Beginning my adventure

MeletaG
on 3/13/08 4:31 am, edited 3/13/08 4:39 am
Well it looks like my adventure is just beginning with my new life. I had a follow up visit my my general doctor Tuesday and she has sent me a referral to attend the New Image Nutrition & Exercise program. I got a call yesterday morning from New Image and I have set up my first visits for April 9th and 15th. My insurance requires me to participate in the program for a minimum of 6 months and then if my doctor still thinks that I could benefit health wise to have the gastric bypass then I have to get pre approval from my insurance to see Dr. Chris Edwards who is the Bariatric doctor here at St. John's hospital in Springfield, Mo. They said my doctor would have to send over all her notes and info to the Bariatric doctor for approval. Am I missing anything on how this all works? I worry that I am not taking the right steps for my insurance to pay for the surgery. I still don't know what BMI the insurance has to go by to approve my surgery.My insurance will only pay for the gastric bypass and will only pay for it if my BMI is 40 or over which it was whenever I first went to see my general doctor but I have joined an exercise program and having been doing the WW diet on my own and now I am 5'0 and 193 down from 202.So now I am not sure what my BMI is. And what about when I go through the New Images program and I lose some will they deny me then? I want to lose and would love to be able to do it on my own but I need the surgery for my health. I have high blood pressure, diabetic, fatty liver, sleep apnea, bladder inconsitence and my family history is horrible. My mom has had 3 heart attacks, 4 stents, triple bypass, and 2 major strokes and that is just my mom. My life is so hindered my weight. I also need a hysterectomy due to endometreosis and scarring but he can't operate until I look some weight.HELP ME! PLEASE!!!
cotonmom2
on 3/13/08 4:49 am - Wichita , KS

I went to the BMI cac. on this site and figured out your BMI which would be 37.6 I know some insurance will not pay unless your BMI is 40 or above but that is something you will have to find out from them?  I was on a 6mo diet before my surgery and I only lost 5 lbs.  I was told you don't have to lose during that phase they just want to see how committed you can be to a diet and the dr. appts.  If I were you I wouldn't try to lose any more weight if your wanting the surgery because they may deny you cause they see that you are able to do it on your own even with the co-morbidities.  I know it doesn't make since that they require the dieting cause probably if your like most of us you have been dieting for years and will lose only to regain it all and then some?  They have their rules and a lot of times they will find any thing and everything or ways to deny paying for the surgery so be careful what you do.  Document every phone call you make to them with date, time, who you spoke to and what they said keep that information you may need it.  Ask to speak to the Bariatric team and get their direct number cause I found out that if you just call the general 800 customer service number those people know nothing!!!!  Good luck to you just remember this is a long process to get approved and get a surgery date but don't get discouraged hang in there it will all come together it just takes time.

    
Tammy H.
on 3/13/08 9:46 am - Holcomb, MO
Meleta...Prayers going up that your journey goes well for you....I would be careful on loosing to much before you are approved....Cotonmoms right you usually have to have a certain BMI and a lot of insurances expect you to be at least 100lbs over weight....But don't give up now...you never know what your insurance will decided they are all different.....Keep us posted....Luv & Hugs..Tammy~ammy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

                Tammy~Ammy
 ~~~Happiness is being Christa's Nanna~~~
   Start~474lbs /Now~285 /Goal~200lbs
   Surgery:06~04~07 Total~191 lbs down!
         

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