Can you tell me your timeline. From start to end.

I have CareFirst insurance.

I did some research but still no clear.
What were the steps you took from the day you first make your appointment? How long it took you to get to your surgery date?

I’m in Alexandria, Virginia and just started to look into weight loss clinics and signed up for one seminar.

So this question really depends if you have insurance. Typically with insurance most have to do like 6 months of supervised weight loss attempts and such.

I had no insurance.. So i saw my surgeon for the first time on December 14th. This is where he ordered all the testing like EKG, Chest Xray, Bloodwork, psychological exam. I did the testing pretty quickly. The psychological exam took 2-3 months to book. There were no openings before that so that was on March 1st. One of my test came back abnormal which was the EKG. So i had to visit my cardiologist to get clearance for surgery. This is when they ordered a nuclear stress test. after that i was cleared for surgery. Once everything came back normal my surgery was scheduled for 3 weeks later. So if it wasnt for that stupid psyc exam i could have had the surgery months ago.

My insurance (Highmark Blue-shield, I am in Pennsylvania) has no program specific requirements for education/classes or pre-op weight-loss requirement.

My program put me on a 3 month schedule - the shortest duration they offer… because of getting pre-op clearances.

I had the intro meeting plus three classes where we went over their program material & requirements. My first intro class was May 16th. Classes were spaced about every two weeks. I had two in June and a final appointment and weigh in on July 7th (my program required I not gain weight after my initial weigh-in).

I managed to get all my pre-op testing in fairly quickly, but it was not all reviewed and signed off on by the July 7th class, so I had to wait a few more days to schedule to meet the surgeon.

First available appointment to meet the surgeon was July 21st. She scheduled me for her first available surgery for August 16th, 2022.

So my whole program from first appointment to surgery will be exactly 3 months … that is not typical from what I understand.

Most of the people in my intro class were on 6 month schedules or longer, which was dictated by their insurance.

My process took almost exactly 6 months from my initial consult until my surgery date.

I have CareFirst! Needed 6 months of medically supervised weight loss (I didn't lose weight, though) and I had to produce medical records from the last 5 years showing that I'd been very overweight for a while. Here's what I remember it looking like:

October - initial consultation, determined I would not need a sleep study which I think is unusual

November - dietician visit 1

December - dietician visit 2, endoscopy

January - dietician visit 3, psychological evaluation

February - dietician visit 4

March - dietician visit 5, mandatory life after surgery virtual classes

Mid-April - dietician visit 6 -- submitted to insurance -- was approved in about 72 hours

Late April - final check up before surgery to get sign off, got May 20 date

Early May - pre-op appointment

May 20 - surgery

My insurance covered nothing. Also I work in the school system so once the decision was made I was anxious to get my surgery done as close to the beginning of summer as possible so I would have the summer to heal and miss as little work as possible. I am taking on a new position in the 2022-2023 School Year and was told that frequent absences would not be good. I'm leaving a situation where I was part of a team and easily covered, to a position where I am alone and have to have a substitute.

I saw my surgeon for the first time on April 29, 2022. He explained the sleeve and the bypass and ask if I had a preference. I had done some research of my own and wanted the gastric bypass RNY. He agreed that was the best choice for my case with my co-morbidities. I was given the tests that I would need to take but he used a lot of my existing tests because I was self pay and I already had a Psychologist that was ready and willing to write a letter, so I didn't have to wait for that.

I went back May 27th with all my clearances and tests done and he made it my pre-opp appointment, knowing I was anxious to get it done soon. We scheduled my surgery for June 7,2022. I went in on June 7, 2022 and had a routine surgery with no hiccups. I was released from the hospital June 9, 2022. Follow- up with my surgeons PA (Just as awesome) was a week later and I saw the dietician then to. I talked to the dietician 5 weeks after that and she checked to see how I was progressing into soft food. I will get to start slowly adding solid food on August 4th but I will hold off until the weekend in case it doesn't go well. My next appointment with the PA and the dietician is in the office on September 15.

I was able to return to light duty on July 11th. No heavy lifting but lots of walking (4000-7000 steps a day). I actually ran a couple times and didn't die!!!

I hope this helped?

I managed mine in just over 3 months.

My insurance demanded a 6 months medically supervised diet, but I had that proven via two different paths of two different programs in the previous 12 months, so they had no gripe there. They also wanted 5 years of proven morbid obesity and and I had that proven medically and with pictures so again, they were beaten. All that remained were all the tests proving I could live through the procedure, which I managed quicker than usual, since I made frequent calls pestering for any appointment cancellations.

When the doc's office submitted for approval Friday afternoon, I was surprised to learn I was already approved Monday morning. My surgery, originally scheduled for 4 weeks later was 2 weeks later.

I suspect a lot has changed in the subsequent years.

Good Luck,

Tek

I had a very long timeline. LOL.

I started orientation in January 2020, started a 10 week class March 2020 (which got cancelled)

Classes resumed July 2020 (online).

Finished my classes in August 2020 but had to wait because my A1C levels were still too high with a retest in January 2021.

Again levels too high, August 2021 my levels were good so I was referred to the surgeon. Had orientation with the Bariatric clinic in October 2021 and met with surgeon November 2021. Appointment with Internal medicine was December 2021 and meeting with Psychologist January 2022. It took a couple of weeks for them to schedule me due to having to take care of patients who got their surgery cancelled and needed rescheduled. I got my surgery date late February 2022 for surgery April 2022.

16 hours ago, james2021 said:

I have CareFirst! Needed 6 months of medically supervised weight loss (I didn't lose weight, though) and I had to produce medical records from the last 5 years showing that I'd been very overweight for a while. Here's what I remember it looking like:

October - initial consultation, determined I would not need a sleep study which I think is unusual

November - dietician visit 1

December - dietician visit 2, endoscopy

January - dietician visit 3, psychological evaluation

February - dietician visit 4

March - dietician visit 5, mandatory life after surgery virtual classes

Mid-April - dietician visit 6 -- submitted to insurance -- was approved in about 72 hours

Late April - final check up before surgery to get sign off, got May 20 date

Early May - pre-op appointment

May 20 - surgery

Thanks for the detailed reply. This really helps.

15 hours ago, The Greater Fool said:

I managed mine in just over 3 months.

My insurance demanded a 6 months medically supervised diet, but I had that proven via two different paths of two different programs in the previous 12 months, so they had no gripe there. They also wanted 5 years of proven morbid obesity and and I had that proven medically and with pictures so again, they were beaten. All that remained were all the tests proving I could live through the procedure, which I managed quicker than usual, since I made frequent calls pestering for any appointment cancellations.

When the doc's office submitted for approval Friday afternoon, I was surprised to learn I was already approved Monday morning. My surgery, originally scheduled for 4 weeks later was 2 weeks later.

I suspect a lot has changed in the subsequent years.

Good Luck,

Tek

That’s amazing. I am trying to gather documents from previous visits to doctors. I tried phentermine and glucophage for weight loss but didn’t lose much. Maybe that can show how I have been trying over the years.

I have Medicare and Tricare. Roughly 6 months. Monthly visits with my GP, psych, and I would have been scoped to look around in my stomach except for the fact I had it done some 10 months earlier for some other thing. Also meeting with a nutritionist. Just jumping through the hoops. (The psych was SO funny. "Do you ever think about suicide?" Sure, like I would tell you if I had! Duh!!)

I would first recommend talking to your insurance company to find out if they cover bariatric surgery, and if they do, what all is required/covered. One thing I learned is that even at the same insurance company, the coverage and the requirements to qualify can vary widely. This is because most larger employers actually are "self-insured". This means the insurance company just administers the health plan and your employer is the one paying the bill. As a result, the insurance companies let the employers have wide latitude in what they will and won't cover and what the qualification requirements will be.

For example, I have United Healthcare. I was also on United Healthcare last year, but with a different employer. The bariatric programs are quite different in terms of what they required and what procedures they'll cover. Note that some insurance companies also have specific providers they recommend.

Once you clarify all that, check with your bariatric program/physician. The bariatric program I chose required a psyc eval, an upper GI scan, and three months of meetings with their dietitian, even if the insurance didn't require those things.