Surgery questions... PLEASE HELP!!!!

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kreyolcakee
kreyolcakee Posts: 12 Member

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!

Replies

  • garber6th
    garber6th Posts: 1,894 Member
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    The wait time for surgery varies greatly between insurance companies and surgeons.

    My insurance required that I be in a 6 month program with my surgeon prior to surgery before they would even schedule the surgery or the tests required. Once the 6 months passed, they started scheduling the sleep test, psych evaluations, EKG, endoscopy, etc, and then they scheduled my surgery. All in all it was 9 months of pre-surgery requirements. I could have had the surgery a bit sooner but the date I chose worked with my schedule.
  • MeemawCanDoIt
    MeemawCanDoIt Posts: 92 Member
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    I had already met my 6 month supervised diet requirement in May when I officially started this journey. My PCP and I had already been monitoring weight and diet for a year. I'm still waiting for my PCP's office to submit all the correct records to the bariatric office for forwarding to insurance. I've been delayed three months because of this. In the meantime, I met for the psych eval, had a consult with the dietician, and met with the bariatric nurse practitioner. Also while waiting, I had all bloodwork and a scope. I have met all the requirements as of a month ago and still nothing has been submitted to my insurance. Insurance will take up to a month, and then I'll have to wait for an appointment to meet the surgeon (a month), followed by waiting for the surgery. I'm looking at late November, probably. That's a six month wait AFTER meeting the 6 month diet my insurance requires. :( In the meantime, I've been dieting. My BMI was recorded at my first visit with the NP at the bariatric clinic, and it was 40. I have lost more weight since, but insurance will use the weight at my first visit to determine eligibility. I'm getting close to wonderland but look forward to the surgery as a tool to manage my weight loss and achieve my goal weight. It's a long process, but I've been using the time to get used to the changes I would have had to make for surgery. Best of luck!
  • loveshoe
    loveshoe Posts: 365 Member
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    I had BCBS, there was no waiting period or required diet. I'm sure that depends on how BCBS was negotiated by my employer. My initial visit with the doctor was in August, I immediately scheduled my psych visit and upper GI/sonogram etc. I was approved in September. I waited until the next year to have the surgery because I had not met my deductible for insurance and didn't want to pay at the end of the year. If I had a complication I wanted to get the full benefit of my prepays.
  • prettydreamy
    prettydreamy Posts: 13 Member
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    i havr bcbs and didn't have a supervised diet restriction, but my surgeon made me lose a certain pecentage of my body weight before surgery. he did make me follow a liquid only diet for a week before surgery, which was the hardest part. i followed the ketogenic diet during my 6 months prior to surgery to lose almost 50 lbs (more than my surgeon asked) to show my committment to this lifestyle. per my insurance, i had to have the following: 2 dietician appointments, 1 psych eval and appointment, 1 cardiologist appt, 1 pulmonary dr appointment for a sleep study (where i ended up with a cpap, UGH). also had to have a swallow test to check for hernias (test did not show a hernia but he had to repair it once he went in to see it). all in all it took about 5-6 months from my first appointment with the surgeon to finally have the surgery. i pushed to get my appointments in fast because i was so impatient! no regrets. would have the surgery all over again. i am a smaller size than i was in high school and i have a ton more energy.
  • clcmfp
    clcmfp Posts: 108 Member
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    I have Blue Shield of CA. No supervised pre-op diet. I saw the surgeon for the first time on Dec 13 and had surgery Feb 22. During those 2 months, I did the psych eval, upper gi, insurance approval, and was asked to lose 10 pounds. It all went very fast.
  • Lgcoulter33
    Lgcoulter33 Posts: 54 Member
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    I have united healthcare community plan through medicaid. I have to have 6 months monitored diet and a psych evaluation and a letter of medical necessity from my doctor. The scope and sleep study are required by the surgeon. My insurance covers it all as long as the appointments for the pcp say that they are about weight loss. I just started in July. I go to my 3rd appointment with my pcp on September11th
  • pneschich
    pneschich Posts: 325 Member
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    My BXBS required 6 months, 3 year weight history, shrink visit and dietitian visits. Use the time to get your head right. This is a tool not a solution. Lose now, shrink your liver and make surgery easier on you and the doctor. Learn to plan and prep and make it a habit. Try, fail then forgive yourself now when it doesnt hurt, but learn what caused it. It is my head that still requires the work. 6 months post VSG. Lost 50 pre and almost 75 since.
  • professor700
    professor700 Posts: 78 Member
    edited August 2017
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    I was self pay. 1 psyche clearance. 1 pcp clearance. wait time < 3 weeks. If you have that option, take it.
  • Mandy_1982
    Mandy_1982 Posts: 160 Member
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    My insurance required 6 months of dietitian appointments/weight management education classes, a sleep study, a psychological evaluation, and a physical therapist evaluation (for exercise).

    After the six months of classes are done and all other conditions are met, patients meet with the surgeon and schedule surgery.

    For me, it was nearly a year from starting my program to actually getting my surgery. This was because I took time after my six months was over to finish up my semester at school before having surgery. I started my program June 2016 and had surgery May 2017 (but could have had surgery in January 2017).