Changed my insurance (Metroplus) Plus Requirements

Maryvsg87
on 8/28/17 9:06 am - Bronx, NY
VSG on 11/20/17

So I went to my first consultation last week with Dr. Kini from Mount Sinai St Luke's in NY and I am excited to say that I will be going forward with WLS. We have decided to go with VSG and I had my consultation with the Gastroenterology the following day and scheduled my endoscopy for Sept 8th. I scheduled my Psych eval for Sept 4th. I have a support group tomorrow and then I have to pick another day in Sept for the second group. I have 2 appointments coming up with my PCP in Sept and October and God willing I will be set for October. So I was terminated from Healthfirst on July 31. Found out on 08/02 called back and was given Medicaid for the month of August and then enrolled to Fidelis starting Sept but then found out that with Fidelis you would have to do the 6 month diet and I have been dieting and on this weight loss journey since 2005. 12 years of trying of yo-yo dieting, of fluctuating in weight and feeling depressed and honestly speaking I didn't want to wait another 6 months. So I switch and all I need is 1 visit with my provider and a few requirements. Hopefully when I see him in October I will be scheduled for my surgery. He said I will have to lose from here till October around 5 to 10 lbs. I am currently 255 with no Co-morbidity with a BMI of 42.5 something like that. I have to be over 40 to get approve so that's why I think he is not fussing with me losing an X amount of weight. I'm nervous but definitely ready for this. I did my blood work the same day and they told me when I go in October I will see the Nutritionist and that is it. I need 2 letter from my provider one from her (letter of necessity) and one clearing me from cardio and pulmonary. I am wondering though if I need to see those specialist or would she be able to provide those letters to me. I guess next week I will see. So yea that's all they are asking weird I hear a lot of people do sleep study but I wasn't. I will call to make sure I do not want to go in October and then prolong it even more because they forgot.

teresafr
on 8/28/17 11:57 am
RNY on 08/14/17

I also didn't have to do a sleep study. Sounds like you got lucky. Changing ins. sometimes makes surgery not doable such as if new insurance plan doesn't cover it. I went straight through a surgeon so my surgery was pretty quick from first appointment to surgery date(not quite 2 months). All I needed through my insurance was a psych and cardiac evals. Easy peasy. I got lucky.

Maryvsg87
on 8/28/17 1:06 pm - Bronx, NY
VSG on 11/20/17

Congratulations. You know my doctor gave me my list of requirements and it says "support letter from primary medical doctor must include cardiology and pulmonary clearance" I hope my doctor doesn't refer me out so I can go easy peasy too. lol When did you have surgery? What kind? Is your health better? How much have you lost? Can you tell me about your psych? What to expect?

teresafr
on 8/28/17 8:09 pm
RNY on 08/14/17

I'm two weeks rny post-op. I'm JUST now starting to feel as good as pre-op. I did a 2 week liquid diet and lost 14 pounds then gained 6 pounds in hospital (fluids). Including 2 week pre-op I've now lost 27 pounds. Still a little sore on my right side. My psych eval started out answering a bunch of questions on an internet site and the second half was over the phone. Again, easy peasy. They just want to make sure you're going into this with eyes wide open and not in a manically depressed state. Pretty much everyone in our position has been depressed in the past so it's not a big deal. There are tickers under most folks posts that show their weight loss or how much they have to go. Also on top right you can read the type of surgery. The cardiac part was the slow down for me. It was several appointments and I failed one of the tests and had to have a heart catheterization of one spot they were unsure of....not really a problem.

Maryvsg87
on 8/29/17 6:39 am - Bronx, NY
VSG on 11/20/17

Thank you for your response and very detailed I like.... :-) I wish you well on this new journey can't wait till you hit goal weight!!

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