the process to surgery? - ThinnerTimes

raquel · 01-17-2007, 10:40 PM

1. I'm so glad to find this site. I love it. Even though I havn't posted before.

2. My question: What is the usual process to go through? So far I have my PCP's letter of reccomendation, seminar, EKG, EGD, psch evaluation, I have had my first appointment in the office with the physian assistant, (everyone sees this person first), and I have my first appt. with the nutritionist on Feb. 1st. What next? Do I see the surgeon before the insurance is submitted? The nutrionist is the last thing on my list from the office of the things I need to do.

3. Also I am really worried; I have no records of going through any kind of supervised diet, like weight watchers, nutri system, and so on. I have heard of a 6 month dr supervised diet requirment from insurance companies. Will 2 years of Dr records help? Or I can go to my previous Dr and get 4 more.

What do you helpful people think?

Thank You
Raquel

Kendebrat · 01-17-2007, 11:52 PM

Every Insurance has different requirements. I did not have to prove prior attempts, but I did have to have 2 co-morbalities (sleep apnea, high blood pressure and or diabetes). It sounds like your DR's are trying to get you approved by giving you all the tests so your insurance will approve you. I believe you are on the right track - Good Luck

JenBear7 · 01-18-2007, 02:19 AM

I too fretted about what my insurance companies requirements were... then I went online and found their bariatric surgery policy... maybe your insurance company has one too?? The supervised diet is the only thing I am worried about.. the wording for my insurance company is 6 months worth of dieting that my physician is aware of.. so I do not think that is going to be a hurdle.. but if it is... I'll do my 6 months knowing that at the end... it will be worth it..

Good Luck!

raquel · 01-18-2007, 05:26 AM

I am 5'2" and weigh 303. BMI of 53. I have sleep apnea, I'm insulin resistant, joint pain, edema, and my blood pressure is slowly rising. It's sad to think that all these bad things that are wrong with you are a "plus".

Thanks

Zenomia · 01-18-2007, 06:23 AM

Every insurance Company has a different policy on Bariatric/Weight Loss surgery. Some even have exclusions to it. Best bet is to CALL Your Company and ASK! That is always the first thing I tell people who are interested in the surgery. Call you Ins. company and ask what you policy covers, what the guidelines are, and what has to be 'qualified' in order to maintain an approval for the surgery. All of those questions can save you a lot of time and $$ if they cover nothing. Plus, you will know in advance what you MUST have in order to get their approval. They may need additional testing that your center does not require. Best choice is to ASK! The Ins. company should be your first call...IMHO.

Tawanda · 01-18-2007, 07:51 AM

Hi Raquel,

I just wanted to pop in and say I agree with Zen (geez...don't I always? heh.)

CALL your insurance company and talk to them about this. And don't forget about your privilege of appealing. Ask about that, too, just in case. I appealed twice and was still denied, but my insurance company is nasty, there are lots of other people that appealed the first denial and then were accepted.

As far as the supervised diet and exercise...why not start now? After surgery you will need to do workouts to optimize your results anyway. If you start doing that NOW, you'll be in better shape for the surgery and you'll already be in the routine for later.

Good luck to you!

JenBear7 · 01-18-2007, 02:09 PM

I should have added that one of the "suggestions" from the surgeon was to call the insurance company.. but there have been somewhere between 15 and 20 people at my company that have had the surgery covered by my insurance.. I just wanted their rules.. thats why I didnt CALL.. and they had their requirements in black and white...

NewMel06 · 01-18-2007, 06:33 PM

Welcome Raquel!!!
You will find many helpful peeps here!
Just take it one step at a time. Though I reported on my questionaires about my Jenny Craig and Weight Watchers documented diets, no documentation was ever asked for. So just be truthful in answering questions and take it one step at a time. Good luck

raquel · 01-18-2007, 08:34 PM

Thanks to everyone I really don't know why I'm so worried my drs office told me exactly what is needed (pretty much). He said that aetna would either accept all the info they send (pcp refferal, surgeon refferal, psych, nutrition,
ekg, and co-morbities) or they request more info. The dr and web site said
6 month dr supervised nutrition or Multidisciplinary surgical preparatory regimen which is what I'm doing now. I'm just obsessed with all this and a worry wort. I read everything I can and think about it always, and worry, worry, worry and of course think about what I can do afterwards.
This board is great. thanks

Cinerbelle · 01-18-2007, 08:44 PM

What state do you live in? Do you have Aetna HMO or PPO? I have Aetna HMO...but it was actually my Medical Group that required me to do their 6 month nutrition program...it couldn't be WW or JC. I believe that Kristi (monkeygrly) also had Aetna and she wasn't required to do the 6 months (we both live in CA.)...see how everyone's journey is different!!