Janecoda

I was finally able to get some clarification regarding my coverage. Knowing what to expect puts me at ease. Gastric Bypass Surgery (Bariatric Surgery) is covered only if specific medical criteria are met:  Bariatric surgery may be indicated for patients 18 to 60 years of age. Requests for bariatric surgery for patients less than 18 years of age should include documentation that the primary care physician has addressed the risk of surgery on future growth, the patient's maturity level and the patient’s ability to understand the procedure and comply with postoperative instructions, as well as the adequacy of family support. Patients above 60 years of age may be considered if it is documented in the medical record that the patient’s physiologic age and co-morbid condition(s) result in a positive risk/benefit ratio. • The patient has been clinically evaluated by an MD or DO. The physician has documented failure of non-surgical management including a structured, professionally supervised (physician or non-physician) weight loss program for a minimum of six consecutive months within the last four years prior to the recommendation for bariatric surgery. The six consecutive month weight loss program listed above is waived for super morbidly obese individuals who have a BMI ≥50. Documentation should include periodic weights, dietary therapy and physical exercise, as well as behavioral therapy, counseling and pharmacotherapy, as indicated. • Documentation that the PCP and the patient have a good understanding of the risks involved and reasonable expectations that the patient will be compliant with all postsurgical requirements. • A psychological evaluation must be performed as a pre-surgical assessment by a contracted mental health professional in order to establish the patient’s emotional stability, ability to comprehend the risk of surgery and to give informed consent, and ability to cope with expected post-surgical lifestyle changes and limitations. Such psychological consultations may include one unit total of psychological testing for purposes of personality assessment (e.g., the MMPI-2 or adolescent version, the MMPI-A). • The physician needs to be aware and follow-up with individuals who have had gastric surgery for any long-term complications. • In cases where a revision of the original procedure is planned, documentation of all of the following is required: - Date and type of previous procedure - The factor(s) that precipitated failure - Any complications from the previous procedure that mandate (necessitate) the takedown - If the indication for the revision is a failure of the patient to lose a desired amount of 51 weight then the patient must meet all of the initial preoperative criteria. Note: The following surgical procedures are considered experimental/investigational because their safety and/or effectiveness have not been proven: • Loop gastric bypass gastroplasty - also known as mini-gastric bypass • Stomach stapling Endoscopic procedures to treat weight gain after bariatric surgery to remedy large gastric stoma or large gastric pouches are considered experimental/investigational.

Thank you all for the kind words and advice. Today the universe told me to slow down by me hitting a piece of metal on the expressway driving to my 1st appointment. Unfortunately, I had to reschedule for 15 April, which will set my timeline back. I know I personally need 6 months of medical supervision to be successful with my new lifestyle changes.

I guess what I mean by "fast track" is, my cousin had the sleeve surgery and her BMI was over 50. She also went through Beaumont and she did not have to do the 6 month supervised diet.....at least that is what she told me. During my process I will also be recovering from a total knee replacement. I already have my WLS appointments booked through March and will complete my 6th appointment in August. I hope to have surgery in September if that is actually how the plan goes. My insurance company or at least the lady I have communicated with has not been very helpful at all. We have Cofinity/Varipro through my husbands union. She did say it was a covered benefit if I met the criteria, which is set by a third party American Health Holdings. She however could not provide the specifics. I swear one lady works there because I have called a couple of times for information. I guess I will find out more tomorrow.

Hello Everyone! Not sure if I am posting in the right place or not. Tomorrow is my very first appointment to begin my weight loss journey. I live in the Metro Detroit area and will be going through the Beaumont Weight Control Center. I am excited and nervous at the same time. Food has been a comfort, but I need help. I think I have tried everything out there. I understand this will not be easy, but honestly I cannot continue on my current path. I will be 49 in July and I am having my 2nd knee replacement next month. I swear I have the joints of a 90 year old! I also am being treated for Psoriatic Arthritis, high blood pressure and I have been using a CPAP machine since 2019. I'm 5'4 and my current BMI is 41.7 (243lbs). Insurance wise, I do not believe I qualify to be fast track....I think my BMI needs to be over 50. I am just hoping for the best and that I can be approved. My joints are in constant pain and exercise right now with my knee is almost impossible. Has anyone ever had the 6 month supervised medical waived with a BMI under 50? Anyway, I look forward to making some new friends here and absorbing the wealth of knowledge on this forum.