Jump to content
×
Are you looking for the BariatricPal Store? Go now!
$99 Yearly Supply Alert! 🎉 "1 per Day!" Bariatric Multivitamins

Insurance question

Who'sThere

By Who'sThere, in Gastric Bypass Surgery Forums

Recommended Posts

Who'sThere    331

Who'sThere
Posted

How many of you had to go through the same criteria as an initial bariatric surgery patient???

My surgeon's office asserts that everyone has to go through the same 6 month process even though my insurance has told me differently--twice! (Even talked to the bariatric nurse in the precert department.) Now, they want me to call the insurance company and have them call the surgeon's office on 3way to tell them that. Does this seem odd to anyone else?

I get why they would want me to do the long process. It is more money for them as I would have to see the surgeon more often and they would not change their routine. However, I would love to have this done before the end of the year to save lots of money!!!

I think "everyone" has done it this way because no one else has done their own legwork and questioned their process. Oh, and it is the office staff that is giving me a hard time, not my surgeon. He says let's get this done. When I had my band, there was one woman who did this. She's gone and now there are 3 doing her job, and none too well, I might add.

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Shaunie    123

Shaunie
Posted

I had to go through the 6 month pre-op!!! I didn't have to meet with surgeon other then the very beginning & at the very end. The process is to prepare you and teach you how to eat proper and make better decision. It also is mentally setting you up for success by meeting with the psychologist. It is very hard to play the waiting game but I think its all for our on good. I also had to loss 10% of my starting weight in those six month to proof to them this is a challange I was reading to take on.

Good luck with your process ;-)

Sent from my SGH-T999L using the BariatricPal App

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted (edited)

I had to go through the 6 month pre-op!!! I didn't have to meet with surgeon other then the very beginning & at the very end. The process is to prepare you and teach you how to eat proper and make better decision. It also is mentally setting you up for success by meeting with the psychologist. It is very hard to play the waiting game but I think its all for our on good. I also had to loss 10% of my starting weight in those six month to proof to them this is a challange I was reading to take on.

Good luck with your process ;-)

Sent from my SGH-T999L using the BariatricPal App

This is a revision. I've already done all that the first time. My surgeon only wants me to do a brush up nutrition class, support group meeting, EGD and barium swallow. I agree that this is important for WLS virgins, if you will, and so does my surgeon. He requires all this whether you have insurance or not for a first procedure. He knows I am adequately prepared for the revisions. Well, at least as much as one can be for such a serious life changing surgery.

Oh, and if I DO have to do the 6 month diet, I will NOT qualify if I lose 10% or more of my body weight. I have to show an INABILITY to lose that much by conventional means.

Plus, I have to have been a bmi or 40 or more for 5 years and I haven't been. (I dont have three comorbidities yet.) My band was great until I had it unfilled with my pregnancy and then i a double hit with a Hasimotos flare up. I will have to wait 2 more years.

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Edited by Who'sThere

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted

my insurance only required 4 months of weigh in's plus the other appointments for clearance.. what insurance do u have?

Sent from my SAMSUNG-SM-G935A using the BariatricPal App

I have BCBS TN for state employees. post-39479-14774463258034_thumb.jpg

This is what they sent me, but my surgeon's office staff thinks it means I have to meet BOTH unfilled circles. Ugh!

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted (edited)

@@Shaunie and @@CarenL, what insurance do you guys have? Was it an insurance requirement or surgeon requirement that you redo the whole process? Did your policy look anything like mine? I'm very discouraged at this point.

Oh, and what we're y'all's reasons for revision?

I'm hoping the 3 way call will help, too. The lady I talked to at insurance today said she couldn't guarantee that they will do a 3way call but to call and ask whoever was working tomorrow. :/

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Edited by Who'sThere

Share this post

Link to post
Share on other sites

Shaunie    123

Shaunie
Posted (edited)

I had gastric bypass10 months after I had to have the lapband emergency removed. I have Tuft!!! It was my insurance requirements but the surgeon recommended it. When I had the band put in I also had to do 6 months and I had Harvard Pilgrim. My bariatric Team had control over making the final dicission if they thought I was ready at the 6 month point. I would think most people are because that's what there job is lol.

Edited by Shaunie

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted

I had gastric bypass10 months after I had to have the lapband emergency removed. I have Tuft!!! It was my insurance requirements but the surgeon recommended it. When I had the band put in I also had to do 6 months and I had Harvard Pilgrim. My bariatric Team had control over making the final dicission if they thought I was ready at the 6 month point. I would think most people are because that's what there job is lol.

The bariatric pre-certification nurse said if they "remove the lapband and convert to RNY in one fell swoop" it is considered a revision and I do not have to meet the initial criteria. If i have two separate procedures, though, I DO have to meet the initial requirements again whether the band is out 2 days or 2 years. Now, I see why your insurance required the 6 months.

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted

O ok that makes sense. I Didn't know that.

It will all work out ;-) you will be skinny before you know it ;-)

I just don't want diabetes! Lol. I want ti be around ti watch my 3 year old get old and sassy. Skinny will be a nice side effect.

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted

My paperwork is being submitted in the morning! I'm on pins and needles

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Who'sThere    331

Who'sThere
Posted

Approved yesterday, scheduled today. My date is December 15

Sent from my SAMSUNG-SM-G890A using the BariatricPal App

Share this post

Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
Go To Topic Listing Gastric Bypass Surgery Forums

  • Trending Products

  • Trending Topics

  • Recent Status Updates

    • LeighaTR

      LeighaTR

      Four days post surgery. I am sipping as fast as I can and getting NO WHERE near the goal of 60 - 80 grams of protein or the 64 oz of liquids. I just feel FULL. I don't know if it can still be the gas build up (I would think by now that would be gone) but it is a struggle to drink. And so far I have not had the nausea or spasms and don't want to wander into that territory by pushing too hard with liquids. I about passed out today as it was my most "strenuous" day. Went from second story to basement for shower and I was sure I was going to pass out. Looking back on my last few days I have had a total of less than 1000 calories. Am I just not getting enough nourishment in me? Once again a friday where I can't get ahold of the doc until Monday rolls back around so I am hoping maybe someone here has some experience on how to keep energy going. I do have fibromyalgia too and that may be where some added fatigue comes into play. How did you all fair with the goals the week after surgery?
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      2 days until I fly out to San Diego to have my Bypass Surg. in Tiajuana Mexico. Not gonna lie, the nerves are starting to surface. I don't fear the surgery itself, or the fact that I'm traveling alone, but its the aftermath that I'm stressing about the most, after this 8 week wait. I'm excited to finally be here, but I am really dreading the post surgical chapter. I know its going to be tough, real tough and I think I'm just in my head to much now that the day i here. Wish me luck, Hopefully I'm one of the lucky ones, and everything goes smoothly. Cant wait to give an exciting update,. If there is anyone else have a June bypass or even a recent one, Id love to have someone to compare war stories with. Also, anyone near San Antonio Tx? See ya soon with the future me. 💜
      · 3 replies
      1. Phil Penn

        Phil Penn

        Good Luck this procedure is well worth it I am down to 249.6 lb please continue with the process..

      2. Selina333

        Selina333

        I'm in Houston so kind of near you and had the sleeve in Dec. Down 61 lbs. Feeling better. Was definitely worth it. I hope the everything is going well for you. Update us when you can!

      3. Doughgurl

        Doughgurl

        I am back home after my bypass surgery in Tiajuana. I'm post op day 4. Everything went great! I guess I'm one of the lucky ones who have not encountered much pain at all, no nausea thus far and I'm having no problem keeping down broths and water. Thank you for your well wishes. I cant wait to keep up this journey and have a chance at better health and simply better quality of life. I know there will be bumps in the road ahead, and everything won't be peaches and cream, but at least I have a great start so far. 😍

    • LeighaTR

      LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 2 replies
      1. Selina333

        Selina333

        I'm so happy for you! You are about to change your life. I was so glad to get the sleeve done in Dec. I didn't have feelings of regret overall. And I'm down almost 60 lbs. I do feel a little sad at restaurants. I can barely eat half a kid's meal. I get adults meals often because kid ones don't have the same offerings at times. Then I feel obligated to eat on that until it's gone and that can be days. So the restaurant thing isn't great for me. All the rest is fine by me! I love feeling full with very little. I do wish I could drink when eating. And will sip at the end. Just a strong habit to stop. But I'm working on it! You will do fine! Just keep focused on your desire to be different. Not better or worse. But different. I am happy both ways but my low back doesn't like me that heavy. So I listened (also my feet!). LOL! Update us on your journey! I'm not far from you. I'm in Houston. Good luck and I hope it all goes smoothly! Would love to see pics of the town you go to for this. I've never been there. Neat you will be traveling for this! Enjoy the journey. Take it one day at a time. Sometimes a few hours at a time. Follow all recommendations as best you can. 💗

      2. Doughgurl

        Doughgurl

        Thank you so much for your well wishes. I am hoping that everything goes easy for me as well. We don't eat out much as it is, so it wont be too bad in that department. Thankfully. Also, I hear you regarding your back and feet!! I'd like to add knees to the list. Killing me as we speak! I'm only 5' so the weight has to go. Too short to carry all this weight. Menopause really did a doosey on me. (😶lol) My daughter also lives in Houston. with her Husband and my 5 grand-littles. I grew up in Beaumont, so I know Houston well, I will be sure to keep in touch and update you on my journey. I may need some advice in the future, or just motivation. Thank You so much for reaching out, I was hoping to connect with someone in the community. I really appreciate it. 💜

    • Alisa_S

      Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

  • Recent Topics

  • Hot Products

  • Sign Up For
    Our Newsletter

    Follow us for the latest news
    and special product offers!
  • Together, we have lost...
      lbs

    PatchAid Vitamin Patches

    Bariatric Forums

    For Patients

    Health Professionals

    Search Surgeons

    Bariatric Surgeons: Want to research a weight loss surgery surgeon? Enter their last name below to start!

    ×