AK37

I got my sleep study results back today. I have severe sleep apnea, 32 apneas per hour. I'm going to get a CPAP machine. I will also be able to get an appointment with the bariatric surgeon now that I meet my insurance requirements. Sent from my XT1575 using BariatricPal mobile app

I went to my first appointment with the cardiopulmonalogist today. She did an EKG and said it looked like one from a sleep study of a person experiencing sleep apnea even though I was awake. I'm going to have an echocardiogram next week and will get a sleep study soon. Sent from my XT1575 using BariatricPal mobile app

My surgeon's office said I need at least one comorbidity for Medicare to cover my bariatric surgery. My PCP has put in a referral for me to have a sleep study done to see if I have sleep apnea. I do snore loudly every night (my boyfriend has to leave and sleep in another room), feel tired during the day, have trouble falling asleep, and am a light sleeper. It can take me up to 12 hours of being in bed to feel rested. I'm definitely not a morning person LOL. According to my Fitbit, when I sleep I spend 17% awake, 20% REM, 50% Light, and 13% Deep during my average of 7 hours of sleep. My PCP said it would be an at-home sleep study, and depending on the results I would go to a sleep lab for further testing. I've never done a sleep study. I hope my results will come back positive for sleep apnea so I can get bariatric surgery, and also find a solution to my poor sleep, snoring, and tiredness. Has anyone here thought they had sleep apnea but your sleep study results came back negative for sleep apnea? Please cross your fingers for me, this is my only shot at getting my insurance to cover my surgery.

I found out today that my insurance requires that I have a comorbidity to get bariatric surgery. My PCP had put in a referral for a sleep study a while ago and am waiting to hear back. I do snore. I know it sounds bad but I really hope I'll get diagnosed with sleep apnea, otherwise, I'm up poo creek

Awesome! Congratulations!!!

How long does it take a PCP to get a referral to a bariatric surgeon? She said she was doing a referral on January 9th, I called her office a week ago and they said it takes a couple of weeks. It has been the longest 3 weeks ever. I'm anxious.

Thank you [emoji5] Sent from my XT1575 using BariatricPal mobile app

How do they determine if you have been previously unsuccessful with medical treatment for obesity? Do they require a 6 month supervised weight loss program or will telling your doctor about the diets you've been on do? Sent from my XT1575 using BariatricPal mobile app

I've tried that, multiple times. BCBS makes excuses and won't send me the information. They have their medical policy online but said it's different for me because I have Medicare, Medicare tells me the same thing. It has been a headache. Sent from my XT1575 using BariatricPal mobile app

I went to my new primary care physician last week and she getting me a referral for bariatric surgery and is going to get me tested for sleep apnea. Tomorrow I have a physical exam. I don't know how long it will take to see a surgeon, and am unsure about my insurance requirements. I keep on getting different answers, sometimes they say a BMI over 40 is all I need, sometimes they say a BMI over 35 plus a comorbidity. I also get different answers on whether the 6 month supervised diet is required. I hope once I get in to see the surgeon that I can talk with their insurance people and they can contact my insurance and get something in writing about the requirements. Sent from my XT1575 using BariatricPal mobile app

Which surgery did you get?

I spoke with BCBS this morning. They said I only need a doctor to say that Bariatric surgery is medically necessary; no BMI requirement, no comorbidity, no supervised weight loss. I'm still waiting to hear back from my local surgeon's office. Sent from my XT1575 using BariatricPal mobile app

I just got off the phone with a surgeon's office. They said since my primary insurance is Medicare, they think I would not have to go through the 6-month weight loss program. However, that surgeon is out-of-state, and they weren't sure if the same applies to the Medicare policy in my state. This is potentially good news though

The closest DS surgeon is in Cincinnati, Ohio. Since it is out of state, BCBS said it is out of network and I would have to pay for 40% of the surgery, which is expensive for me right now. I plan on getting a VSG nearby instead, but am worried about the higher risk of long-term weight regain compared to the DS.

I am in Kentucky and have Anthem Blue insurance. I have called my insurance several times and keep on getting different answers when I ask about their insurance approval policy for bariatric surgery. They say they cover bariatric surgery and say that I just need my doctor to say it is medically necessary. All the information given to me about the details of BMI, and weight loss program information varies each time I speak with a person. One person said whether I can get surgery depends on my BMI. Hoping to get details, I asked how. They said that if my BMI is very high then I'd need to lose weight for the doctor to perform the surgery (I think she just made that up, having a very high BMI shouldn't affect insurance approval). I tried to confirm with them the bariatric policy on their website https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm and accidentally gave them the wrong document number and they said: "Yes, that's it." I requested to be sent a copy of the policy and they said: "I can't do that because we don't keep copies of all of the policy info here because the paperwork takes up so much space". Anyway, I have had more productive conversations with my dog. Has anyone with Anthem Blue had their surgery covered without having to do the 6-month pre-op weight loss routine?

You can add flavored extracts to make them taste better. Sent from my XT1575 using BariatricPal mobile app

I'm think the pre op diet is going to make me moody, then again I'll probably be very excited for the upcoming surgery. I'm in the first steps of finding a surgeon and doing insurance inquiries myself. I wish you the best! Sent from my XT1575 using BariatricPal mobile app

I'm in Kentucky. Good luck! Sent from my XT1575 using BariatricPal mobile app

I've told my S.O., my best friend, and my brother and sister. If anyone asks about my weight change I'll just tell them about the diet and exercise aspects. My medical issues are no one else's business. Sent from my XT1575 using BariatricPal mobile app

Just getting the ball rolling here. My new insurance just started today. Everyone is closed because of the New Year so I will be making a bunch of calls tomorrow. I read it's best to start by finding a surgeon to guide you through the process for the best chance of insurance approval, so that's what I'm doing. Sent from my XT1575 using BariatricPal mobile app

I'm looking for a Duodenal Switch surgeon near Lexington KY. I found Dr. Weiss in Lexington but he only does SIPS as a revision to a past VSG surgery. I saw a center in Cincinnati Ohio that might do it but wonder if my health insurance (Medicare w/Anthem Blue) will cover out of state surgery. Sent from my XT1575 using BariatricPal mobile app

He read my letter, and thought it was sweet. He did argue with me that he wanted me to try a different diet and exercise method with him in control. I told him I've already tried that, and when I told him last year that I was going to consider wls if trying to loose weight failed again then that was the time to have done it. I'm not going to wait any longer. I stuck to my guns. He'd prefer I lost weight without surgery but will stand by me for this. He is happy that I am taking my health into control and I think he will get more comfortable with the idea of wls as time goes by. Sent from my XT1575 using BariatricPal mobile app

I wrote him a note, it's easier for me to tell him this way so I get my thoughts together and be less nervous about it because it's so important to me. I'll give it to him when he gets home from work in the morning. Depending how open he is, I will take him to a seminar once I can. I'll let ya'll know how it goes. Wish me luck!

Taking him to a seminar is a great idea, thank you!

Maybe if I write down the reasons why I want the surgery it would make it easier for me to tell him.