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

[dstgirl11 22]

On 4/9/2017 at 6:32 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!

After completing six-months of weight-loss check-ins, a 1400 calorie diet a day, submitting 3 years of medical records from a PCP, I was denied. The insurance company need a medical records from my PCP that I did not have because my doctor moved her practice. So, the insurance company told me to send in a letter of medical necessity and dated photos from the year I was missing. I did that and they stalled and stalled and stalled. After I kept calling them, they finally approved my surgery since I guess they couldn't find another excuse to deny me. I really was looking for a way to self-pay because the process was very tedious and heart beaking.

[ChaosUnlimited 559]

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!

My requirements, between insurance and the surgical center:

5 Year weight history from PMD

6 month supervised diet

Enrollment in the insurance bariatric program - basically had to schedule two phone calls with an insurance nurse and answer all the questions

Psych Eval

sleep Study

EGD

Labs

3 Nutrition Classes with one more pre-surgery

2 Support Group/Education meetings

3 visits with surgeon

No weight gain after starting the program, preferably weight loss

The requirements were a real hassle, but in retrospect, necessary to ensure that I was ready to make the commitments needed post surgery. I have learned a lot, and I go into this surgery knowing that it will be a lifelong commitment and change is needed to be successful. The classes really motivated me to make changes in my diet and start exercising again, so while I wished the whole time that it was an easier process, I'm glad in that I feel very prepared for what I have to do.

[rainyann 118]

I had what seems like all the tests and It did seem discouraging at first but I am happy I went through them all. I had no co-morbidities except moderate sleep apnea. I had an "at-home" sleep study, a pulmonary consult with pulmonary function tests and chest x-ray. A cardiac consult with echocardiogram and cardiac stress test. All the blood tests. An endoscopy, abdominal sonogram, lower extremity dopplers. The abdominal sonogram was good to have because it picked up very large gall stones which prompted my surgeon to remove the gall bladder at the same time. A psychologist evaluation, and met with the nutritionist. I did not have to have supervised weight loss but I was told I needed to show I could lose some weight while in the pre-op mode. Then I had to write my weight loss history and attend a nutrition and pre-op class. The best part, and I realize I am lucky. I didn't pay for any of these... my insurance paid for ALL the testing and fully covered the cost of the surgery and hospital stay. All I paid for were a couple of $40 co-pays for some of the MD visits. Everything was free as long as I used one of the hospitals in our health system. So I feel I am blessed and didn't mind the extensive work-up. I just don't understand those insurance companies that don't realize this surgery can be life saving.