Hello,

I have Aetna gold hmo insurance and want to get the gastric bypass. My BMI is 43. I honestly have no idea where to start in this process..do I go to my Pcp? Call my insurance? Any help is much Appreciated!

Apparently I'm not allowed to type HMO lol

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Yes, start with your PCP and let them know about you wanting to have the surgery and he can refer to a surgeon!

Ok! I didn't know if I start with my doctor or with my insurance. After reading a lot everything sounds so complicated! lol

After your doctor gives you the Ok, he will refer you to the surgeon, then the surgeon will walk you through your insurance requirements!

Sounds great!! Thank you so much!

I'm also worried cus a lot of people are saying you need 2 years of previous weight history and I'm only 22 and have probably been to the doctor like twice in the last 2 years.

I do plan on getting records from my weight loss doctor (tried and failed) that has weigh ins and one trip to urgent care like 2 1/2 years ago where I was having foot pain and the doctor noted the source as obesity..hoping this will do..

Most insurances require you to start the process by being on an supervised diet for six months. You're surgeon will clear it up for you and answer any questions you will have.

Thank you so much for your help! And good luck on your journey as well

My journey actually started with my OBGYN, so if you have been under the routine care of a OBGYN maybe they would help to point you in the right direction? All of my health problems are related to female issues and I hardly ever have to see my PCP so I did all of my surgical prep with the OBGYN and only consulted with my PCP's nurse via the phone and through paperwork because my OB had documentation that my recent (last two years) health was declining and two surgeries did not help me. Just an idea. Good Luck!

Hmm maybe..they only have 2 weigh ins from me too..I've only had this insurance for 2 years lol I'll fight for this though! I have sports induced asthma and 4 compressed discs in my lower back so hopefully they'll take that into consideration as well.

I wish you much success on your journey also and please keep us updated!

Thank you so much!! I sure will!

My insurance required a 5 year weight history. They just needed a single medical record with the weight noted: once each year in 2009, 2010, 2011, etc. I had to get records from doctors in several states, and there were some years I couldn't get. So I just went back further and had an older doc send records from 2006, 2007, etc. my insurance accepted this without hesitation.

The purpose of this is to demonstrate that your weight problem didn't come out of nowhere, which would suggest that they should look for a different medical cause. So having some gaps in years was no problem because it told a very consistent story. Hope this helps!

As for where to start, I went straight to the surgeon. They run a "comprehensive weight loss center" at the hospital and have regular free info sessions. So that's where I went and they told me everything I needed to know about referrals and who to ask for what. They are old pros. You might want to check and see if any hospitals in your area have similar programs. The magic google machine can probably help you there.

Makes sense! Thank u so much!

I would call your insurance to make sure it is not an exclusion. Not all insurances cover it.