I got the paperwork in the mail today from my insurance company saying that they will approve my surgery for the sleeve. It gives a list of requirements and such that I have to do first. Now all I have to do is find an approved hospital and surgeon. That seems to be the hardest part. I thought that would be the easy part and the insurance company would be the hard ones. Crazy right?!?

Good luck to you!

By chance, is one of the requirements that you have to have surgery in a Center of Excellence?

~Amy

All the best! Hope everything works out fine for you!

1) Evaluation by a mulit-disciplinary team consisting of medical, surgical, psychiatric and nutritional components.

2)Presence of severe obesity as defined by either of the following:

*Body mass of > 35 with co-morbidity

*Body mass of >40 with no co-morbidity

3) Documentation of willingness to comply with preoperative and post operative treatment plans, to include compliance with pre-operative dieting.

(the following are about the surgeon and hospital requirements)

4)The facility must be contracted with CDPHP and participate in the network.

5)Adequit written bariatric program description including patient selection criteria

6)Adequate patient management plans and protocols that include therapeutic and evaluative procedures for all phases of treatment.

7) Must follow NYS HPA surgical management of obesity consensus guidelines.

8)Must be performed at facilities that are:

*Certified by the ACS as a level 1 bariatric surgery center OR

* Certified by the BSCOE (here is the excellence one)

It seems like there are FAR more requirements of the surgeon and hospital than there are of the actual patient lol.

I am not 100% but it seems they are expecting you to go through a bariatric type program and that the documentation of willingness to comply is usually a predicate of a program that consists of the six month pre-op appointments.

PLEASE DON'T DESPAIR. I did I swear I cried but I made it and it was the quickest six months of my life. Less torturous than the two week pre-op shake diet I have to be on. If that's the case, please don't reconsider. You looked into this route for a reason, and so many people back out because of the six month program. It's worth it in the long run I think and there will be so many people to help you along the way.

If you do there's a lot of help along the way. Usually these bariatric centers expect a food journal to be turned in once a month and you meet with a Dr. (normally their internist or bariatric weight loss specialist) for weigh ins and eventually they set you up with a nutritionist, then you have a psych evaluation, do not miss an appointment, it will show unwillingness to comply. For ease in keeping your journal use something like http://myfitnesspal.com which makes keeping a record of your foods so easy, even if you are a busy mom like me.

You will probably have to sit in on a seminar like Weight Loss Surgery is it right for me, and then you will meet the surgeon. After your six month evaluation, and you jump through some hoops and tests which may include a sleep study, ekg, upper gi, stress test, upper gi, they will send it off to the insurance company. The insurance company takes between 2 days and 4 weeks to come back with an approval and then you get set up with your surgeon once again. They will probably give you a class on pre-op diet, post op diet etc.

Keep us informed when you find a program what they expect and good luck.

My seminar is on the 30th, then I make the appointment to meet with the surgeon for the initial consultation. The only advantage I have is that I already meet with a nutritionist monthly because of my diabetes. I hope that cuts some time off it but if not, 6 months is not a long time when I am getting the rest of my life in return

I have also already done the sleep study! 2 things off the list I have diabetes, sleep apnea, infertility, depression and occasional incontinence. My bmi is 61.8%. I don't think I will have to jump thru too many hoops. My insurance company is actually all for me having the surgery. They have been so helpful I can't believe it! They have gone above and beyond to help me get all the information that I would need to choose a hospital and a surgeon. They sent me a copy of their entire policy for bariatric surgery. I think they looked at my $600 a week insulin regimen and realized that this was going to save them a ton of green hahaha. It's the only time in my life this fat has ever come in handy.

They should also be able to give you some surgeon's that would be approved under your policy. I'd give them a call. It sounds like they are more than willing to assist you.

Good luck as your begin your journey to a healthier and smaller you!

Sadhasivam, Subramaniam, M.D.

He is the surgeon that accepts my insurance in that hospital. That is the only part that sucks. If I don't like him I will have to go to a different hospital. The next closest one is about 2 hours away. That is the one that I originally thought I would have to go to until today when my insurance case manager called me and told me that I could use the hospital 20 minutes from my house I am so beyond excited and ready! I have been looking into this since 2004. I didn't want to have the bypass though because I didn't want my insides butchered. I have been waiting for something less "slice and dice". 8 years later, I finally found it and I am just so excited!

You have a great attitude. I have sleep apnea, diabetes, lupus and I used oxygen too. I had a stress test prior, a reveal heart monitor removed during the six months, and my meds were almost 2000 a month for a while there, so that's a big load that some of the tests I didn't have to have, because I had them recently.

Since your doctor is in a centers of excellence bariatric program, they will have a curriculum set up for their patients which should be easy to follow. I seen he has like 30 years experience, so I am thinking he's not a slicer and dicer. You don't really have to like him as a person though, just be confident in his surgical ability. Personally most surgeons are a bit cold or aloof, their job doesn't deal with the patients in the same way their nursing staff or the bariatric specialist intake person does, so don't let that be a deciding factor.

If you have to do a month or six months, I'll be happy to give you tips or pointers that I used to deal with things and I'm sure there are many here that are willing to help support you. Your attitude is going to go a long way to making this a success.

I am just so excited and ready! I know that it's going to be hard sometimes, but I want to be able to chase my son thru the playground. I want to be able to give him a sister (if I get a boy it's going back to the turd factory hahaha). I want to go to an amusement park and go on a roller coaster! I have never been I want to finally start living my life!!! I have decided that even if I have to save pennies, do fundraisers, take out loans and pay for it myself (at least I will get a vaca in Mexico ) I will have this surgery before I am 30!

My seminar is on the 30th' date=' then I make the appointment to meet with the surgeon for the initial consultation. The only advantage I have is that I already meet with a nutritionist monthly because of my diabetes. I hope that cuts some time off it but if not, 6 months is not a long time when I am getting the rest of my life in return [/quote']

My insurance accepted my nutrition classes for diabetes. Good luck!

Little Bits

Your CDPHP insurance did not have Medicare or Medicaid did it? I'm so afraid I won't be approved because mine is neither????

@ I am done,

Congrats on starting your WLS journey.

I had CDPHP insurance for 15 years and the two Dr's in my immediate area didn't accept CDPHP. I'm happy for you that you were able to find a surgeon in your area.

Best wishes to you. ????