Discouraged

[Daizeoh 9]

I was feeling so excited and happy about things and getting things done but now seeing that after meeting with a surgeon for the first time (On the 15th) there’s going to be more things to get done and I’m just feeling so unmotivated discouraged and I keep thinking what if my insurance denies it can anyone tell me what you will need and how long do you think the process will take. I know everyone is different but it would help (:

[Creekimp13 5,838]

Best thing to do..is to call your insurance company and ask yourself. Will save you a lot of heartache and you'll get the answers straight from the horse's mouth.

My insurance, blue cross blue shield of MI required 6 months medically supervised weight loss with a dietitian, therapist clearance, Upper GI, (I ended up also needing an endoscopy, too, cause my upper GI was abnormal). My surgeon required a support group meeting, a fitness trainer meeting, and a bunch of stuff presurg...blood, EKG, chest films, etc. Also a clearance and referral from my PCP.

My first seminar was in May of last year...surgery was in December.

Edited February 8, 2018 by Creekimp13

[Daizeoh 9]

Should I call before or after my consultation with the surgeon?

[Creekimp13 5,838]

I called before.

[_Shane_ 63]

I had my first appointment with my surgeon, signed up for the nutritional counseling (in office) and set all my appointments for the next 6 months, then called the Insurance company's bariatric services (Optima I guess). I did this at the direction of the surgeon's office.

Almost forgot - prior to all this, I called the surgeon's office and they took down my insurance information and determined my coverage, for me, before my first appointment.

[kakatlady612 1,053]

Is this a Duhh or a Whaa moment? Maybe one hand not being aware of what the other hand is doing?

Sent from my VS880PP using BariatricPal mobile app

[lucylu1313 38]

On 2/8/2018 at 1:34 AM, Daizeoh said:

Should I call before or after my consultation with the surgeon?

Your doc should give you a folder with all his requirements . He should know what are the requirements for your particular insurance. You should call your insurance to double check that they do pay for bariatric. BELIEVE ME TIME GOES BY SUPEr fast . Good luck.

[elforman 234]

Hi @daizeoh. Here's more information than you asked for. I'm just a thorough kind of guy,

The insurance company will only deny you for these reasons:

1. You do not meet the criteria.
2. Failure to follow the pre-op protocol.
3. Not passing the psychiatric evaluation.
4. Not being covered for weight loss services.

CRITERIA: I'm pretty sure the standard rule of thumb for eligibility, at least for males, is a BMI of 40 or up or a combination of BMI of 35-40 with other complicating factors like severe sleep apnea. It may differ for women.

PROTOCOL: Each insurance company has different pre-op protocols regarding things like pro-op dieting. Your doctor's staff will know what your insurance requires. There are reports of requirements of pre-op diets ranging from zero to six months as well as other things like endoscopies and other pre-op exams to ensure you're healthy enough to endure the surgery. The doctor's staff will all handle checking with the insurance company to find out exactly what you need. It's probably better to let them deal with the insurance company than doing it yourself since they know exactly what to ask.

PSYCH EXAM: If you do not pass the psych exam you may be able to get a treatment protocol to follow that would help you get past that hurdle. The psych exam includes things like not having drug or alcohol addictions, so if you've had that recently they'd require you to be sober for six months. If they determine you have undiagnosed or untreated depression they might recommend seeing a therapist weekly until the therapist believes you have a handle on it. The psych exam also ensures that you have a good support system in place for your recovery period, so if you live alone with twelve cats but have no local friends or family, you're a poor candidate.

NOT COVERED: Not all insurance policies cover weight loss services and bariatric surgery. This is something you could call and ask about yourself. If you have coverage through an employer and these services are not covered, it's because your employer decided not to include the coverage, which can be done to keep premiums lower.

The most important thing is to ask questions. You'll get a lot of advice here, often confusing and conflicting. In addition, all doctors are different: most will do the surgery in a hospital and have you spend the night, some will do it outpatient and you'll be home by 4pm the same day. Some will require a pre-op liquid diet, others won't. No two people will have a similar experience, so just because one person says they have the same insurance company as you does not mean you'll have the same requirements.

Edited February 11, 2018 by elforman

[Daizeoh 9]

29 minutes ago, elforman said:

Hi @daizeoh. Here's more information than you asked for. I'm just a thorough kind of guy,

The insurance company will only deny you for these reasons:

1. You do not meet the criteria.
2. Failure to follow the pre-op protocol.
3. Not passing the psychiatric evaluation.
4. Not being covered for weight loss services.

CRITERIA: I'm pretty sure the standard rule of thumb for eligibility, at least for males, is a BMI of 40 or up or a combination of BMI of 35-40 with other complicating factors like severe sleep apnea. It may differ for women.

PROTOCOL: Each insurance company has different pre-op protocols regarding things like pro-op dieting. Your doctor's staff will know what your insurance requires. There are reports of requirements of pre-op diets ranging from zero to six months as well as other things like endoscopies and other pre-op exams to ensure you're healthy enough to endure the surgery. The doctor's staff will all handle checking with the insurance company to find out exactly what you need. It's probably better to let them deal with the insurance company than doing it yourself since they know exactly what to ask.

PSYCH EXAM: If you do not pass the psych exam you may be able to get a treatment protocol to follow that would help you get past that hurdle. The psych exam includes things like not having drug or alcohol addictions, so if you've had that recently they'd require you to be sober for six months. If they determine you have undiagnosed or untreated depression they might recommend seeing a therapist weekly until the therapist believes you have a handle on it. The psych exam also ensures that you have a good support system in place for your recovery period, so if you live alone with twelve cats but have no local friends or family, you're a poor candidate.

NOT COVERED: Not all insurance policies cover weight loss services and bariatric surgery. This is something you could call and ask about yourself. If you have coverage through an employer and these services are not covered, it's because your employer decided not to include the coverage, which can be done to keep premiums lower.

The most important thing is to ask questions. You'll get a lot of advice here, often confusing and conflicting. In addition, all doctors are different: most will do the surgery in a hospital and have you spend the night, some will do it outpatient and you'll be home by 4pm the same day. Some will require a pre-op liquid diet, others won't. No two people will have a similar experience, so just because one person says they have the same insurance company as you does not mean you'll have the same requirements.

THANK you! I really appreciate you answering me in a very informative way. I have done the 6 month Weight watchers that my insurance requires , I have my first consultation with the surgeon on Wednesday and I’m excited! A step closer! I’m just worried and nervous for what comes after that

[elforman 234]

When it comes to being nervous, I'm actually rather stoic about the whole thing. I know there are many things that can potentially go wrong but I just don't obsess over stuff like that. I've always thought that worrying is a waste of time. I just try to control the things I can control and learn as much about the things I can't so I'm prepared. Stay calm until there's a legitimate reason not to. And if for whatever reason there's a delay or glitch in the process, don't obsess over what went wrong, just start doing what you can to fix it. You'll be fine.