Why does a surgeon approve your surgery?

[imaginegirl 47]

I've been waiting to get into a certain bariatric surgeon for 2 months because he's been bombarded with interest. In that time, I've had a lot of time to research and ask questions.

I am 5'2" and 100 lbs overweight. I've tried several things to lose weight -- going to the gym, doing power yoga, walking, counting calories, Weight Watchers several times, giving up sugar and white food, eating as few things a day as possible.

I'm never able to stay on my routine without getting discouraged that I haven't lost much. And of course, I gain back the weight and more.

You know how it goes.

So...I don't have high blood pressure, high cholesterol, or other conditions that weight can effect. I do have a family history of these two and diabetes.

Do surgeons make a decision to operate based on your BMI *and* other health issues?

What if you don't have other health issues as I do? Is my chance of getting surgery less?

My insurance company says my BMI has to be over 40 OR I have to have these comorbid condition. I'm OK as far as that goes, I think unless I flunk the psychiatric exam.

[biginjapan 647]

I'm also short (5'3") and for my first surgery was 150 pounds overweight, for my most recent revision, 100 pounds overweight (which put me at 41 BMI). I had no other co-morbidities at the time of either surgery. However, I was self-pay for both, so did not have to go through insurance at all. Unfortunately I think insurance companies have more say than doctors do, but if you meet the minimum requirement I can't see why they wouldn't accept you for surgery. Just don't lose any weight until you get approved!

[AZhiker 2,252]

the surgeons want you to be successful, because that makes then successful. The surgeon wants to know that this procedure will improve your life and that the benefits out weigh the risks. It is the insurance company that dictates what will be approved as far as BMI, comorbidities, etc. The surgeon will do the surgery as long as they know they will get paid and that you aren't going to die on the table. Obese patients are higher risk patients. That's why many surgeons require cardiac clearance -they need to know it is safe to operate on someone. The psych and nutrition consults are important for long term success - the surgeon does not want his patients to fail. So the bottom line is that if you are medically cleared, and you are psychologically prepared, the surgeon will most likely go ahead as long as you meet the insurance criteria which means he/she gets paid.

[BayougirlMrsS 3,934]

7 hours ago, imaginegirl said:

I've been waiting to get into a certain bariatric surgeon for 2 months because he's been bombarded with interest. In that time, I've had a lot of time to research and ask questions.

I am 5'2" and 100 lbs overweight. I've tried several things to lose weight -- going to the gym, doing power yoga, walking, counting calories, Weight Watchers several times, giving up sugar and white food, eating as few things a day as possible.

I'm never able to stay on my routine without getting discouraged that I haven't lost much. And of course, I gain back the weight and more.

You know how it goes.

So...I don't have high blood pressure, high cholesterol, or other conditions that weight can effect. I do have a family history of these two and diabetes.

Do surgeons make a decision to operate based on your BMI *and* other health issues?

What if you don't have other health issues as I do? Is my chance of getting surgery less?

My insurance company says my BMI has to be over 40 OR I have to have these comorbid condition. I'm OK as far as that goes, I think unless I flunk the psychiatric exam.

I suggest you do a little homework first. Call your insurance company and ask what are the requirements for WLS. Back in 2009 (lapband) the insurance i had the requirements were..... 35 bmi with 2 co morbids OR over 40 bmi with no co's. I quilified for the 40 bmi.
I am also 5'2".... (this is one time where being short pays off). I was 232lbs so my bmi was around 42 i think. WLS was a life saver for me in so many ways. Because i had the LB my weight loss was so, but i stuck with it and followed the rules. Got to 143lbs and stayed there for nearly 8 years. Then in March of 2017, after years of zero problems, i got sick and for a week i threw up violently, slipped my band and had to have her removed. Over the next 2.5+ years (and starting menopause) i put back 30lbs of the 89 i lost. Which was still great.... but i hated how i felt. I also hated that no matter what i did.... diet, diet pills, not eating, tracking food, crossfit,.... nothing stopped it. After about a year without her i realized i wouldn't be able to keep all the weigh off with out some intervention. So i started looking for a Dr. to do a revision. My plan was to get the MGB, but no one would do it..... all i kept hearing was... You don't weigh enough.... ughhhh. I started plans to go down to Mex and have it done there.... then on a last ditch effort i called a local Dr. and had a meeting with him. He agreed that had i NOT been a previous WLS patient he would never do anything.... BUT because i was he could get me in as a "revision". So on Aug. 28, 2019 i went in for the Sleeve. No, it's not what i wanted, but i grabbed the chance and ran with it... that and 14K. Mex was about 9-10k i think. Yes i would have saved a few thousand, but it was worth the extra to have my dr. 10 min from me and not in Mex.

Today, i happy at my current weight of 131lbs. The day i was sleeved i was 173.5lbs. Worth every cent of that 14k.

[catwoman7 11,213]

most insurance companies and surgeons follow the guidelines of BMI of 35-40 you need to have two co-morbidities, and BMI 40+ no co-morbidities needed.

I can't remember who puts out those guidelines, but they're the ones most places follow.

As someone said above, there are surgeons who will do the surgery even if you don't meet the guidelines, but insurance companies are pretty strict about it.

Edited March 16, 2020 by catwoman7

[imaginegirl 47]

8 hours ago, catwoman7 said:

most insurance companies and surgeons follow the guidelines of BMI of 35-40 you need to have two co-morbidities, and BMI 40+ no co-morbidities needed.

I can't remember who puts out those guidelines, but they're the ones most places follow.

As someone said above, there are surgeons who will do the surgery even if you don't meet the guidelines, but insurance companies are pretty strict about it.

i talked to a third person at the insurance company who gave me more precise info. She said sometimes the surgeon is strict about their own requirements because they want the patient to be successful. But as far as ins goes, I do meet the requirements of 40 or higher BMI.

[imaginegirl 47]

10 hours ago, BayougirlMrsS said:

I suggest you do a little homework first. Call your insurance company and ask what are the requirements for WLS. Back in 2009 (lapband) the insurance i had the requirements were..... 35 bmi with 2 co morbids OR over 40 bmi with no co's. I quilified for the 40 bmi.
I am also 5'2".... (this is one time where being short pays off). I was 232lbs so my bmi was around 42 i think. WLS was a life saver for me in so many ways. Because i had the LB my weight loss was so, but i stuck with it and followed the rules. Got to 143lbs and stayed there for nearly 8 years. Then in March of 2017, after years of zero problems, i got sick and for a week i threw up violently, slipped my band and had to have her removed. Over the next 2.5+ years (and starting menopause) i put back 30lbs of the 89 i lost. Which was still great.... but i hated how i felt. I also hated that no matter what i did.... diet, diet pills, not eating, tracking food, crossfit,.... nothing stopped it. After about a year without her i realized i wouldn't be able to keep all the weigh off with out some intervention. So i started looking for a Dr. to do a revision. My plan was to get the MGB, but no one would do it..... all i kept hearing was... You don't weigh enough.... ughhhh. I started plans to go down to Mex and have it done there.... then on a last ditch effort i called a local Dr. and had a meeting with him. He agreed that had i NOT been a previous WLS patient he would never do anything.... BUT because i was he could get me in as a "revision". So on Aug. 28, 2019 i went in for the Sleeve. No, it's not what i wanted, but i grabbed the chance and ran with it... that and 14K. Mex was about 9-10k i think. Yes i would have saved a few thousand, but it was worth the extra to have my dr. 10 min from me and not in Mex.

Today, i happy at my current weight of 131lbs. The day i was sleeved i was 173.5lbs. Worth every cent of that 14k.

I've talked to the ins co three times about the requirements and they said I'll be qualified as long as the psych exam goes ok. I do meet the min BMI. I just wondered about which qualifications are the doctor's vs the ins co. I'll know more soon because I finally got my drs appt.

[imaginegirl 47]

17 hours ago, AZhiker said:

the surgeons want you to be successful, because that makes then successful. The surgeon wants to know that this procedure will improve your life and that the benefits out weigh the risks. It is the insurance company that dictates what will be approved as far as BMI, comorbidities, etc. The surgeon will do the surgery as long as they know they will get paid and that you aren't going to die on the table. Obese patients are higher risk patients. That's why many surgeons require cardiac clearance -they need to know it is safe to operate on someone. The psych and nutrition consults are important for long term success - the surgeon does not want his patients to fail. So the bottom line is that if you are medically cleared, and you are psychologically prepared, the surgeon will most likely go ahead as long as you meet the insurance criteria which means he/she gets paid.

Thank you for the confirmation. I feel better prepared to meet the dr in two weeks.

[imaginegirl 47]

17 hours ago, biginjapan said:

I'm also short (5'3") and for my first surgery was 150 pounds overweight, for my most recent revision, 100 pounds overweight (which put me at 41 BMI). I had no other co-morbidities at the time of either surgery. However, I was self-pay for both, so did not have to go through insurance at all. Unfortunately I think insurance companies have more say than doctors do, but if you meet the minimum requirement I can't see why they wouldn't accept you for surgery. Just don't lose any weight until you get approved!

Yeah. I was going to start Weight Watchers in case the surgeon requires me to lose weight. But then I decided to wait to see if he requires it. if he does, I want to get credit for all the weight i lose starting with our first appt.