Bariatric surgery help!!!!!!
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kreyolcakee
Posts: 12 Member
Did anyone have to surgery thru iehp/medi-cal??
I recently just started my journey to bariatric surgery on Aug 14th. My insurance requires a managed weight loss program, psych exams etc as I'm sure some of u kno! Being that my BMI is > 50 I'm req. to do the program for 3 months, and I had my first sit down with my psychologist yesterday (Aug 19th) ... my insurance authorized 4 sessions. But there are so many questions!!
First off !! How long after the weight loss Program did u have ur ACTUAL SURGERY? And did u have ur ekg and ex rays after the program or during?? Reason asked is bc the way my PCP was explaining everything made me think that I would be able to have my appointments during my 3 months with weight watchers. I was even shocked that I got a call from my psychologist 2 days after I even spoke with my doctor about the surgery.
Also , has anyone ever been denied? If so wat was the reason?
Pals with all insurances can respond with advice and answers ! But if u went they iehp please give me some clarity!
I recently just started my journey to bariatric surgery on Aug 14th. My insurance requires a managed weight loss program, psych exams etc as I'm sure some of u kno! Being that my BMI is > 50 I'm req. to do the program for 3 months, and I had my first sit down with my psychologist yesterday (Aug 19th) ... my insurance authorized 4 sessions. But there are so many questions!!
First off !! How long after the weight loss Program did u have ur ACTUAL SURGERY? And did u have ur ekg and ex rays after the program or during?? Reason asked is bc the way my PCP was explaining everything made me think that I would be able to have my appointments during my 3 months with weight watchers. I was even shocked that I got a call from my psychologist 2 days after I even spoke with my doctor about the surgery.
Also , has anyone ever been denied? If so wat was the reason?
Pals with all insurances can respond with advice and answers ! But if u went they iehp please give me some clarity!
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Replies
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If you want to skip dealing with insurance altogether, look into a weight loss clinic called "A Lighter Me" in Tijuana, Mexico. My sister had the sleeve done in March of this year and she has already lost like 70 lbs! She def recommends it. There is a Facebook group if you wanted to see other patients and their stories. Good luck!2
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In the end, I decided not to do the surgery, but when I was considering it, I had to do 4 months doctor supervised weight loss before my insurance would cover the surgery. I did all the other pre-op testing within that 4 month time period and they told me that as soon as I finished my 4th visit they could submit the paperwork and (at least in theory) you could have surgery as soon as the approval came back.
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kreyolcakee wrote: »Did anyone have to surgery thru iehp/medi-cal??
I recently just started my journey to bariatric surgery on Aug 14th. My insurance requires a managed weight loss program, psych exams etc as I'm sure some of u kno! Being that my BMI is > 50 I'm req. to do the program for 3 months, and I had my first sit down with my psychologist yesterday (Aug 19th) ... my insurance authorized 4 sessions. But there are so many questions!!
First off !! How long after the weight loss Program did u have ur ACTUAL SURGERY? And did u have ur ekg and ex rays after the program or during?? Reason asked is bc the way my PCP was explaining everything made me think that I would be able to have my appointments during my 3 months with weight watchers. I was even shocked that I got a call from my psychologist 2 days after I even spoke with my doctor about the surgery.
Also , has anyone ever been denied? If so wat was the reason?
Pals with all insurances can respond with advice and answers ! But if u went they iehp please give me some clarity!
My insurance isn't with iehp/medi-cal, but, Yes, I got denied back in 2015--the reason was due to failing my pre-surgical psychological assessment for bariatric surgery--I got diagnosed with an eating disorder called BED (Binge Eating Disorder) & I would not be able to move forward with bariatric surgery until that was resolved.
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BarneyRubbleMD wrote: »kreyolcakee wrote: »Did anyone have to surgery thru iehp/medi-cal??
My insurance isn't with iehp/medi-cal, but, Yes, I got denied back in 2015--the reason was due to failing my pre-surgical psychological assessment for bariatric surgery--I got diagnosed with an eating disorder called BED (Binge Eating Disorder) & I would not be able to move forward with bariatric surgery until that was resolved.
When u went to ur psych did u have to take a written test? I heard there's a written test with like 300+ questions... when I went I had to fill out a paper with about 10 -20 questions before I was even seen by the therapist, u kno... general paper work u before u see any doctor... was that the assessment? I wanna make sure so that I complete everything accordingly0 -
kreyolcakee wrote: »When u went to ur psych did u have to take a written test? I heard there's a written test with like 300+ questions... when I went I had to fill out a paper with about 10 -20 questions before I was even seen by the therapist, u kno... general paper work u before u see any doctor... was that the assessment? I wanna make sure so that I complete everything accordingly
I had to do a psych assessment, and there was a questionnaire but I don't think it was that many questions (less than 100 as I recall).
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kreyolcakee wrote: »BarneyRubbleMD wrote: »kreyolcakee wrote: »Did anyone have to surgery thru iehp/medi-cal??
My insurance isn't with iehp/medi-cal, but, Yes, I got denied back in 2015--the reason was due to failing my pre-surgical psychological assessment for bariatric surgery--I got diagnosed with an eating disorder called BED (Binge Eating Disorder) & I would not be able to move forward with bariatric surgery until that was resolved.
When u went to ur psych did u have to take a written test? I heard there's a written test with like 300+ questions... when I went I had to fill out a paper with about 10 -20 questions before I was even seen by the therapist, u kno... general paper work u before u see any doctor... was that the assessment? I wanna make sure so that I complete everything accordingly1 -
kreyolcakee wrote: »BarneyRubbleMD wrote: »kreyolcakee wrote: »Did anyone have to surgery thru iehp/medi-cal??
My insurance isn't with iehp/medi-cal, but, Yes, I got denied back in 2015--the reason was due to failing my pre-surgical psychological assessment for bariatric surgery--I got diagnosed with an eating disorder called BED (Binge Eating Disorder) & I would not be able to move forward with bariatric surgery until that was resolved.
When u went to ur psych did u have to take a written test? I heard there's a written test with like 300+ questions... when I went I had to fill out a paper with about 10 -20 questions before I was even seen by the therapist, u kno... general paper work u before u see any doctor... was that the assessment? I wanna make sure so that I complete everything accordingly
Yes, my assessment was a 500 question "test" (mostly T/F, multiple choice--done on a computer) and talking with a psychologist. I was probably there for about 3-4 hours total.0 -
from beginning to end 7 months1
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Two years. I'm Canadian.
The psychiatric portion was done as a ten week group therapy and of the original members six ended up getting the surgery.
If you are not a good candidate (I.e. eating disorder) then the surgery is not for you.
I have heard good things about the Mexican clinics; no wait time, clean facilities, licensed skilled surgeons and good food. What they can't offer is post operative care and if anything does go wrong, you're stuck.
Sometimes the waiting, the classes, assessment, and tracking can be a good thing. It sets you up for success later.2 -
All the crazy hoops and then they only covered 5k, so I didn't do it, decided I can do this, on my own
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If you want to skip dealing with insurance altogether, look into a weight loss clinic called "A Lighter Me" in Tijuana, Mexico. My sister had the sleeve done in March of this year and she has already lost like 70 lbs! She def recommends it. There is a Facebook group if you wanted to see other patients and their stories. Good luck!
As someone who has seen the outcome of medical tourism go wrong (very, very wrong), I can't possibly disagree with this idea strongly enough.
I'm in Canada, so when someone comes back with complications it comes out of tax dollars. From what I understand in the US, when someone comes back with complications, it won't be covered by insurance companies.
OP, if you are even considering this, please do your research on what happens if things go wrong. Financially, it could be devastating. As for your life, it could lead to permanent disability, if not death (worst-case scenario, obviously).
Go through your local programs, do the work, and make sure that you are following their instructions. Do the hard work that may be required in the psych appointments. It is well worth it for you to get as much out of it as possible. Also look at how the surgery will effect your life moving forward (each type of surgery will have risks and benefits, look at these and ask a lot of questions of the professions working with you).4 -
Two years. I'm Canadian.
The psychiatric portion was done as a ten week group therapy and of the original members six ended up getting the surgery.
If you are not a good candidate (I.e. eating disorder) then the surgery is not for you.
I have heard good things about the Mexican clinics; no wait time, clean facilities, licensed skilled surgeons and good food. What they can't offer is post operative care and if anything does go wrong, you're stuck.
Sometimes the waiting, the classes, assessment, and tracking can be a good thing. It sets you up for success later.
I strongly agree with this! Now that I've been cleared of my Binge Eating Disorder (BED) and looking back on my attempt to get bariatric surgery 2 years ago when I got diagnosed with BED, I think I would have been one of the failures had they let me go through with it at that time.
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Each insurance carrier is different, and requirements are usually determined by the employer.
I had my orientation back in January, and I'm glad that I had the time to do everything under supervision and by following the rules. They took great pains to explain that the sleeve is only a tool. The rest is up to me. Adding exercise and nutritional classes was a plus. Getting in the proper frame of mind and understanding the choices and consequences if I didn't follow the established plan was very eye-opening.
Psych exam was no big deal. One-on-one twice, and it took about an hour to answer the 300 questions. A true no-brainer.
Do yourself a favor and take the time and jump through the "hoops". You only get one shot at this. Make it count. My gastric sleeve surgery is scheduled for 8/29.0 -
BarneyRubbleMD wrote: »kreyolcakee wrote: »BarneyRubbleMD wrote: »kreyolcakee wrote: »Did anyone have to surgery thru iehp/medi-cal??
My insurance isn't with iehp/medi-cal, but, Yes, I got denied back in 2015--the reason was due to failing my pre-surgical psychological assessment for bariatric surgery--I got diagnosed with an eating disorder called BED (Binge Eating Disorder) & I would not be able to move forward with bariatric surgery until that was resolved.
When u went to ur psych did u have to take a written test? I heard there's a written test with like 300+ questions... when I went I had to fill out a paper with about 10 -20 questions before I was even seen by the therapist, u kno... general paper work u before u see any doctor... was that the assessment? I wanna make sure so that I complete everything accordingly
Yes, my assessment was a 500 question "test" (mostly T/F, multiple choice--done on a computer) and talking with a psychologist. I was probably there for about 3-4 hours total.
Jeez 500 questions? I have a professional certification and the test for that was only 200....0
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