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Insurance Discuss insurance topics for the gastric bypass and Lap BandŽ operations.

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Old 01-05-2009, 11:48 AM   #1 (permalink)
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Default So it's all up to my PCP

So I did a bit more researching. I called Health net last week to see if they covered WLS and yes, my plan does. So I called them again today to ask about specific qualitfications. They said it is strictly up to my PCP and what she thinks as to whether they pay for it or not. (medically ness) I keep reading the big 3 evils are high blood pressure, sleep apnea and diabetes.

I have degerative disc disease and GERD. Anyone have just these two issues and get it done.

My appointment is next Monday....the longest week of my life.
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Old 01-05-2009, 07:39 PM   #2 (permalink)
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I don't have either one but wanted to wish you the best of luck on your appointment.
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Old 01-05-2009, 07:50 PM   #3 (permalink)
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It will mostly be based upon your BMI and I believe your other things may count as comorbids. Good luck with your PCP! You're on your way!
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Old 01-05-2009, 08:00 PM   #4 (permalink)
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Default The big three

I had the big three High blood pressure , Diabetes and sleep apnea all of which are gone :-)
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Old 01-05-2009, 09:33 PM   #5 (permalink)
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good luck sweetie, but yea, comes really down to bmi if the doc will suggest it. Just lay your story out of him and why you think this surgery is best for you. Do alot of research on how WLS will help your Gerd and disk problem so you can have that knowledge to help him know you know what you are talking about.
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Old 01-06-2009, 12:08 PM   #6 (permalink)
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Quote:
Originally Posted by Melissah View Post
So I did a bit more researching. I called Health net last week to see if they covered WLS and yes, my plan does. So I called them again today to ask about specific qualitfications. They said it is strictly up to my PCP and what she thinks as to whether they pay for it or not. (medically ness) I keep reading the big 3 evils are high blood pressure, sleep apnea and diabetes.

I have degerative disc disease and GERD. Anyone have just these two issues and get it done.
It really depends on your PCPs view of weight loss surgery. I don't have any co-morbidities and a BMI of barely 40 and my PCP could not have been more enthusiastic (due mostly to my family history)!
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10/15/08-appt with PCP-full blessing to proceed
10/27/08-begin 3 month supervised diet
11/10/08-attended surgery seminar
12/1/08-sleep study - no sleep apnea
1/6/09-first appt with surgeon
1/23/09-psych evaluation scheduled
1/30/09-upper encoscopy scheduled
2/3/09-complete 3 month supervised diet
3/3/09-documents sent for insurance appoval
3/23/09-APPROVED
4/27/09-pre op surgeon visit
5/20/09-surgery scheduled
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Old 01-06-2009, 12:24 PM   #7 (permalink)
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Thanks Sheepla....I am hoping that because she is a SHE and young that maybe she will lean towards the idea. That doesn't really prove anything but I am hoping she can see my point of view. I have printed up so many articles online by doctors, studies etc...when related to obesity, GERD, Osteoarthritos and such in regards to WLS and its outcome.
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