My first Appointment

[amf1025 71]

Well today I finally had my first appt. With my surgeon and I absolutely love her. She answered all of my questions and didn't make me feel rushed. She said this process will take 6 weeks to 6 months I'm praying for sooner. So now I start all the checklist of requirements to get approved !!!!!! I'm so excited !!!!!!!!!

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[Who'sThere 331]

Best of luck! A lot of the time depends on your insurance and surgeon's requirements. Even if it is 6 months (I know you don't want it to take that long!) try to use that time to research and build better habits that will lead you to success. I know it took me a while to "break up" with my daily McDonald's Sweet Tea. Some used that time to stop smoking or give up pop. Anyway, I wish you the best.

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[az062217vsg 40]

Good luck! I have my first appointment tomorrow. Hoping for a quick approval, too.

[kaypitre5 28]

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

Edited December 21, 2016 by kaypitre5

[kaypitre5 28]

Well today I finally had my first appt. With my surgeon and I absolutely love her. She answered all of my questions and didn't make me feel rushed. She said this process will take 6 weeks to 6 months I'm praying for sooner. So now I start all the checklist of requirements to get approved !!!!!! I'm so excited !!!!!!!!!

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[amf1025 71]

I have to have a upper GI test, I have to see my neurologist because I have epilepsy , i have to see the hospital physiatrist and that's 150 cash fee. The dietician and have your Dr sign 6 months of medical weight loss supervision records.

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[amf1025 71]

Oh and she found I have a hernia that will be fixed after I lose some weight .she says I don't have to lose any weight before surgery or have a catheter I has happy about that lol

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[livvsmum 2,368]

Congrats on starting your journey! Good luck!

[Raymia 565]

Good Luck it seems we both will be going in around the same time depending on your insurance :0 ) I was told 6 weeks but I had to work around my work schedule so its more like 10 weeks for me.

[amf1025 71]

I just made my upper GI test they got me in on the 27th that's sooner than I expected.

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[Who'sThere 331]

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

I don't mind at all. I'm a revision patient, but I'll tell you about both.

For my initial surgery (lapband) and if this(rny) had been an initial surgery (different insurances then and now) the requirements would've been the same.

Visit with psychologist and his/her approval; 6 month physician (other than my surgeon) supervised diet with an inability to lose 10% of my body weight within the past 2 years; 5 year history of morbid obesity; bmi or 40 or more with no comorbidities or 35 or more with a certain number of comorbidities from a certain list (I will put a screenshot in pics

In addition to this, my surgeon requires attending at least one nutrition education class that is 2.5 hours long, and at least one support group meeting. I continued the support group meetings because they are soooo helpful. At these, the first 45 minutes is a group discussion with a licensed counselor then the bariatric nutritionist talks to us for 20 minutes or so and gives us tips and recipes and such. The next part is Q&A where preop patients ask questions of post ops. The last part, the preops and postops divide into groups and talk about whatever. There are 2 bariatric registered nurses and a bariatric dietician at these meetings.

This time, I was a revision patient, and my surgeon required a refresher on the nutrition and a support group meeting since it had been 7.5 years since my initial surgery. Insurance only required a letter of either surgical or medical complication. My initial consultation for my revision was September 26. My surgery was December 15, 6 days ago.

I'd be happy to answer any questions you have. I'm a very open person.

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

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[Jess55 97]

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

I don't mind at all. I'm a revision patient, but I'll tell you about both.

For my initial surgery (lapband) and if this(rny) had been an initial surgery (different insurances then and now) the requirements would've been the same.

Visit with psychologist and his/her approval; 6 month physician (other than my surgeon) supervised diet with an inability to lose 10% of my body weight within the past 2 years; 5 year history of morbid obesity; bmi or 40 or more with no comorbidities or 35 or more with a certain number of comorbidities from a certain list (I will put a screenshot in pics

In addition to this, my surgeon requires attending at least one nutrition education class that is 2.5 hours long, and at least one support group meeting. I continued the support group meetings because they are soooo helpful. At these, the first 45 minutes is a group discussion with a licensed counselor then the bariatric nutritionist talks to us for 20 minutes or so and gives us tips and recipes and such. The next part is Q&A where preop patients ask questions of post ops. The last part, the preops and postops divide into groups and talk about whatever. There are 2 bariatric registered nurses and a bariatric dietician at these meetings.

This time, I was a revision patient, and my surgeon required a refresher on the nutrition and a support group meeting since it had been 7.5 years since my initial surgery. Insurance only required a letter of either surgical or medical complication. My initial consultation for my revision was September 26. My surgery was December 15, 6 days ago.

I'd be happy to answer any questions you have. I'm a very open person.

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

Screenshot_20161221-175846.png

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I'm jealous. Lol. I'm revising too and they made me do the entire process again. All the pre op clearances and the 6 months. I was hoping I wouldn't have to do the 6 months and have my surgery this month. But the insurance coordinator said insurance would never approve without it. Now I have to pay my deductible again, pulse my out of pocket witch I'd already paid some of as well. Money I don't have,

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[Who'sThere 331]

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

I don't mind at all. I'm a revision patient, but I'll tell you about both.

For my initial surgery (lapband) and if this(rny) had been an initial surgery (different insurances then and now) the requirements would've been the same.

Visit with psychologist and his/her approval; 6 month physician (other than my surgeon) supervised diet with an inability to lose 10% of my body weight within the past 2 years; 5 year history of morbid obesity; bmi or 40 or more with no comorbidities or 35 or more with a certain number of comorbidities from a certain list (I will put a screenshot in pics

In addition to this, my surgeon requires attending at least one nutrition education class that is 2.5 hours long, and at least one support group meeting. I continued the support group meetings because they are soooo helpful. At these, the first 45 minutes is a group discussion with a licensed counselor then the bariatric nutritionist talks to us for 20 minutes or so and gives us tips and recipes and such. The next part is Q&A where preop patients ask questions of post ops. The last part, the preops and postops divide into groups and talk about whatever. There are 2 bariatric registered nurses and a bariatric dietician at these meetings.

This time, I was a revision patient, and my surgeon required a refresher on the nutrition and a support group meeting since it had been 7.5 years since my initial surgery. Insurance only required a letter of either surgical or medical complication. My initial consultation for my revision was September 26. My surgery was December 15, 6 days ago.

I'd be happy to answer any questions you have. I'm a very open person.

If you don't mind me asking.. what were the list of the requirements that the surgeon gave you? I have my first appointment the 2nd week in Jan..

Screenshot_20161221-175846.png

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I'm jealous. Lol. I'm revising too and they made me do the entire process again. All the pre op clearances and the 6 months. I was hoping I wouldn't have to do the 6 months and have my surgery this month. But the insurance coordinator said insurance would never approve without it. Now I have to pay my deductible again, pulse my out of pocket witch I'd already paid some of as well. Money I don't have,

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Interesting you mention this. The lady in my surgeon's office told me the same thing. However, before my new first consultation, I called my insurance and asked what they required and had them send it to me in writing as well. When I told the lady that, she argued with me. She said she had never had a patient NOT have to do all the (long) criteria. I read it to her, and she still didn't agree with me. So, I highlighted it and emailed it to her. She still disagreed. She told me I would have to call insurance and have them call her on 3way to be sure. I did. She told the insurance lady on the phone who was reading her email regarding ME from the bariatric nurse case manager saying that if I was having my band removed and rny done in one procedure, I would be approved with a letter of medical or surgical complications. She told that representative that she talked to this lady (Raylene with BCBS) daily, and that she would call her herself to verify. She called Raylene and TOLD her I didn't have any surgical complications and read her my EGD report. Well, here's the thing, I never claimed to have surgical complications. Mine were medical. When I mentioned that, she gave me to another girl who told me it really wouldn't matter what my endocrinologist said because my band didn't "cause my endocrine problems" and that it would be pointless to submit, but they would if I insisted. See, medical complications to necessitate a revision don't have to be "caused by my band." They can be any medical complication that necessitates the need for a different apporach. So, I went to my next visit very upset, and my surgeon himself walked out to the office manager (lady above the two I'd been dealing with) and asked her if we would burn any bridges by submitting--him knowing we wouldn't--and she said no, we could always appeal then even reapply later. He said thought that was the case, and ordered them to send my paperwork in with my letter from my endocrinologist.

I have no idea why they were so adamant that I wouldn't be approved. I honestly think they have been telling people just what they told you and me so that they can use the same checklist for everyone. When challenged by someone who knew better and had done her own research, they were surprised and didn't want to be wrong. That's the only thing I can think of. This submission was much less paperwork for them. I was easily and quickly approved.

It's not that I'm stubborn, but I needed to have this now, not in 6 months for 2 reasons. First, my insurance changes Jan 1 and my out of pocket would be much higher. Most urgently, though, is that my endocrine issues were going downhill fast. Without intervention, I would almost assuredly have been diabetic by the 6 month mark.

Seems like at this point you are almost there. However, whether it be bariatric surgery or any procedure, my advice is to call you insurance company yourself and ask them for the specific policy on that and to send it to you in writing. Your insurance company provides a service that you and/or your employer pays for. Don't be afraid of them. Know your coverage and advocate for yourself!

Best of luck on this journey! It's hard but worthwhile!

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[Who'sThere 331]

@@Jess55 I think I misread at first. Don't wait the 6 months I'd you don't have to. That's time and money you won't have to spend. It's probably too late to get it done this year, but at least you won't have to wait as long maybe.

What insurance do you have?

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[Who'sThere 331]

@@kaypitre5, I just now realized you were asking OP for her criteria, not me. Oops, sorry. I may have overshared. Lol. Maybe I will help someone else at least.

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