Getting started

[Leigh W 22]

I'm just getting started on my journey. I do not have weight loss options on my health insurance but they said surgery would be covered if it is decided it is medically necessary. They won't tell me exactly what that means but general guidelines are BMI at 40 or above, attempted weight loss over time, psychological evaluations, etc. I can self refer to a surgeon but they won't take me as a patient until my insurance approves it. So that means I have to go through my PCP and jump through all the hoops with her. Who has had to do this with their PCP? Did you have to repeat any of the process for the surgeon? Would love to hear how this went for you. TIA!

[Mattymatt 491]

Hello! Welcome to the first step of a big journey. Some insurance companies require a referral so it would be a good idea to get one from your PCP. From there, you usually attend an information session, and if you're still interested, you begin the process with your first visit with the surgeon. Your surgeon will most likely order blood work, an abdominal ultrasound, and an upper G.I study. You will also have somewhere between 3-6 months of medically supervised weight management which is often an insurance requirement. In between this time, you'll meet with a psychologist and get tested for sleep apnea. You may also get a stress test and a lung function test. If you are diabetic, generally-speaking, you must have your A1C below 8% to be considered safe for surgery.

Hope this helps you somewhat. The process is long but it is ultimately worth it. I think it taught me a lot of patience. I start my two week pre-op diet on Monday, February 26th and surgery arrives on Monday, March 12.

[Leigh W 22]

Thanks for your input. I don't have to have a referral which is nice, but they won't see me until my insurance approves it. I hope my PCP knows what all we'll need to do. I have my appointment next month.

[elforman 234]

6 hours ago, Leigh W said:

...I do not have weight loss options on my health insurance but they said surgery would be covered if it is decided it is medically necessary. They won't tell me exactly what that means but general guidelines are BMI at 40 or above, attempted weight loss over time, psychological evaluations, etc...

Sorry, I'm a little confused here. Which "they" said it would be covered if it was a medical necessity? The insurance company or the doctor's office? If your insurance policy normally doesn't cover weight loss surgery but the insurance company is willing to make an exception in your case due to "medical necessity" that usually only happens when your health is in imminent danger. While I hope that's not the case, you should expect to have to provide a lot of documentation to the insurance company from your PCP detailing all of your medical conditions and from the surgeon with his recommendations. The two doctors will likely work together to ensure they provide all the information your insurance will need.

[DaleCruse 756]

LOTS of people have been in your situation. In fact, that's something you'll discover the longer you're on this board. Whatever you're about to go through, other people have gone through too. Good luck. You are not alone.

[domi 237]

Definitely not alone. I started this process in July 2017. I went to an information session. Then got a referral to the surgeon., attended healthy plate classes, saw a nutritionist for 4 months, went to a trainer 2 months ( still going), Saw a psychologist 5 visits (will go back after surgery). I also had to write a letter of all the diets I tried and why I want surgery. My paperwork was finally submitted on Thursday. I'm glad I went through all of this because I have learned so much. Now I'm praying insurance approves my surgery. It is scheduled for April 5th.

[Leigh W 22]

11 hours ago, DaleCruse said:

LOTS of people have been in your situation. In fact, that's something you'll discover the longer you're on this board. Whatever you're about to go through, other people have gone through too. Good luck. You are not alone.

Thank you so much for your kind words!

[Leigh W 22]

1 hour ago, domi said:

Definitely not alone. I started this process in July 2017. I went to an information session. Then got a referral to the surgeon., attended healthy plate classes, saw a nutritionist for 4 months, went to a trainer 2 months ( still going), Saw a psychologist 5 visits (will go back after surgery). I also had to write a letter of all the diets I tried and why I want surgery. My paperwork was finally submitted on Thursday. I'm glad I went through all of this because I have learned so much. Now I'm praying insurance approves my surgery. It is scheduled for April 5th.

I hope you get your approval soon!

[domi 237]

I just got my approval [emoji3]