Learning about Weight loss surgery
When i found out my insurance covered weight loss surgery i was so excited . Just the thought of getting my weight under control was enough to make me feel hopeful . Ive been trying to find the answers because i know these are probably the most asked questions but maybe someone can help me out.
Do u need a referrel from your doctor to have weight loss surgery ? I seen that u have to get approvel from your insuranace company its all a little confusing to me .
My bmi is 36.6 and im 33 years old . I suffer from severe depression and have my whole life . besides being over weight thats my only real health concern besides my colestrol being a little high . I have back and knee pain all because of my extra weight . I guess what im saying is how hard is it going to be to get my insuranace to approve the surgery and what are the first steps in getting everything started ? Any help is aprreciated thanks in advance =)
The first thing you need to do is contact your insurance company and ask them a few questions. You already know they cover it, and that is half the battle. Not you need to ask them these questions:
1. Are there any exclusions specifically for my policy?
2. What surgeries do you cover?
3. What exactly are the list of requirements to be approved for surgery?
4. What surgeons in my area are in network and recommended for my surgery?
You will want to get that list of surgeons and do some research on each one. Go to their free seminars to see if you like how things are run.
Most insurance companies will require a 6 month supervised diet with your PCP or the surgery center. Some surgery centers have everything in house that you will need for your surgery. You will need to get a letter of medical clearance from all of your doctors currently treating you, a letter of medical necessity from your PCP, and the stuff required by the surgeon, along with whatever diet hoops the insurance company will require, together and your surgery center will present that to your insurance company as a full package for approval. Then you will get your approval, and set your date!
It seems like a ton, and honestly it is, but if you stay organized it can go pretty quickly.
LapBand Weight 460 (2006) | Panni Removal Weight 200 (2008) | 3rd kid (2009)
Revision to RNY Weight 355 (June 2015)
Insurance companies are all different. They each have their own policies and procedures.
Like the other poster said you will want to call you insurance company find out. Tell them to mail all the info to you also. You want it in writing. You don't want someone giving you the wrong info on the phone or you misunderstanding something or forgetting.
There will be some hoops to jump and it will seem like a lot tests and doctor visits. It may seem like you have to wait forever. But it's all worth it in the end.
Good luck
Yep, It all goes back to the insurance, some require a referral to see the WLS Surgeon from your Primary Care physician and some not. But even if you don't need it up front, the surgeon will require you get that clearance from your PCP after the fact. The surgeon usually has an insurance rep who will assist you with the process, and schedule your appts, etc. Usually the Insurance companies require a BMI of 40% for approval or 35% BMI if you have documented comorbidities, ie high blood pressure, cholesterol, arthritis in the joints. all of which sound like may at least be starting with you. If they are well documented, hopefully you would be approved. if not, use the interim time to document them now.
Good luck in your decision making!
I'm Jo 
HW 245, SW 236, CW 151 Yeah (Normal BMI!!!!)
M1=213 (-23), M2=201 (-12), M3=186 (-15), M4=175(-11), M5=166(-9), M6=157(-9), M7=153(-4)
Batwingsman · 4 replies · 1325 views