[PHOENIX3023]

is it really 6 months of evaluations before being set up for surgery?
exactly what tests do they perform?

[Kenyar]

the length of time is dependant upon your surgeon or your insurance (they may have their own requirements) I was not required a 6 month wait by either. you have to check with your insurance to see what they require in the 6 months. most require documentation of a failed weight loss attempt...

just make sure you have all the info before you start. you dont want to be denied for not completing a requirement after waiting out the 6 months.

[DeMarie]

It's hard to say - each insurance company is different, surgeons too. I know for me, once I went to the seminar for my surgeon, my surgery was 4 months from then. That wasn't any requirement, it was just how long it took to do everything: cardiologist (if required), nutritionist, psych eval, blood work, sleep apnea (if required)...surgery date.
Also, when I went to my primary and brought the surgery up, I had with me my bank statements showing the year before I had gone to weight watchers for 10 months, and also showed membership dues to Curves - so if you have anything like that, get it ready, it can only help. Seeing that I tried several things, and knowing my history, my primary was ready to address the letter that went to my insurance (may be required) stateing I was a candidate for the surgery. So all these things helped move everything along. The other bit of info I got was Document everything, who you spoke to, their name, what date and time it was. Hope this helped - Godd luck.

[MsVickie]

Kenya is right. Most of the time spent waiting if there is any is due to your own insurance companys requirments. The physican has to follow them along with yourself. You may find it is the surgeon who requires additional things. So the best advice right now is to call your insurance company and ask them If they will pay for Gastric bypass surgery. If so then ask what the requirments are.

[MsVickie]

Posted at the same time Demarie did ! LOL she is right also !

[judijo]

I am a member of a "managed care" insurance company (as is most of Southern Cali...means HMO/PPO type plans). The medical group that I go to has a bariatric surgery program. The doctor determines the basic requirement for the need for surgery (BMI >40 or >35 w/co-morbidities and proof of effort in 2 supervised but failed wt. loss efforts) then refers the patient to the bariatric education department. Bariatric education is a 6 month group of classes explaining the available surgeries, nutrition before/during/after surgery, and exercise options. While taking classes, the patient meets with the primary doctor to complete other tests for preoperative screening (mammogram, endoscopy and heart tests, if needed, etc). After ALL this is done, the doctor can finally refer the patient to a bariatric specialist.

These hoops to shoot ourselves through is created by the surgeon, the contracting insurance co, and the medical groups.

The very well educated patient is more likely to have success in the long term.

[qt82699]

depends on what insurance requires and what the place you are going thru requires for their program...my insurance did not require anything but the program did..i had to see the shrink 3 times, dietician 3 times, physical therapy once, endoscopy and swallowing test...but like i said all places are different

[carylk]

My first appointment was in January and I'm still jumping through hoops! My insurance required 3 months physician supervised weight loss (some require 6 months). So started that in February, and in the mean time have been fulfilling all of the other requirements-met with nutritionist x2, psychiatrist x2, attended a WLS class, and a diet/nutrition class, met with physical therapist. They also have a mandatory weight loss prior to surgery- usually 10-15 lbs, which was easy enough to meet since learning all the new info from this process. All my paperwork was just submitted to insurance co for review, and not until after approval will they have me do an EGD and sleep study before surgery can be scheduled! Initially, we didn't know about the 3 month wl part- new requirement- so thought I would have had surgery a month ago! It's tough to have to go through all the steps and wait, but it does give you time to prepare mentally. 1 month ago I was scared that even after WLS I would fail somehow. Now, I feel much more confident and sure of the life changes that have already begun. Don't fight it, take it step by step and it will work out!

[carylk]

Forgot to add: insurance required a 3 year weight history. Well, I REFUSED to be weighed in at the doc's office.(Weighed you in a very open part of the office- no discretion- they verbally announced your weight- humiliating!) This has gone on for years, so I had no official record of weight in the past 2 years. Had to pull surgical files from the hospital, and luckily had entered some weights on new patient files at ob/gyn office and podiatrist office! We had to search for the weights. So think about that too. I was gathering photos and putting dates on them (if they didn't already have them) to submit in case needed. They don't like to use photos, but will if that's all they have. Good luck!

[DocSanae]

I like carylk's take on this.

Originally Posted by carlyk

Don't fight it, take it step by step and it wll work out

A lot of people think of the process as "fighting" the insurance companies, but watching this from the sidelines, I can see that a lot of this gives you a chance to evaluate your eating habits, helps you prepare for the life that comes post op, helps you be patiend with people and processes that you have no control over, and with info seminars, meet others face to face who are seeking the same surgery as you, or are already on the post op journey. In other words, the time spent jumping the hoops may be irritating and frustrating, but it also arms you with lots of weapons to get you through the actual journey.
So, check out all the details before hand so you don't get hit by hoops you didn't expect. do your homework thoroughly, and arm yourself with every info you can.

If you haven't already, then you need to call your insurance co to check out the exact details that the company requires.

((((((((HUGS))))))))) and good luck on the process.