VSG in Ohio - Insurance, letter of medical necessity and Requirements

on 12/5/17 5:29 pm

Hello, I am looking for some advice and info about having the vsg done. I am going to choose between Paramount Advantage and United Health (both Medicaid) and I'm having a hard time getting information and the requirements. A lot of post I have seen are a lot older and I'm new to this site so I am still learning how to get around. If you guys have advice or info that would be great.

Also i you know of any physicians in the Toledo, Ohio area who don't want an arm, both legs and my spine for a letter of medical necessity that would be a great piece of info to get. I only ask because I am currently looking for a new physician as I havent been going to the doctor consecutively for some time due to lack of insurance and doctors with horrible bedside manners. I went to the same pediatrician till i was 20 (24 now) and I'm sure I have plenty of medical history of morbid obesity and trying different diets, a visit with recorded weight in 2015 and 2016 or 17. Thanks for reading my post and again information you guys can give would be great!!!

on 12/6/17 8:38 am - PA
VSG on 08/23/16

I would call customer service numbers for both carriers and just straight up ask what they cover or don't and what the requirements are. Or search their websites - each plan is going to vary.

Keep on losing!


HW 271.5 (April 2016) SW 246.9 (8/23/16) CW 158 (5/2/18)

on 12/6/17 10:11 pm

Will do!!! Thanks for replying!

Sparklekitty, Hag of Science
on 12/6/17 8:46 am
VSG on 12/10/13

Every insurance plan is different. Your best bet is to call the insurance companies, give them the info on the plan you're looking for, and ask for specific coverage requirements for bariatric surgery.

I can't speak to your experience, but I know many people (myself included) who were able to have the letter of necessity/medical recommendation written by the surgeon who was performing my WLS.

Nerdy Little Secret (#42) - Tucson Roller Derby

on 12/6/17 10:12 pm

Yeah I'm definitely going to call and find out whats required and ask a lot of questions lol. Thanks for replying to my post!

Happy Holidays!

on 12/6/17 12:20 pm
VSG on 12/14/17

Do you have an online account with your insurance? If so, perhaps you can download the coverage documents to get more information.

In my case, I contacted the Weight Loss Surgical Group that I wanted to use. The secretary got the requirements and gave me a list. It is lengthy; I would start getting this information as soon as possible. For instance, I had to have: cardio clearance, letter of necessity from surgeon AND primary care physician, weight checks for 6 months on a "physician-supervised diet," two nutritionist visits with a registered dietician that were at least 31 days apart, psychological evaluation, complete lab work for two different visits including a cholesterol panel, and THEN I was able to meet with my surgeon and schedule a date.

Now, hopefully you won't have all these checkmarks, but if you do you'll want to get started.

There are two ways you can proceed:

  1. Suggested Way: Contact your insurance directly. It may take hours on the phone, but find out what you need to do to have this surgery. I would find a regular doctor as soon as possible, because you'll need bloodwork and office weigh-ins no matter what, most likely.
  2. Contact the nearest reputable bariatric clinic. See if they work with your insurance company. They should know. They also both have free seminars if you are interested in attending. Here are a couple I found:
    1. https://www.promedica.org/toledo-hospital/pages/specialty-se rvices/metabolic-and-bariatric-center.aspx
    2. http://mercyweightmanagement.org/Insurance-and-financing/bar iatric-surgery-cost.aspx

Amanda 12/2016 HW: 393 11/2017 Consult: 378 12/2018 SW: 350

2/2018: 309 3/6/2018: Broke a barrier! 297 4/2018: 286 5/2018: 279

Pre-op: -28 M1: -25 M2: -16 M3: -12 M4: -11 M5: -7

Short-term Goal: 250 by August 15th!

on 12/6/17 10:10 pm, edited 12/6/17 2:10 pm

Wow! Thank you so much, this is very helpful! Im hoping i dont have all those requirements. But i will find out whats what. Thanks for taking the time out to help me with this, I appreciate it!!

Happy Holidays!!!!

on 12/6/17 10:24 pm
VSG on 03/14/17

Oh, you WILL need to do all those things ... but it's not all that bad since it happens over 6 months.

If you fall down you just have to get back up.

on 12/6/17 10:26 pm

Oh okay I was just wondering! I have never been to NHA. Which doctor would you recommend at rhat clinic? Im definitely willing to go

on 12/7/17 1:26 am
VSG on 03/14/17

I don't really have a name to give you. I just see whichever doctor is there.

If you fall down you just have to get back up.