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Hi There, I'm (hopefully) going to get sleeved by Dr. Schwack this summer. What things were they not on top of in regards to your insurance? I was feeling unsure about what they were telling me were my pre-reqs as well. I'm with Oxford UHC. They were telling me I just needed 6 months of weigh-ins and then to see the psych, get the endoscopy, see primary care physician, and nutritionist. Did you find anything missing from their requirements? Just trying to make sure I personally have my ducks in a row. Bad enough having to wait 6 months but if they screw up my pre-reqs I'd be mad... lol

They knew what my requirements were, but not everyone in the office does. For example, when scheduling my 4 months of appointments, I was scheduled to see the doctor only when my insurance required monthly nutritionist appointments. We didn't catch this until after all of the appointments were set in stone, which required some work to rearrange. At my last appointment I wasn't given the pre-op booklet, so I had no clue about the PCP clearance and pre-op testing. My emails went unanswered until I called to get the information.

When all was said and done, everyone worked with me to rectify all of the issues above, and I was approved on time. I also managed to proceed with surgery on the date scheduled. So everything worked out just fine, but only because I also knew my requirements. Once the issues were discovered they were solved quickly, so I give credit for that.

Call your insurance and know your requirements and make sure you're covering it all!

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My surgery is Feb 23 at South Nassau Hospital....I cant wait...make sure you keep copies of all your clearances, sleep apnea, psychological and nutritionist....

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@, I also have Oxford United. I am getting sleeved with a different doc on Feb. 26 but the ones you mentioned are the requirement for Oxford. You don't need anything else

My question is, though, does my 6 months start when I see the nutritionist or does it start at that first weigh-in? The surgical coordinator told me it started at my first consult when they took in my weigh-in but that doesn't make sense to me if Oxford wants me on a supervised nutrition program... When I called Oxford they were vague and then just pointed me to the PDF with the requirements. NOT VERY HELPFUL. lol The nutritionist is 250 out of pocket so I was hoping to wait a month or two to see but if I need that to start my 6 months I'll just eat ramen for a few weeks. lol (jk but sorta not)

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I went through the approval process with Oxford/United Healthcare last year. It took a little over a year from my very first visit until I had the surgery, but this is what I had to do:

6 monthly visits with a PCP that documented diet & exercise, weigh-in's, weight loss progress, etc. - $30 co-pay each, plus the first visit didn't count towards the total so it was actually 7

1 Bariatric seminar @ Hackensack Medical Center (Oxford told me none were in NYC, which I found hard to believe but that is what they told me) - this was $50 cash. You will get a "certificate" from this seminar that you will have to provide to your bariatric surgeon, who in turn has to provide it to Oxford/UHC.

1 Bariatric seminar held by my surgeon's practice - I think this was free but by reservation only

4 visits with a Nutritionist - $40 each plus $150 narrative report/letter asserting my fitness for the surgery, adhering to the program, etc. There was literally a 3 month wait to get an appointment with a nutritionist. I ended up going out of network.

Psychiatric clearance - I already knew a psychiatrist from being treated for PTSD after a high-profile incident so I got a clearance letter without visits. It basically has to say you don't have any mental health issues that would interfere with compliance, you fully understand what you are doing (stomach won't grow back, etc) and you are ready willing and able to comply with post-operative instructions and lifestyle requirements. If you don't already know someone or aren't in therapy, you will have to pay for a couple of visits and a letter.

When you are done with ALL the monthly PCP visits, get a copy of your medical records and bring them to your bariatric surgeon.

I've had sleep apnea since I was a kid so I obviously didn't need clearance for that, but less than 30 days before surgery you will be getting a chest x-ray, full blood work-up and EKG. Your bariatric surgeon will order all the tests.

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Wow if it takes that long I might just do it in Mexico. They were telling me I could probably get it done by late July or early August. Glad it worked out for you. Are you doing well after the fact?

Edited by Debranua

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I went through the approval process with Oxford/United Healthcare last year. It took a little over a year from my very first visit until I had the surgery, but this is what I had to do:

6 monthly visits with a PCP that documented diet & exercise, weigh-in's, weight loss progress, etc. - $30 co-pay each, plus the first visit didn't count towards the total so it was actually 7

1 Bariatric seminar @ Hackensack Medical Center (Oxford told me none were in NYC, which I found hard to believe but that is what they told me) - this was $50 cash. You will get a "certificate" from this seminar that you will have to provide to your bariatric surgeon, who in turn has to provide it to Oxford/UHC.

1 Bariatric seminar held by my surgeon's practice - I think this was free but by reservation only

4 visits with a Nutritionist - $40 each plus $150 narrative report/letter asserting my fitness for the surgery, adhering to the program, etc. There was literally a 3 month wait to get an appointment with a nutritionist. I ended up going out of network.

Psychiatric clearance - I already knew a psychiatrist from being treated for PTSD after a high-profile incident so I got a clearance letter without visits. It basically has to say you don't have any mental health issues that would interfere with compliance, you fully understand what you are doing (stomach won't grow back, etc) and you are ready willing and able to comply with post-operative instructions and lifestyle requirements. If you don't already know someone or aren't in therapy, you will have to pay for a couple of visits and a letter.

When you are done with ALL the monthly PCP visits, get a copy of your medical records and bring them to your bariatric surgeon.

I've had sleep apnea since I was a kid so I obviously didn't need clearance for that, but less than 30 days before surgery you will be getting a chest x-ray, full blood work-up and EKG. Your bariatric surgeon will order all the tests.

JerseyCityGal - First off congrats! that's so exciting. Seems we are about the same stats and I love your progress! Couple questions if you don't mind... 1. Did UHC Oxford mention anything about your progress as far as weight loss? I've gained some weight because I had the flu and basically sat around for days on end.... 2. My Bariatric facility seems to think right after my 6th visit with the NUT we can submit my paperwork my only concern with that is that's only 5 months total on the "motivated attempt" I'm wondering if that's true... I'm so worried about the weight gain it's driving me crazy!! Any encouragement will help. Thanks.

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I was told the same thing by my weight loss facility which is NYU Langone (ie 6 weigh-ins, 5 months of actual attempt time.) Did you gain weight higher than your starting weight or just a little weight back from your loss over the past 6 months? I can't imagine you'd be cancelled by a 3 or 4 pounds but I would email your surgical coordinator about it.

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Wow if it takes that long I might just do it in Mexico. They were telling me I could probably get it done by late July or early August. Glad it worked out for you. Are you doing well after the fact?

It normally takes about 6 to 8 months with Oxford/UHC.

I had delays because the trial from my incident kept getting postponed by the defendant.

Yeah, I'm doing great. 91 lbs down @ 8 months out.

Edited by JerseyCityGal

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From what my insurance coordinator told me, Oxford/UHC are not big sticklers to weight loss. They just want to see the 6 months of nut visits. Try not to gain obviously but it's not a big deal if you do. I had periods of weight gain also but I got approved

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JerseyCityGal - First off congrats! that's so exciting. Seems we are about the same stats and I love your progress! Couple questions if you don't mind... 1. Did UHC Oxford mention anything about your progress as far as weight loss? I've gained some weight because I had the flu and basically sat around for days on end.... 2. My Bariatric facility seems to think right after my 6th visit with the NUT we can submit my paperwork my only concern with that is that's only 5 months total on the "motivated attempt" I'm wondering if that's true... I'm so worried about the weight gain it's driving me crazy!! Any encouragement will help. Thanks.

I'm 54, so if you are younger you will probably lose faster.

No, as long as I was doing my best and didn't weigh more than when I started, I was ok. I initially went from 268 to 235 and then bounced back up to 255 from the stress of trial delays and everything. I held it together for as long as I could and then I just couldn't do it any more. Something had to break, and it was my diet that went. It was either that or my sanity at that point. I wish it could have been different, but it was a set of extreme circumstances.

My PCP was really supportive.

My paperwork was submitted before it was finished to get the process going too.

Start changing your habits now. One at a time, even if it's taking the stairs instead of the escalator. It all adds up. I still can't believe I'm not heading out for fresh Bagels every weekend. I used to live for that. Now I'm heading to the gym.

A few days before surgery I went through my kitchen and literally threw out everything that wasn't going to be suitable for my new life after surgery. I gave away bags of food to my next door neighbor. I stocked up on all new spices (I have every spice on earth now, lol). Out of sight, out of mind. I bought measuring cups, measuring spoons, a blender and 4 oz ramekins.

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I'm 54, so if you are younger you will probably lose faster.

No, as long as I was doing my best and didn't weigh more than when I started, I was ok. I initially went from 268 to 235 and then bounced back up to 255 from the stress of trial delays and everything. I held it together for as long as I could and then I just couldn't do it any more. Something had to break, and it was my diet that went. It was either that or my sanity at that point. I wish it could have been different, but it was a set of extreme circumstances.

My PCP was really supportive.

My paperwork was submitted before it was finished to get the process going too.

Start changing your habits now. One at a time, even if it's taking the stairs instead of the escalator. It all adds up. I still can't believe I'm not heading out for fresh Bagels every weekend. I used to live for that. Now I'm heading to the gym.

A few days before surgery I went through my kitchen and literally threw out everything that wasn't going to be suitable for my new life after surgery. I gave away bags of food to my next door neighbor. I stocked up on all new spices (I have every spice on earth now, lol). Out of sight, out of mind. I bought measuring cups, measuring spoons, a blender and 4 oz ramekins.

Well.... I'm up but here's the thing 2nd weigh in I had a sinus infection for like a month so I couldn't exercise and really wasn't into dieting. I gain 2lbs. 3rd weigh in was after christmas I tried to lose but ended up gaining another almost 2lbs. 4th weigh in I had influenza (flu) for the past month and 1/2 gain another 2lbs... THEN! i got a sinus infection again! and now I'm weighing in tonight for my 5th weigh in and I know it's going to be a gain again could be a 12lb gain by the time I'm done. I'm so scared. I've done everything else perfect. Everyone said UHC Oxford doesn't look at weight but I can't imagine them not seeing the gain. Ugh. Add on top being sick for almost 4 months straight.

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Well.... I'm up but here's the thing 2nd weigh in I had a sinus infection for like a month so I couldn't exercise and really wasn't into dieting. I gain 2lbs. 3rd weigh in was after christmas I tried to lose but ended up gaining another almost 2lbs. 4th weigh in I had influenza (flu) for the past month and 1/2 gain another 2lbs... THEN! i got a sinus infection again! and now I'm weighing in tonight for my 5th weigh in and I know it's going to be a gain again could be a 12lb gain by the time I'm done. I'm so scared. I've done everything else perfect. Everyone said UHC Oxford doesn't look at weight but I can't imagine them not seeing the gain. Ugh. Add on top being sick for almost 4 months straight.

Well, you can't lose weight by tonight ... so it is what it is.

I'm not trying to shame you or anything because I have been where you are, but after surgery there are no more excuses. It doesn't matter if you are sick or whatever. You have to stick to the plan.

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You probably need to call your surgeons assistant/ surgical coordinator and ask them. I didn't see anything in the UHC requirements about needing to lose weight but I didn't see anything about gaining either. Have you been tracking your food on fitness pal? There might be a blind spot you're having with measurement/cal intake. I know when I was still gaining earlier this year I realized I was getting WAY too many calories from my Creamer and sugar in my coffee. Like I was literally doubling my Breakfast cals with my coffee intake alone. Sometimes getting your weight to at least stabilize just takes having an honest look at what your intake is and seeing if there's any tweaks you can make to at least get it to flatline. My trick was just switching to milk from half and half and not using sugar anymore (I prefer no sugar to fake sweeteners.) I do think that the Insurance could look at consistent gaining across the 6 months as a negative so better to be safe than sorry! But again, you should ask your doc office.

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I just got off the phone with UHC and they basically said I can't be denied because of weight gain/loss or staying the same. That said I do think that I've been eating "bad" because subconsciously I might be feeling like this is my last "hurrah" if that makes sense. Kinda like going crazy before you go to prison. Like food jail. Isn't that terrible? I definitely wasn't doing it purposely so who knows. I do have to put my foot down though and start preparing. Thanks Ladies!!!

Edited by Stephanie Salsera Perrott

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@@Stephanie Salsera Perrott

Life after the sleeve isn't a life of denial. I love food and go out to eat all the time. You just change the way you eat, what you eat and how much.

I've followed this surgeon's eating advice. I got the book on Kindle a few days after surgery. It made a huge difference in my outlook on post-surgery life and I pimp it every chance I get. He really knows how to lay it out for people and teach you how to eat after surgery. Everyone thinks they know how, but they don't. He made things a lot easier for me and I still refer to the book constantly.

http://www.amazon.com/Ultimate-Gastric-Sleeve-Success-Practical/dp/0615830447/ref=sr_1_2?ie=UTF8&qid=1424296331&sr=8-2&keywords=duc+vuong

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