The process, from beginning to surgery date. - ThinnerTimes

MSP · 05-13-2005, 12:06 PM

Hi all,

I've been doing a lot of research on this forum but I can't find quite exactly what I'm looking for. Can someone explain to me the entire process, step by step from beginning to end? Starting from the first day you tell your PCP that you want to have this surgery. Assuming he's supportive, what happens next? Do you take it upon yourself to make the nutritionist, psychologist, etc. appointments? Or would it be wise to just wait until you get your referral from your medical group before doing anything? I just want to get the ball rolling...

Thank you so much!!

Gladitsme · 05-13-2005, 12:43 PM

Hey MSP,

Welcome to the forum. I think the reason you haven't seen it step by step is that different doctors have different requirements. In my case, I decided I was sick of being fat, and wanted to do something to make my life different. So, I called and got a reservation for an educational seminar. I went last December. Then in January, I got an appointment with my PCP and told him what I wanted. He gave me the familiar answer, just exercise more, and eat less. I got mad, and he finally agreed to send the referral to the Utilization Management committee. I got the referral and called Dr. Callery's office. They signed me up for their educational seminar, and told me since I'm married, my husband had to come with me. They mailed me directions and my reservation letter. We went to the seminar, and both of us were impressed with Dr. Callery. They gave us some paperwork to fill out and a list of required medical exams we needed to have. I got my well woman check up, mailed my paperwork back to Dr. Callery's office and waited. Finally I got the phone call to come in for an appointment with Kelly who is the nurse practitioner there. I waited impatiently, and then my husband and I went to that appointment. They weighed me, figured my BMI, my fat percentage (yikes!) and went over their policies and procedures. Gave me the list of tests I need, blood tests, UA, mammogram, well woman check, gallbladder ultrasound, psych eval, etc. Some people have to have a sleep study if they have sleep apnea.
I've finally gotten all my tests done, and am waiting to get the results mailed to me, so that I can get them to Dr. Callery's office. Once that's done, they will dictate the request for auth for surgery and send it to my insurance. Then if insurance says yes, they will call to schedule me for a preop appointment. I haven't done that part yet, but they also give me my surgery date. I'll let someone else take it from there.

Ann8615 · 08-10-2006, 08:03 PM

Hi,

Excellent question. Here's my process so far: (I'm sure everyone's will be a little different). Let me apologize in advance if it is too detailed.

Mid - December, 2005 - Began thinking seriously about WLS. Weight approx. 215. Knew I would have to quit smoking before I could have the surg. & didn't want to begin the process til after quitting smoking because I was afraid I might not be able to quit the cigs!
April 3, 2006 - Quit smoking (major miracle!)
06/01/06 - Saw Primary Care Dr. (PCP) to discuss WLS and request referral for WLS consult. My weight was 224. He agreed, and did preliminary bloodwork (CBC only).
06/05/06 - Rec'd call from Insurance Co. to discuss approval for WLS consult. They were reluctant to approve consult becuase I did not have a recent (within the past 12 months) medically supervised weight loss effort that failed. Explained that I have been through J.Craig, Weight Watchers, Slim Fast, Meridia (pills), Phen-Fen (pills), Overeaters Anon, and most recently, LA Weight Loss (1 year, $2,000 and a 15 pound gain on that one, folks)

Explained that I was at the end of my rope, started to cry....(not enough drama in my life?

). She said she needed a detailed history of my efforts (dates, names of programs and approx results over the phone would do) and would have to discuss my case with the medical director of the insurance company. 2 hours later she called back with verbal approval for consult.
06/07/06 - Received written approval from ins. co. for WLS consult. (I don't believe anything til I see it for myself!)
06/27/06 - Attended WLS education lecture (required by Dr. Callery before consult can be scheduled). Received WLS consult registration packet (which included an assignment to write an essay on why I want WLS). I would have attended this 2 weeks earlier, but had a prior evening committment.
07/04/06 - Slipped on the smoking thing & smoked 2 cigs.
07/11/06 - Submitted WLS registration packet to Dr. Callery.
07/12/06 - Made WLS consult appt.
07/13/06 - Saw my psych, he had to make med adjustment (getting off anti-depressent Paxil) in anticipation of surgery. His thinking is that the Paxil is the cause of my weight gain (yeah, right, I've been obese since I was 20, only been on Paxil 3 years).
07/14/06 - OB/GYN annual exam. Requested test results be sent to WLS surgeon (Dr. Callery)
07/20/06 - Another psych appt. (this guy is very thorough, and since I have bi-polar disorder, it's probably a good thing.) If you're not seeing a psych on a regular basis, you will probably have only a brief psych. consult in prep for WLS, ask your surgeon to recommend someone. Psych agrees to one more appt on 08/22/06 before he will approve WLS.
07/26/06 - Attended Dr. required Dietary Education meeting.
07/31/06 - Had WLS surgery consult. They agree that the surgury will be helpful. Yay! They sent me home with Dr. orders for a boatload of blood tests, EKG, Abdominal Ultrasound, Mammogram, echo cardiogram. Because I slipped on the smoking, they also asked for a Nicotene Level, and will take another one prior to surgery.
08/04/06 - Blood tests, EKG and urinalysis done at PCP's
08/08/06 - Echo Cardiogram (fancy ultrasound for heart function)
08/09/06 - Abdominal ultrasound (to search for gallstones I guess)
08/10/06 - Mammogram. Checked with WLS website, they received all my blood work results (YAY). Expect all other test results by 08/17/06
08/17/06 - Recieved email from Dr. Callery's office - they have all test results except my psych eval (which is scheduled for 08/22). How amazing - I guessed exactly right, that they would have all the results by today!

That is the process so far. FYI, each of the test appointments took approx. 1 hours, so I was able to do them on my lunch hour, taking a little extra time for driving time).
08/22/06 - Will see my pysch and request his written approval. Expect about a week for psych.s approval to get to Dr. C. (All he has to do is dictate a letter & fax it over, but knowing my psych, this will take at least a week!)

Here is what Dr. Callery's office is telling me to anticipate as far as dates are concerned. By:

08/29/06 (estimate) - Labs placed in chart, checked & readied for dictation (estimated duration 1 week)
09/7/06 (estimate) - Chart dictation & transcription (estimated duration 1 week)
09/14/06 (estimate) - Insurance authorization preparation & mailing (estimated duration 1 week)
09/30/06 (estimate) - Insurance authorization review & approval (estimated duration 1 - 6 weeks, usually about 2 weeks). As soon as Dr. receives authorization from insurance company, they will call me to schedule surgury date. I can schedule surgury anywhere from 1 - 2 weeks to 3 months from the date of my authorization. I say, bring it on, let's do it asap!!

10/15/06 - 10/31/06 (estimate) - Pre-op visit with surgeon (the Thursday prior to my surgury) and WLS surgury. Hoping for this to be done asap.

Again, sorry for the excess detail, but you asked! When I attended the educational seminar, they gave me a handout detailing the steps and explaining that the work-up takes 2-4 months. I think a lot of it depends on what your insurance is like (PPO is faster), and how quickly you can get in for tests. I am pretty agressive, so I was able to schedule the tests right away.

Keep us posted on your journey!

ann

LyndasRoom · 08-10-2006, 08:05 PM

Ann, that detail is a beautiful thing! I wish I'd have kept such a list.

brookscn · 08-10-2006, 08:44 PM

Ann:
That's amazing the way you have that all charted out. I coordinate very expensive tradeshows, and even I don't have the dates down like THAT!

You're a planner, girl!

deadboy · 08-11-2006, 05:38 AM

As with every part of this process, it's different for everyone. You'll hear some people that fought doctors and insurance companies for years. Or some lucky bastards like me decided they want to pursue this surgery. I talked to the surgeon in February. He said see my PCP, which I didn't have at the time, and have them give me a check up for weight and co-morbidities. I found a doctor. Talked to my insurance. I was approved in 3 weeks. Then 2 months, 3 psych visits, 1 nutritionst, 1 cardiac, and 1 pulmonary exam later I was on the table ready for a new life.

gina0922 · 06-22-2008, 01:02 PM

Ok here's the thing with me. I decided last yr that I wanted to do this. I have been fat too long and another diet wasn't going to save me. I spoke to my pcp and she agreed it was a good idea. I officially started on my 6 month supervised diet in March. I knew the chances of my Ins telling me to do it was good so I went ahead and got it started and documented. I attended 2 different seminars and decided I would rather go with Dr Jawad in Ocala. I called my ins comp (BCBSNJ) and was told by whoever was on the other end that wls was excluded unless it was medically necessary. And that I needed to submit a "Letter of Medical Necessity" to them. I'll have to call the ins comp back and find out exactly who "them" is. Who would be the specific person or dept to mail too? Dr Jawad has a $250 consultation fee. I really don't want to spend that much money up front to find out if the Ins comp is not going to approve the surgery. I wanted to see what they had to say before I started putting out the money (copays) for the psych eval, nutritionist, sleep study, and such. Those $30 copays can really add up! Is it ok to go at it this way?

doxielover · 06-22-2008, 10:13 PM

Hi Gina! The Letter of Medical Necessity should come from your PCP. Your PCP will document all of your problems that stem from being obese and your prior diet documentation and submit it to your insurance company. You shouldn't have to pay a consult fee for the surgeon - your insurance will cover all consults if they approve you for a formal referral! Good Luck

Withacy · 06-23-2008, 04:05 AM

I have Kaiser HMO, so my journey has been a long one.

Once I finally decided to do the surgery, I went to my PCP, who had no problem giving me a referral (he seemed glad to do it) - that was early June, 2007 (more than a year ago now). But through Kaiser, the referral wasn't to the surgeon, it was to an endocrinologist who acts as gatekeeper. It took nearly 2 months to get an appointment with him - I saw him on July 27, 2007. He gave me materials, told me all the negatives, and told me that they didn't do "evaluations", they did therapy (both psych & nut) which would be ongoing before AND after surgery. He said that increased the long-term success of the surgery.

I had 20 psych visits (and I had to wait 3-4 weeks between them for appointments), and 8 nut visits (about 3 weeks apart). For the nutritionist visits I had to fill out a form, writing down everything I ate, telling how I felt when I ate it and what my level of hunger (1-10) was at the time I ate it. And then my nutritionist went over my "homework" at each visit.

Finished the nutritionist, she wrote an approval letter. Finished with the psych visits just last month & she wrote the letter. Then I had a sort of "um...now what" moment, because no one could tell me what to do next. Finally the appointment folks told me I had to go back to my PCP. I did, he told me I needed to go back to the Endocrinologist, so I did. He told me I could've just called. $30 down the tube in co-pays. Anyway, that was last Thursday. He said he'd send a final approval letter to the HMO (I'm to call this week and check on it), which will take 7-10 days to be approved. Then I have heart, lung, gallbladder tests and an upper GI. Then I get a referral to a surgeon (if all goes well) and a surgery date. He says it will take about 2 more months. We'll see.

From what I'm reading here, it sounds like my road is a LOT longer than most. Hopefully yours will be shorter.

Claire-in-Texas · 06-23-2008, 04:58 AM

Every situation is different. I experienced NONE of the situations above.

My PCP was NOT in favor of my having the surgery (she is way overweight herself), but my insurance didn't require her letter of medical necessity. I found a great bariatric surgeon, went to him, and wthin the next five weeks I had all the testing and nutritional visits he required and I had surgery. I am grateful it was very simple in my case.

It's just mportant to realize that there is no cookie cutter situation for this, and I wish you the very best of luck in your journey!!!