Looking to get gastric sleeve with medical..will it cover? please help!

[cruzsteff7 0]

Hello! I'm new here just looking for some answers I hope to find...but I'm 5'6 and weigh 260 pounds. my BMI is a little over 40, I believe. I have sleep apnea, but no other comorbidites. Unless IBS or stomach problems count? I have medical, since I am low-income, under LA CARE. I was wondering if anyone here has had this procedure done or know if it is covered by this insurance? Also, how could I start the process? unfortunately at the primary doctor I currently have, it takes so long ti get an appointment, so I was wondering if I could start elsewhere? Thank you everyone!

[Apple203 1,314]

Go online to find a local bariatric program. They all seem to hold regular seminars for people considering surgery, and they'll be able to advise you if your insurance will cover the procedure. You can also call the insurance company and ask for the weight loss surgery policy in writing.

[Rainbow_Warrior 996]

Yes, do a local search for a bariatric clinic/doctor and spend an evening at a seminar.

It could prove to be a catalyst, one way or another to your decision.

[FluffyChix 17,418]

Schedule your appointment with your PCP now, even if it takes time. You'll probably need a referral, but will def need him to sign-off with his support and blessing. Better to know you have him/her on your team now. Also, you'll probably want (for record keeping ease), to have all your tests done within your hospital/care system. (ie If your doc is affiliated with a large teaching hospital, then likely, he'll refer and hook you up with other doctors in his network/hospital system. Then you'll do a seminar with the WLS doc and they will start writing orders for your pre-surgery tests.)

[cruzsteff7 0]

Thank you everyone!

[Sullie06 1,047]

I agree with above, find a bariatric program and see if they have seminars. I did not need a referral from my PCP to enter the program. I attended a seminar and then made an appointment to do an initial assessment with the Bariatric Program NP. I did need a referral from my PCP for my insurance though before they would approve me basically detailing all the past weight loss attempts and any weight related issues I had.

[etc. etc. etc. 440]

In some states in the US (like Illinois where I live) insurers are required to approve weight loss surgery if you meet certain criteria (BMI alone if it's high enough or BMI of a slightly lower level with certain comorbidities). A clinic seminar is your best way to find out.

Edited December 21, 2017 by etc. etc. etc.