Medica Insurance in Minnesota?

ajmsp8879
on 11/10/17 3:28 pm

Hello all,

I'm starting the journey towards the sleeve. I'm been a yo-yo dieter since college. I'm going to be 40 this year, and diets just don't help anymore. I'm on a CPAP for obstructive sleep apnea, have GERD, my joints hurt, and I just feel like poo most of the time. I realize I'm a lower BMI than some, but I'd really like to liver long enough to be a grandfather and great grandfather! Bariatric surgery is covered by my employer, but does anyone know anything about the Medica approval process. I'm going to my GP next month to discuss this further. I'm a little nervous, because I havent seen him in 2 years. My last weigh in with him was 190, because I was on a meat and cheese diet. How much weight history will they need? I realize I'm in this for the long haul, but I feel sort of lost on how to even start. Do I start with my GP, or just make an appointment with a surgeon right away?? Ugh!

hollykim
on 11/10/17 6:27 pm - Nashville, TN
Revision on 03/18/15
On November 10, 2017 at 11:28 PM Pacific Time, ajmsp8879 wrote:

Hello all,

I'm starting the journey towards the sleeve. I'm been a yo-yo dieter since college. I'm going to be 40 this year, and diets just don't help anymore. I'm on a CPAP for obstructive sleep apnea, have GERD, my joints hurt, and I just feel like poo most of the time. I realize I'm a lower BMI than some, but I'd really like to liver long enough to be a grandfather and great grandfather! Bariatric surgery is covered by my employer, but does anyone know anything about the Medica approval process. I'm going to my GP next month to discuss this further. I'm a little nervous, because I havent seen him in 2 years. My last weigh in with him was 190, because I was on a meat and cheese diet. How much weight history will they need? I realize I'm in this for the long haul, but I feel sort of lost on how to even start. Do I start with my GP, or just make an appointment with a surgeon right away?? Ugh!

I can't speak to your insurance but I would caution you against getting the sleeve if you already have GERD.

GERD can be made worse by having a sleeve and can cause GERD if you didn't have or pre op.

the best way to get info is actually to call the number on the back of your insurance card. They can give you all the qualifications for surgery.

good luck.

 


          

 

Kjnelson
on 11/12/17 9:17 pm - AK
VSG on 10/11/17

I also had GERD, have sleep apnea, joints hurt, just like you. I went straight to a surgeon and got evaluated and asked the specialist if I was a candidate. The staff was very knowledgeable on insurance issues and I read over my policy well. I know it is recommended to not choose the sleeve if you have GERD but I had other reasons I thought it was my best choice. I am 4weeks post op and no problems so far.

VSG on 12/10/13

Every person's insurance requirements are different, so nobody here can provide accurate information on your situation. Your very first step should be to track down a copy of your benefit book, or call the customer service number on the back of your insurance card. They can tell you what the specific requirements are.

As previously mentioned, if you have GERD at all it is NOT recommended to get the sleeve. Anecdotally, we're seeing a LOT of people here on the forums who need to have revisions from VSG to RNY because of acid issues.

I am the master of my own regain.

Author of the Five-Day Meat Test

Contadine
on 11/13/17 2:31 pm
VSG on 11/17/17

Each plan is going to vary, probably, so I would call the number on your card and ask. I'm on Medica, and their requirements were 1. BMI/co-morbidities, 2. that I complied with the orders of my surgical/medical team, and 3. that I used one of their 'Centers of Excellence" - at least for my plan. There are 10-12 Centers of Excellence in MN.

Getting the approval from my medical/surgical team took 9 months before they even contacted Medica for the pre-approval. I went to an info session the week after new years, and I am having surgery this Friday.

I would say to call Medica first and ask what the approved center in your area is, and then find out about an info session there. I didn't even talk to my GP, just went straight to the bariatric clinic.

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