Patient criteria question

JLR12679 · 07-13-2006, 01:07 PM

Okay so I received a copy of my medical policy from the Insurance Company, I have a few questions about it When they say the patient is enrolled in a program which provides pre-op and post op multidisciplinary evalualtion and care including behavoral helath, nutrition, and medical management. What exactly does that mean? I think it means that I have to be with a program that does the consults first, They told me the nutritionist, and psycoligist and surgeon will be in attendance at my first meeting I think this is what that means? Does that make sense?

wannabethin · 07-13-2006, 09:10 PM

Good grief, guess they didn't write your insurance book in plain English, huh? Mine is, so it was much easier to understand. I think you are on the right track with what you said it means, though. Maybe you could call them and ask them to explain it to you so you can actually understand it!

DocSanae · 07-13-2006, 10:20 PM

Yup, I'd say you'v got it right.

SHH · 07-14-2006, 05:56 AM

OK, too me multidisciplinary means many areas covered. So, sounds like they want you to see a psychologist to make sure you are MENTALLY prepared, a NUTRITIONIST to make sure you are aware of how you will have to change your eating habits, and your SURGEON and other doctors to cover the medical end. I think the medical part includes all the others you need to see.............for me that was a Cardiologist, Gastroenterologist, and my PCP, and additionally some ultrasound tests. Some also need to see a pulmonologist and have a sleep study.

Good luck to you...........sounds like you are on the right track. S

muffins · 01-04-2007, 12:26 AM

Are these tests done before the insurance will approve you or do they approve you first and then you have them done? In other words , are they out of pocket or does your insurance company pay for them?

"Cardiologist, Gastroenterologist, and my PCP, and additionally some ultrasound tests. Some also need to see a pulmonologist and have a sleep study."

fr1endly2 · 01-04-2007, 04:54 AM

MUFFINS in my case all the preop clearances were done prior to
my insurance approval.

hope that helps!

wls-surgery · 02-04-2007, 12:12 PM

This is what it means. They just want who ever you use to have a full program. Any of the Bariatric Centers of excellance should meet these criterias

07-13-2006, 01:07 PM	#1 (permalink)
JLR12679 Big Loser Join Date: Jun 2006 Location: Massachusetts Posts: 155 Weight Statistics 7/26/06 Start Date: 10/3/06 Surgery Date: Please Enter Height: 314 lb Start Weight: 145 lb Current Weight: 145 lb Goal Weight: 169 lb Weight Loss: 53.821656051 % % Lost: 10/3/07 Goal Date: Body Mass Index 52 BMI Start: 24 BMI Current: 24 BMI Goal: Weight Loss Method Roux en Y Gastric Bypass	Patient criteria question Okay so I received a copy of my medical policy from the Insurance Company, I have a few questions about it When they say the patient is enrolled in a program which provides pre-op and post op multidisciplinary evalualtion and care including behavoral helath, nutrition, and medical management. What exactly does that mean? I think it means that I have to be with a program that does the consults first, They told me the nutritionist, and psycoligist and surgeon will be in attendance at my first meeting I think this is what that means? Does that make sense? __________________ Jessica Surgery date 10/3/06 My before pictures http://s102.photobucket.com/albums/m94/JLR12679/ Follow my WLS journey here: http://tazdevil12679.blogspot.com/ My myspace website http://www.myspace.com/jess12679

07-13-2006, 09:10 PM	#2 (permalink)
wannabethin Guru In Training Join Date: May 2006 Location: In the country Posts: 336 Weight Statistics August 2006 Surgery Date: Please Enter Height: 210 lb Start Weight: 141 lb Current Weight: 125 lb Goal Weight: 69 lb Weight Loss: 16 lb Lb Left to Lose: 32.8571428571 % % Lost: August 2007 Goal Date: Body Mass Index 38 BMI Start: 25 BMI Current: 22 BMI Goal: Weight Loss Method Roux en Y Gastric Bypass	Good grief, guess they didn't write your insurance book in plain English, huh? Mine is, so it was much easier to understand. I think you are on the right track with what you said it means, though. Maybe you could call them and ask them to explain it to you so you can actually understand it! __________________

07-13-2006, 10:20 PM	#3 (permalink)
DocSanae Super Moderator Join Date: Nov 2005 Location: Tokyo, Japan Posts: 8,032 Blog Entries: 2 5' 5" Height:	Yup, I'd say you'v got it right. __________________ "In every job that must be done, there is an element of fun."

07-14-2006, 05:56 AM	#4 (permalink)
SHH WLS Master Guru Join Date: Apr 2006 Posts: 504 Please Enter Height:	OK, too me multidisciplinary means many areas covered. So, sounds like they want you to see a psychologist to make sure you are MENTALLY prepared, a NUTRITIONIST to make sure you are aware of how you will have to change your eating habits, and your SURGEON and other doctors to cover the medical end. I think the medical part includes all the others you need to see.............for me that was a Cardiologist, Gastroenterologist, and my PCP, and additionally some ultrasound tests. Some also need to see a pulmonologist and have a sleep study. Good luck to you...........sounds like you are on the right track. S __________________ SH August 10, 2005 265/139/?????

01-04-2007, 12:26 AM	#5 (permalink)
muffins Whipper Snapper Join Date: Dec 2006 Location: St. Louis, Mo. Posts: 13 Please Enter Height:	these tests Are these tests done before the insurance will approve you or do they approve you first and then you have them done? In other words , are they out of pocket or does your insurance company pay for them? "Cardiologist, Gastroenterologist, and my PCP, and additionally some ultrasound tests. Some also need to see a pulmonologist and have a sleep study."



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01-04-2007, 04:54 AM	#6 (permalink)
fr1endly2 Seasoned Veteran Join Date: Jan 2006 Location: SOMEPLACE LONG ISLAND, NY Posts: 6,755 Weight Statistics June 1, 2005 Start Date: Please Enter Height: 310 lb Start Weight: 167 lb Current Weight: 159 lb Goal Weight: 143 lb Weight Loss: 8 lb Lb Left to Lose: 46.1290322581 % % Lost: Body Mass Index 51 BMI Start: 27 BMI Current: Weight Loss Method Roux en Y Gastric Bypass	MUFFINS in my case all the preop clearances were done prior to my insurance approval. hope that helps! __________________ LISA http://w5.photobucket.com/widgets/dy...164/fr1endly2/ LAP RNY Gastric Bypass

02-04-2007, 12:12 PM	#7 (permalink)
wls-surgery Newbie Join Date: Feb 2007 Posts: 7 Please Enter Height:	This is what it means. They just want who ever you use to have a full program. Any of the Bariatric Centers of excellance should meet these criterias __________________ Our Weight Loss Surgery Blog

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