Question:
I dont know where to start!
I am 23 years old 5'7 and 305lbs, I have a bmi of 51, and am considering WLS Can anyone tell me where to start ? do I just call a surgen reccomended, do I see my pcp Please help Im so confused on this. — cara G. (posted on August 3, 2004)
August 3, 2004
First, gather as much information as you can from this website. Then, talk
to your primary care physician (who will have to clear you for surgery--
whether as an insurance requirement or as a condition of the surgeon's).
At that time, you should talk to your insurance company and find out all
the hoops through which you'll need to jump--- supervised diets, gathering
old medical and weight loss records, attending nutrition classes and the
potential list goes on and on. By that time, you would have a chance to
find a surgeon, attend her/his support group and informational meetings and
speak with that surgeon's patients. Good luck.
— SteveColarossi
August 3, 2004
Cara,
So cool to be at your age and heading into this. What I would have given
to have the extra years of life given to me! I was 38 when I had my DS and
man - what a transformation my life has undergone. I had no idea how fun
and totally mind-blowingly cool it is to be a WLS post-op.
The first place to start is to research the 5 most commonly performed
versions of WLS. Some good sites to check out:
http://www.obesityhelp.com/morbidobesity/m-surgerytypes.phtml
http://www.gr-ds.com/generalinformation/comparison.html
www.duodenalswitch.com
And of course, here on AMOS, too.
If I could give you any advice at all, it would be this: don't let
insurance or geography determine which form of WLS you pursue. This is for
the rest of your life, and you want to be 1000% sure that you're going to
be living with a post-op lifestyle that you're happy with.
Hope that helps some!
Blessings,
dina
— Dina McBride
August 3, 2004
You should start by calling your insurance company, or reading your
insurance procedures that are covered and find out if your insurance will
cover your WLS. If they do not cover this surgery, then start getting
things together to pay for your surgery, depending on where you have your
surgery done the cost will probley be low end $17,000 high end $50,000.
If your insurance covers this surgery, you need to go to your pcp and get
him/her to document your BMI, and co-mobilities and then have your pcp send
in to your insurance company that this surgery is medically necessity.
Depending on how your insurance works, you could call them and get a list
of WLS surgeons in your network, and then start doing research on each
surgeon, if you chooce your surgeon before you go to the pcp, you can have
your pcp put that surgeon on his paperwork that is submitted to your
insurance.
Some insurance companies have pretty tuff requirements, like years of
supervised diets, and certain co-mobilities, you need to research that.
If you get an approval back for this surgery, the surgeon will also have
requirements, like a seminor, pshc eval, stop smoking, blood tests,
controlled diabetes, my required me to lose 10 lbs to help shrink my liver.
I also had to have a Cardiologist surgery clearance.
Good luck, and having this surgery will be the best thing you can do for
yourself.
Cindy Smith
Open RNY 8-6-03
-154 lbs
— cindy
August 3, 2004
Cara,
I would recommend talking to your primary care physician. That is how I
got started. Mine actually referred me to a surgeon and I went from there.
Also you could call your insurance and find out what exactly they need
from you to get the ball rolling.
I hope you have good luck in your journey to WLS. I am having surgery on
August 31st. Wish me luck.
Joy
— gerardlovesjoy
August 3, 2004
— Rosemary L.
August 3, 2004
I wish I could've had the surgery at your age! It would have given me 20
additional years of high quality living! Here's what I would do......First
I would call my insurance company and ask them: Do you cover gastric bypass
(or whatever procedure you've chosen) that has been deemed medically
necessary for the treatment of morbid obesity? If you will ask them like
that it leaves no room for them to tell you "no" based on a
loophole. If they say "no" then you can start considering how to
pay for it. If they say "yes" then if you think your primary
care physician will be supportive I'd contact him/her. If you don't think
he'll be supportive I'd contact a surgeon or program directly and check to
see if they require a referral. Many programs do not and more and more
insurance companies do not. Research the surgeons in your area and try to
locate a local support group. If you can attend an open group you can get
information on many of the surgeons in your area. Follow the program your
surgeon recommends and stay in a support group. Best wishes to you as you
embark on the most exciting journey of your life!
— ronascott
August 3, 2004
thank you all for the advise the good news is that I called my ins and they
do cover it if it is a ness. I will call my pcp today, the funny thing is
that I work at a very well known health ins and I actually got into this
web site by a member that called me to get plastic surg benefits, she
directed me here and I am so greatfull, If anyone has questions about ins
please feel free to email me Im kinda behind the scenes and know the
tricks, i guess yould call them thank you all soooo much for your support,
ps still looking for an angle
— cara G.
August 4, 2004
Find a BTC Center near you and make an appointment for a consulation and
they will be able to help you with insurance questions. I did mine this way
,started 5/4/04, saw the Dr at BTC and got the approval in 2 weeks time.
8/10/04 is my surgery date.
— Angel C.
August 4, 2004
Cara, reference your offer to answer insurance questions/issues, just check
back here frequently and look at the questions asked. Often times, someone
does have an insurance issue or question and you could help by providing
them with an "inside" answer. Good luck!
— Cindy R.
August 5, 2004
Unless your insurance company requires a referral, there is no need to call
your pcp. I just called the surgeon of my choice up and got an
appointment. my PCP found out after the fact. i had casually mentioned it
to him before and I could tell he didn't think much of gastric bypass. he
is my biggest fan now.
— Delores S.
Click Here to Return