New Member.. questions.. - ThinnerTimes

mindycure · 04-12-2006, 07:15 AM

Hi everyone, I am new to this board, but so glad I found it. I have not really done too much in the way of going to doctors and such so I really don't know what I will need. I have my first consulation with a doctor on the 26th of this month. I did already go in and filled out a bunch of paper work and have attended one support group so far, but that is it. I am really worried with some of the topics on here that I will be denied through my insurance. I have The State Health Plan for my insurance.. I don't have any proof of any dieting i have done. What are they looking for in this, just to see if you have attempted to lose weight, or what? I brought in my doctor documents from when I went to my back doctor over the past 5 years and my reg. gyno doctor, but I don't have anything in there on weight loss, so I am getting worried that I won't have the documentaion they will need.
I am currently 255 pounds, and as far as any other health problems, I have a lot of back problems, and I just get really tired out quickly, but I am sure that is normal with being heavy. Sorry for this long message, but I want to be prepared for my first doctors appointment and to know what the insurance people are looking for. I would love to hear from some of you.. Mindy

coptergirl · 04-12-2006, 07:29 AM

Hi Mindy..

First, let me welcome you to the forum

As far as your first visit goes, do all the research you can so you are prepared to possibly educate your PCP on the subject. I also had compiled a spreadsheet with all of my weight loss attempts listed which impressed my doc b/c he saw how prepared I was...that this wasn't a fleeting thought on the way over to see him. I would also read the fine print in you insurance clause/contract to see if wls is covered - or you can call your insurance company to discuss it.

I wish you the best of luck on your journey...again, welcome to the forum family!!

mindycure · 04-12-2006, 07:46 AM

Well my appointment on the 26th is with the bariatric doctor. I have been to a regular doctor in several months. I told the place that i am going to this, and they said to go ahead and come in, they said that with the insurance i have I didn't need a doctor referral, but I am just wondering what documentation I will need. I had called my insurance a few weeks ago and they said they do cover WLS as long as it was medically necessary.. So who knows.. I just pray I will get approved, I am so ready to shed these pounds!

coptergirl · 04-12-2006, 08:20 AM

Then your surgeon, through his meeting with you and subsequest tests he will do on you will determine if you're eligible. Good luck

riotgrrl · 04-12-2006, 08:53 AM

hey just wanted to wish you goodluck!
i did not have "proof" of my dieting but i did have the nurse cordinator write it down. i also needed proof that i had been overweight for 5 years. im sure you will do fine. good luck!

mindycure · 04-12-2006, 09:02 AM

thanks for the replys. Yeah i hope that i don't have any documentation won't hurt. But you don't really think about this until it's time to do it, you know? I just hope it all goes smoothly

NewMel06 · 04-12-2006, 12:08 PM

It just really depends on your insurance companies requirements. I didn't have documentation of my weightloss efforts, nor did I have to do the doctor supervise weightloss program of 3 to 6 months that you hear about. Each company seems to have it's own set of rules. Hopefully your surgeon will have performed WLS on someone else with your insurance, and his/ her administrative assistants will be able to fill you in on what the company is like and their requirements. Do you have a handbook from your insurance? They may state specifics in there, or call the insurance company and see if you can get some one on the phone who will help you out. If so,anything they state to you over the phone, ask for a hard coppy of what they are saying or promising. I know this is sort of an uneasy period. You made the decision to do this, and now there is so much red tape and uncertainty. I wish you luck. Welcome and we are all here for you.

Dave T in SD · 04-12-2006, 12:40 PM

Welcome Wendy,
Sorry I can't answer your question on insureance problems, but I'm sure there are people that can help ya!

Remember, the only bad question is the one that goes unasked!!

Zenomia · 04-12-2006, 01:04 PM

Quote:

Originally Posted by mindycure

I have The State Health Plan for my insurance.. I don't have any proof of any dieting i have done. What are they looking for in this, just to see if you have attempted to lose weight, or what? Mindy

First and Foremost....WELCOME!!! Second, Don't freak yet. No reason to. Like Whitney said, be prepared!!

I would call your Insurance Company again and ask specificially what WLS is covered what isn't and what criteria you need to meet in order for that coverage to be deemed medically necessary. They will look at your particular policy and let you know exactly what it says. Or, you can look at the policy yourself and see what is required. (Calling is sometimes easier, though not all insurance people will answer questions fully...so be specific and don't quit asking until you know exactly what you need to have have to get approval!!)

For instance: My Insurance required 5 years of diet records/history followed by a physician, a BMI of 40 or higher with no co-morbidities or >35 with 2 co-morbidities documented and with current perscriptions. I also had to have a referral from my PCP and the Psych. Eval was required. I learned all this from one call, and went to my PCP prepared for what I needed to do!! I suggest the same for anyone starting this process....Good Luck, and welcome!!

Kitty · 04-17-2006, 03:50 AM

I too am going thru the motions of opting for weight loss surgery. I'll keep an eye on your progress, and if any information comes up that I get thru my journey, I will make sure I post it on yours. Lots 'O Luck to ya chickie...

Jacqueline