I'm curious what steps everyone had to take from their first surgeon visit to approval/surgery date. Did you do certain testing, if so, when was it determined you had to do it? No need for major detail unless you feel like it. I'm thinking something like an easy to read timeline...

Example: [date] 1st Surgeon Visit> [date] blood work , stress test, psych test, etc.> [date] insurance approval> [date] start pre-op/liver shrink diet> [date] Surgery date

The reason I'm asking this is because #1 I'm marginally impatient, hate surprises and I'm trying to manage it. #2 My insurance policy that covers bariatric won't begin until 01/01/19 and I go to my first surgeon appointment this coming Monday 12/03. I'm just wondering what all I can squeeze in and get done before that 01/01/19 date. Thanks, folks!

EDIT: My nutritionist person just emailed me and said the only thing I can do prior to my new insurance plan is stress test, EKG and nutrition. Everything else will have to be done closer to surgery date which is TBD.

Edited November 30, 20187 yr by Kimmie K

4 minutes ago, Kimmie K said:

Congrats! Holy cow, that's quick! Who's your insurance?

I thought that was quick too! Made my head spin!! I have BCBS - made me so much more nervous, considering I thought I would at least have 6+ months, butttttttttttt............... here we go.

April 9th met with Surgeon
Mandatory six months MWM program with MD and nutritionist
Had cardiac clearance; psych clearance; PCP clearance
Surgery was 10/17/18
Lots of pre-op blood work, chest X-ray and EKG

1 hour ago, Gingerness said:

I thought that was quick too! Made my head spin!! I have BCBS - made me so much more nervous, considering I thought I would at least have 6+ months, butttttttttttt............... here we go.

Nice!!! I have Anthem Blue Cross (non-California, I'm in Texas, employer is based in Cali)...well, I WILL have it when January 1st rolls around. We just finished open enrollment. I'm going nuts because I don't know the policy requirements yet like nutrition visits, etc. and I can't call because I don't have any policy/ID numbers yet. I do know bariatric is covered from the basic paperwork we were given on the plan. I'm just too impatient LOL

Initial consultation, then cardiologist to check heart for clearance for surgery. Then pulmonary testing (respiratory) for clearance. Dieticians classes on learning to eat right after surgery. Phycologist test before surgery also. Two weeks before surgery have to go on a liquid diet to shrink the liver so that the surgeons can move around inside of you. I just started the process also myself about two weeks ago. All together I was told by the surgeon it will be about 12 weeks before the scheduled surgery and about 2-4 weeks off work. I’m a garbage man so I’m leaning towards 4 since it’s so physical.

On 12/04/2018 at 16:57, Kimmie K said:

Nice!!! I have Anthem Blue Cross (non-California, I'm in Texas, employer is based in Cali)...well, I WILL have it when January 1st rolls around. We just finished open enrollment. I'm going nuts because I don't know the policy requirements yet like nutrition visits, etc. and I can't call because I don't have any policy/ID numbers yet. I do know bariatric is covered from the basic paperwork we were given on the plan. I'm just too impatient LOL

I have Anthem BCBS with employee in Cali. I know the policy by heart. Req 6 mos weight loss (regardless if you are having a revision). No nutritionist requirement except one visit. You must have BMI of 40 (min) or 35-39 with two co morbidities. If you don’t have any co morbidities then you need to have 40 BMI

Md must do required testing based on your health and after the 6 mos monitores weight loss, submit. You will need a referral letter from your general practitioner referring you to a gastric specialist and some documentation by your md showing at least 3 years of attempting to lose weight. Like something giving your back story on challenges with weight loss. WW does not count as a monitored program. However, if that’s something you tried, be sure to have that documented.

You can actually download the anthem policy online. Do a google search for it and I can’t recall what site it is but you can find it for your state etc.

Meant to add the psych evaluation and all the other jazz is also to be done as mandated by your bariatric center. They also prefer you elect what they call “a center of excellence” as a place you have the procedure done. You can verify if your center is one by either calling or when you can log into the site with your policy info.

Here you go: https://www.obesitycoverage.com/anthem-bcbs-requirements-for-weight-loss-surgery/

I can’t seem to find the site I found where I could read the actual 28-29 pg policy but I know it’s out there. It helped with my own research fanatic self and my need to be well informed and prepared. It may help you with the impatience. Time flies once you start the process.

Checklist from my surgeon

On 12/4/2018 at 11:05 PM, mujerona 2019 said:

I have Anthem BCBS with employee in Cali. I know the policy by heart. Req 6 mos weight loss (regardless if you are having a revision). No nutritionist requirement except one visit. You must have BMI of 40 (min) or 35-39 with two co morbidities. If you don’t have any co morbidities then you need to have 40 BMI

Md must do required testing based on your health and after the 6 mos monitores weight loss, submit. You will need a referral letter from your general practitioner referring you to a gastric specialist and some documentation by your md showing at least 3 years of attempting to lose weight. Like something giving your back story on challenges with weight loss. WW does not count as a monitored program. However, if that’s something you tried, be sure to have that documented.

You can actually download the anthem policy online. Do a google search for it and I can’t recall what site it is but you can find it for your state etc.

That's good info. Every document I have, including a 191 page Anthem BC/Prudent Buyer EOC, says nothing about nutrition visits required, doctor letters, 3 years of diet history attempts, etc...which honestly means nothing. That stuff could be mentioned elsewhere in document I don't have that's exclusive to my employer's plan selections. The only thing mentioned is the requirement BDCSC facility and 40 BMI. We just went through open enrollment so I really just need a policy number so I can call Anthem myself and see what the stipulations of my particular policy are. Not knowing is driving me insane. Hopefully we'll get our cards in the next couple weeks.

When did you have your surgery (or when is it scheduled)?

On 12/06/2018 at 11:43, Kimmie K said:

That's good info. Every document I have, including a 191 page Anthem BC/Prudent Buyer EOC, says nothing about nutrition visits required, doctor letters, 3 years of diet history attempts, etc...which honestly means nothing. That stuff could be mentioned elsewhere in document I don't have that's exclusive to my employer's plan selections. The only thing mentioned is the requirement BDCSC facility and 40 BMI. We just went through open enrollment so I really just need a policy number so I can call Anthem myself and see what the stipulations of my particular policy are. Not knowing is driving me insane. Hopefully we'll get our cards in the next couple weeks.

When did you have your surgery (or when is it scheduled)?

I have not had my surgery yet. I just had the call today to schedule my final surgeon consult for Feb 20th. It’s the consult just before they submit papers to the insurance. It’s also my final weigh in.

In March I am going to Europe for 2 weeks and the doctor and I discussed scheduling the surgery date in April once approval is secured. At first I was worried about the trip and approval etc but the approval is good for up to a year. Not that I’d wait a year to do the surgery. Because I’m so close to the 40BMI mark, I’m making sure to lose between 1-2 lbs a month for the monitoring record. The center has been amazing and made sure to tell me my range.

I had an initial consult, 2 nutritionist appointments, 3 nutrition classes I crammed in one day, one set of labs, chest xray, and ecg, (which I did all in one day), ultrasound, 2 psychiatrist appointments, a sleep clinic consult, and a final consent appointment. Was done within 3 months. Would have been sooner but they were booked out. Surgery I had to push out a month even though they had an earlier date due to work. No weight loss requirements or anything. Insurance approved me within 4 days of the surgeon submitting my paperwork. Highmark BCBS.

Anything in yellow txt was required by my insurance carrier and anything in blue txt was required by my program/surgeon.

June 13, 2016 - Referral to Weight Loss Surgery Seminar @ Ohio State University by PCP

July 26, 2016 - Attended Seminar

Nov 03, 2016 - Submitted application to begin weight loss surgery process

Dec 19, 2016 - Entry Psych Eval (All patients have to pass a consult w/ MMPI psych eval prior to entry into the program)

Jan 2017 - Therapist pushed referral to see psychiatrist to discuss medications

Mar 14, 2017 - First of 9 monthly PCP visits per insurance

Mar 20, 2017 - Second Psych Eval @ OSU - Passed and entered program

My insurance requires a consecutive 9 month weight loss monitoring program with a PCP and they counted the visit prior to passing the second psych eval as 1 of 9.

April 5, 2017 - Initial visit with at bariatric clinic with dietitian and nurse practitioner ALSO required EKG and labs

May 2, 2017 - Required Endoscopy to check for h. Pylori (negative results)

May 3, 2017 - 2 of 9 PCP visits

June 7, 2017 - Dietitian follow up

June 8, 2017 - 3 of 9 PCP visits

June 19, 2017 - Cardiology Clearance

July 13, 2017 - 4 of 9 PCP visits

July 30, 2017 - Initial Psychiatrist appt for Mood stabilizers

Aug 16, 2017 - 5 of 9 PCP visits

Sept 14, 2017 - 6 of 9 PCP visits

Sept 9, 2017 - Pulmonary clearance (I have thrombophelia)

Oct 2, 2017 - Gastroenterology Clearance (I had Cyclic Vomiting Syndrome)

Oct 3, 2017 - Required Sleep Study (passed... no apnea) *Had I had apnea I would have then began 6 months of mandatory CPAP usage, followed by another sleep study, etc... this would have extended the 9 month requirement well into 15+ months)

Oct 18, 2017 - 7 of 9 PCP visits

Oct 25, 2017 - Dietitian follow up

Nov 22, 2017 - 8 of 9 PCP visits

Nov 29, 2017 - Dietitian follow up

Dec 12, 2017 - Third Required Psych Eval (Psych Eval had to be within 6 months of surgery so a third one was required)

Dec 12, 2017 Required "Life After Surgery" consult with nurse practitioner *Required my program NOT insurance

Dec 19, 2017 Dietitian follow up

Dec 21, 2017 Required "Life After Surgery" consult with family (husband plus children) with dietitian and nurse practioner. *Required by my program NOT insurance

Dec 27, 2017 9 of 9 PCP visits - ALL paperwork was submitted on this day to insurance including 5 years of weight history (I had to get records from other doctors where applicable and email them to the patient coordinator)

> Began 4 weekly online video conference courses on "Life After Surgery" that had to be completed as a requirement of program

Jan 4, 2018 Insurance Approval!!! Surgery tentatively scheduled for 1/31/18

Jan 15, 2018 Began Liver Shrink Diet (5 protein shakes, 1 300/cal or less frozen meal, 1 salad, 1 small fruit, unlimited non-starch veg)

Jan 23, 2018 Initial meeting with surgeon PLUS dietitian follow up > Surgeon was changed the next day due to scheduling conflict

Jan 29, 2018 - Pre-Op Assessment with anesthesiologist, blood typing, and labs

Jan 31, 2018 - Surgery Day!

I am pretty sure my surgeon is more thorough than most. I am in pretty good health. No issues other than sleep apnea.

In October I think I did the usual lab work and physical, in November and December I was required to have a colonoscopy and endoscopy. I also had to have a chest X Ray, blood gas, stress test, mammogram, well woman exam (pap smear) Psych, nutrition class and follow ups, and weight management appointments with my PCP. These are all separate appointments (usually an hour away) so it was no picnic. But basically I started in October and am having surgery January 22. I made an Excel spreadsheet to keep track of all my appointments and requirements because it can be overwhelming, especially when the specialists are booked up months in advance and you just want to get stuff over with!

Feb 2018 - Initial seminars with two different programs & surgeons. Selected the program that seemed the most flexible.

Mar 2018 - First consultation with care team. This meeting was a small group and lasted a couple of hours. Provided insurance and demographic information.

Mar 2018 - First appointment with surgeon. Recommendation based on extensive paperwork and medical history review was RNY.

Mar 2018 - First appointment with Dietitian. Anthem PPO required 6 months of medically supervised weight management.

Apr, May, Jun, Jul, Aug 2018 - Monthly appointments with Dietitian.

May 2018 - Exercise evaluation.

May 2018 - Psychiatric evaluation.

Sep 2018 - CPAP compliance report.

Nov 2018 - Cardiac clearance, CPAP compliance, lab work including serum Nicotine/Cotinine.

Nov 2018 - Consultation with surgical PA and scheduler.

Nov 2018 - Final consultation with surgeon. Also received insurance pre-authorization from Anthem.

Dec 14, 2018 - RNY surgery. One night in the hospital. Liquid diet 2 weeks prior to surgery to 3 weeks post-op.

Since I had a recent endoscopy and am regularly followed by a cardiologist, meeting those requirements was all done via records transfer. No additional appointments were needed to fulfill those requirements.

So are you recovering well? Looking forward to a Bright new 2019 and January to start it off?