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After many years, I finally decided to have wls.

I made an appointment with my primary care physician to talk to her about it and get set up for a sleep study for sleep apnea. Other than that, I have no idea what I need to do to get the ball rolling.

Does anyone have any experience with United Healthcare Choice Plus insurance and using it for wls?

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Posted (edited)

Congratulations on your decision. Unfortunately I don’t have that insurance but do you usually need a referral to see a specialist? I suppose If you were to call a surgeons office and ask to schedule they would let you know if you really need to wait until you see your primary. Then again if your appointment is soon it may make sense to just wait anyways so they can give you a recommendation for a surgeon if you don’t have one in mind

For me, it was the surgeons office that let me know what all the requirements were. I have seen them vary slightly from one person to the next. It depends on insirance but also varies by the program as well as your medical history. For my Sleeve the requirements were a 6 month medically supervised weight loss attempt, psyc eval and a nutritionist appointment. Ooh and you will need medical clearance for surgery which depending on your health may be just routine lab work or it may be additional appointments like a cardiologist checkup.

They may also require you to sort out the sleep apnea thing and make sure that the cpap is working to treat your sleep apnea sufficiently if you do have it but i’m not 100% certain on that (just seems like I heard something about that). I am currently pending a revision and this time he required an ekg that he didn’t ask for last time. I guess maybe since I’m a little older. They wanted the labs to be drawn within a month or less of my surgery date so I scheduled them and the ekg at my primary doctor at two weeks out from my surgery. Listing it out it seems like a lot but you will have a While to get it all done and they should walk you through it step by step.

Edited by ShoppGirl

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Thanks! I think my insurance requires 6 months supervised diet, psych eval, and nutritionist too. I do have a surgeon in mind.

My PCP appt is the 19th.

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Posted (edited)

1 hour ago, alisasings said:

Thanks! I think my insurance requires 6 months supervised diet, psych eval, and nutritionist too. I do have a surgeon in mind.

My PCP appt is the 19th.

Yea. I guess 9 more days won’t kill you to see if you need to do the sleep study first. But after you get that appt. If I was you I would go ahead and schedule the surgeon a little while after. Mine is always booked a month if not two out. Then again I’m impatient.

Edited by ShoppGirl

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In my case, I was referred by my primary care doctor to the weight management center that is affiliated with the hospital and everything else was done through them. But I know it can be different depending where you are. In my case, my surgeon, dietician, and behavioral therapist were all in one office and I went to the hospital to have my labs drawn and my barium swallow and EKG. I did not have to do a sleep test or endoscopy based on whatever criteria they use for that. My insurance required a certain number of visits with the dietician and surgeon, but I'm not sure now what the requirement was because I had been going to the center for a long time on medically supervised weight loss before switching to surgical, so I had long since met those requirements.

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Posted (edited)

22 minutes ago, NickelChip said:

In my case, I was referred by my primary care doctor to the weight management center that is affiliated with the hospital and everything else was done through them. But I know it can be different depending where you are. In my case, my surgeon, dietician, and behavioral therapist were all in one office and I went to the hospital to have my labs drawn and my barium swallow and EKG. I did not have to do a sleep test or endoscopy based on whatever criteria they use for that. My insurance required a certain number of visits with the dietician and surgeon, but I'm not sure now what the requirement was because I had been going to the center for a long time on medically supervised weight loss before switching to surgical, so I had long since met those requirements.

Ooh yea as @NickelChip just stated and reminded me that they may want an upper GI and/or endoscopy if you have suspected or diagnosed GERD or prior abdominal surgeries. Or some doctors just require them for everyone (I think to look for hernias before they go in there). I have Mild GERD from the sleeve so he wanted those two tests as well as a gastric emptying study prior to my deciding on which surgery is best for my revision (bypass or SADI). That was a pretty complex decision though, since I had already have the sleeved stomach and GERD. I wouldn’t expect all three for a virgin surgery.

Edited by ShoppGirl

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