail yesterday. "Overwhelmed" is a good word. lol

• Insurance requires a 3-month supervised diet period. I need to lose at least 1 lb. but the surgeon would like me to lose 5% of my weight, which is 16 lbs. My first official day was yesterday!
• I have to have a psych eval done - I already did it last week!
• I have to get two EKGs - I did one yesterday and have to do one closer to surgery, which is projected to be in August.
• I must attend a bariatric nutrition class.
• I have to go to at least one support group meeting - I already attend monthly.
• I have to see a pulmonologist - Not sure what this is about yet.
• I have to get bloodwork a few times throughout the process.
• I have to watch some materials on the center's website.
• I must get an abdominal ultrasound.
• I have to get final approval from my primary care physician for some reason.

[chynadoll619 247]

Some days are better than others. The surgery wasn't that bad. Didn't experience a lot of things I read on here. Like the gas and pain. At this moment I'm dealing with figuring out what my sleeve can and can not tolerate. Getting my Protein in is hard even after being moved to the next stage of eating I still find myself only drinking shakes. Have you gotten the procedure yet??

Do you have to drink super slow?

Thanks for the response, no surgery as of yet. But finished with all pre op requirements, waiting for approval.. just trying to get as much insight as in what I could experience.

[emoji813]2017 could it be, a new me? yaaaass please![emoji813]

[Ronnie109 5]

Not anymore the first week and half yes because they stress it so much to sip sip. I guzzled Water one day not noticing until after but didn't have any problems. I hope everything works out and you get approved and sfart your journey. Let me know if you do!