majorsmama

I haven't had surgery yet but I recently stopped taking my metformin. I know I will have to quit before surgery and I was only taking it to improve fertility and since I can't have a baby for a while, I have no use for it. I'm pretty confident based on past weight loss, that weight loss from the sleeve will help me become fertile again so I am happy to kiss those horse pills goodbye!

Call your surgeon. You're dealing with way more than anyone here is qualified to help you with.

It will all depend on your insurance and surgeon requirements. My insurance requires a 90 day medically supervised weight loss and I have two appointments left to go. I had a psych eval already. I have a class I have to take in a couple of weeks, followed by an endoscopy the following day. And then once my 90 days is up (early May), the surgeons office will submit to insurance and upon approval, I will have a blood test and chest x-ray prior to my surgery. I would recommend knowing your insurance coverage and from there you'll get a better idea of what the timeline will look like. Good luck!

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If I didn't like Dr Chen and the medical staff so much, I probably would have switched practices by now. Let's hope we get through this process without additional stress!

I'm having surgery with Dr Chen also! I love him. The office staff, not so much. They are really giving me the run around about the medically supervised weight loss. My insurance company only requires 90 days, and they consider the initial consult the first appointment. Today I was told by someone in the office that their (Banner Bariatric) policy is that they do not count the initial consult. It's been pretty frustrating for me. I've waited so long to be able to have this surgery and to now be forced to wait another month for no good reason is rather annoying. If all goes as planned, I will probably be having surgery in early June. I have my pre-op class and EGD in 2 weeks!

I kinda figured but I have posted this question here before and several Aetna policy holders said the same thing my surgeons office said. So it's either a common misconception that people don't bother to research... or many surgeons are milking people in this same way.

Initial Consultation and Weigh in This is very helpful! My surgeons office is trying to tell me that the initial consult and weigh-in doesn't count as the first appt, however Aetna told me that it absolutely does. So it's nice to hear from someone who has been through it who used the initial consult as the start of the 90 days.

Was your December 2014 visit the initial consultation? or a separate appt?

Can you explain more about not being on the pre-op plan for 90 days? I'm sort of fighting with my surgeons office about this now. They are saying I need 4 appts that are independent with the nutritionist (initial consult when I was told to start the diet not included). But Aetna told me that the initial consult does count if my diet began then. So please explain how yours was short the 90 days??

Oh and as for cost, your insurance will have a max out of pocket that you are required to pay. For example, my plan is 80/20 but my max out of pocket is $2000 so I shouldn't have to pay more than that. So far I have paid my $500 deductible at my initial consultation and then have paid a $27 co-pay at each visit with the nutritionist.

My plan is Aetna Choice II (my card says nothing about POS). I'm not sure how it differs. But here is the bulletin from Aetna regarding bariatric surgery: http://www.aetna.com/cpb/medical/data/100_199/0157.html I am required to do exactly what it states in that bulletin. My BMI is over 40 so I don't need to show co-morbidities. I did have to do a psych eval and I will have an endoscopy but that's more for the surgeon than the insurance company. I didn't have to do all the labs or sleep study and all that.

I'm 5'4" and my ideal weight per my surgeon is 128.2. I wouldn't mind getting there but I think I would be beyond happy at 140.

Why did it take 4 months? Mine is 90 days also so I'm just curious if I should expect longer. ????

If you had to do a weight loss regimen prior to insurance approval, how much weight did you lose in your required weight loss period (e.g. 90 days or 6 months)?

My surgeon told me that my ideal weight based on my body composition was something like 115 and I'm 5'4". That's what the fancy scale at the surgeons office computed. If I can get there, AMAZING! But my personal goal is about 25lbs more than that. It seems odd to me that your surgeon would be insistent on you being any weight considering statistically, the sleeve only averages a 50-75% weight loss. I think most surgeons are a little more conservative and realistic than yours. ????

I called and spoke to the bariatric guru at Aetna and the one thing she stressed to me is to not gain a single pound during the supervised diet. I am pretty certain you'll get denied the first time but maybe your surgeons office can help you with an appeal. Or maybe you can do another month of weight loss and lose 10lbs.

See that's what I'm having trouble understanding. Why 4 appts? At my initial consultation I was asked to start my diet. So today I had my first medically supervised weight loss appt and I had lost 9 lbs. So if I have to go to 4 appts, then my weight loss ACTUALLY should have started today. So I lost 9 lbs and it doesn't even matter or count towards my 90 day regimen. I don't understand why it's not 3 appts. That would be a true 90 day diet.

If you had or are in the process of doing your 90 day medically supervised weight loss, how many appointments are/were you required to have with your dietician?

Well I have my plans requirements and I know what I need to do. I just find it odd that they have these specific 90 day requirements and at the end of the day, they are simply taking your word for the changes you are making.

How do you have to document your exercise and behavior modifications?

I haven't been sleeved yet, but I just wanted to tell you do not question the decision to be sleeved. I'm 36 and I have lost 100+ lbs twice in my life and gained it all back, plus more both times. And in between those huge losses, I've dieted and lost 10-40 lbs many times. Even if you did diet and exercise to lose the weight, the odds of keeping it off long term is only like 5%. I wish so badly that this surgery had been an option for me at 24.

I am using the nutritionist at my surgeons office. I called Aetna and they said that's fine as long as she documents my weight loss, exercise, and behavior modifications. But aside from the weight loss, I can really just make up the other stuff so it just seemed odd to me that they are trusting what I tell the nutritionist. She's just told me cut out carbs for the most part.

For those of you who are doing the 90 day weight loss regimen, what all are you doing? What kind of diet? What kind of exercise? Who is keeping track of it all for the insurance company?

I had my first appt with my surgeon on the 6th I think? At the end of the consult they scheduled my next nut appt and they had me walk downstairs to the psychologists office and schedule my psych eval. That's all I've gotten done yet. I don't have to have a sleep study so I believe all that's left is the ekg, blood work and endoscopy. I asked when I could schedule the endoscopy and they told me that would be later in the process. I'm not concerned about it though because these surgeons and their employees do this for a living and I'm pretty confident they've done it plenty of times before.