Need a little info - ThinnerTimes

ForMyMom<3 · 08-24-2007, 11:04 AM

Hi everyone! I found this place by searching for info about gastric bypass. Ill try to make this short but understanding.

I am here trying to get a little info for my mom, she has scheduled her first seminar and its on Sep. 8. She is very excited and Im am more than excited for her.

I thought I would find out a little bit of info that may help her along the way, and this looks like a great place for tips and fyi's.

What I would like to find out is..what types of information, testing, etc. is she going to have to show documentation for? We just want to know so when she goes in for her first consultation with the surgeon she can be prepared providing information that may take a little time out of the process getting from approval to surgery.

So far this is what she has, and is prepared to take all documetation with her for her first consult.

A refering physician
mammo and pap 2 months ago
documentation of sleep apnea
scheduled her stress echo test w/cardiologist
past history of failed attempts at weight loss

I know that she will have to go for a psych evaluation, is there anything else that she may need to show proof of that may speed the process along.

Thanks for any replies and help!

lward76 · 08-24-2007, 11:14 AM

sounds like she is on the right track, also i would include a eating journal. but i also had to have proof of trying on my own with diet centers like weight watchers and health clubs of at least 1 year!! but, all docs are different and requirements are different...example some docs put you on a liquid diet before surgery and my doc didnt make me!!! im sure others will reply to help you out more!! Good luck!!

electrichoney · 08-24-2007, 11:54 AM

One other thing that makes this question a little difficult to answer is that requirements differ by insurance company as well. For example, my insurance company, Anthem BCBS, has set criteria for who qualifies for the surgery. If you meet the criteria, you qualify. No need for physician-supervised dieting or any of that stuff. My next-door neighbor, on the other hand, has Aetna, and they're giving him the run-around on approval. It's quite likely that your mom will need to undergo a psychological evaluation -- most good bariatric surgeons require that even if her insurance company doesn't, and she'll need documentation of her co-morbid conditions. Her surgeon also may ask her to write a letter to her insurance company stating in her own words why she thinks she needs the surgery. My surgeon had me do that and it was attached to the packet they sent to my insurance company for approval.

Best of luck to you and your mom -- I hope she gets approved!

ForMyMom<3 · 08-24-2007, 12:19 PM

She is on diabaility so her Ins. is Medicare/Medicaid if that helps any.

Gina in NY · 08-26-2007, 03:24 PM

This is a hard one to respond to, as mentioned above. Every surgeon, insurance company etc. in every state is different.

Basically, when she goes to her seminar, have her take a list of questions. Speed is not really the issue if she has do to, for example, a 6 month supervised diet. But the surgeon should know the requirements for medicare in your area. I sure don't.

You could also just call the insurance company. They'll tell you! It is much more up to them than the surgeon when it comes down to it!

Good luck! She's lucky to have such great support!

ForMyMom<3 · 08-27-2007, 06:54 AM

Thanks guys for the info! I guess Im just so excited I wanted to find out anything I could that would be of help to her as far as the approval process. Shes wanted this done for a long time now and Im behind her 100%. I will keep an update here on her!

ForMyMom<3 · 09-11-2007, 07:42 PM

Mom went for her seminar Saturday and it went very well, the surgeon told her she would be a perfect candidate. She spoke directly with him after the seminar and told her he would accept some of the testing that she has recently had done...pap, echo-stress, mammo, etc. She spoke with him about her insurance and he told her that the only other things she would be required to do is the psych evaluation and testing for h-pylori (sp) and a meeting with a nutritionist. She has her next appt with him on the 26th of this month and they will schedule her to have those 3 procedures done all in one day. He told her that her surgery date should be within the next 6-8 weeks. Moving along nicely! He also mentioned that because she has a hernia that during her surgery he will perform some type of tummy tuck. Anybody know anything about that?

Ok, just thought I would update with the good news.

Claire-in-Texas · 09-12-2007, 05:41 PM

Hi, yes, Medicare covered my surgery and I was immediately approved. My surgeon said and did exactly as your mom's surgeon said. And I had surgery in 5.5 weeks from the initial seminar. I wish her the best. It is life-changing in the best possible way - at least that has been my experience!

lward76 · 09-12-2007, 08:59 PM

That is why my rny happend so fast as well...my medicare paid for it and they didnt need a prior approvel due to its a center of advanced medicine builiding after i seen my surgeron it was less then 2 months!! I should have taken more time to study and do more reasearch but being me and naive i didnt ....i just rushed and rushed but i did go to the support meetings which i find is still helpfull, even though i dont like going there anymore due to they look at me with disgust but now i just say tohell with them and go anyway, and i drag me husband cuz he is my backbone and with him there with me i will say anything!!

ForMyMom<3 · 09-13-2007, 05:16 AM

Oh thanks so much for replying! It is very encouraging to see someone who from start to finish had a pretty smooth procedure. We are trying not to get too excited, figure there will be something that comes up but we are keeping fingers crossed that she has surgery by Thanksgiving!