Have A Question
on 8/15/16 8:31 am
Ok. So I have a question for everyone here. I am looking at getting a Gastric Sleeve. I have been doing alot of research and belive that this is what I need to get myself better for me and my family. Here is my problem I am new to my job and benifits. I have not picked out a PCP and am worried I will have to see them for a long period of time before I can bring up the subject of surgery. I am also worried that becuase I am new to my insurance company they would not approve this for me.
What are your suggestions?
Should I wait or bring up at my first meeting?
I have 3 kids under the age of 10 and want to do all the activites they love but am not physically able.
I am 5"1' 225. I have been overweight since I was a teen and am finally at the point in my life that this is the best thing for me.
I have done mnths at the gym going 5 dys a week doing 1 hr a dy and only able to lose 10-15 lbs but it will come back.
I have done most Diets and Pills, Weight Loss Programs.
Here's how mine went. I contacted Surgeons office (referred by a friend). They took down my insurance info and said they would get back to me in a few days. They contacted my insurance and found out everything I needed. They contacted me and told me my insurance policy will cover the surgery, and scheduled my consult. The day I went in for my consult, they showed me everything my insurance required. I have BCBS so I only needed an endoscopy, psych evaluation and 2 nutrition visits. I don't even have a PCP. Some surgeons require a referral from a PCP but not all. You can call your insurance yourself and find out if the surgery is covered on your policy. They will tell you what you need as well.
HW 285 / SW 276 / GW 160
on 8/15/16 9:46 am
i went through the whole process and was supposed to get the sleeve in december 2014. i switched employers in october 2014. my hubby fell ill (he's totally great now) in december 2014 . . . so i didn't revisit pursuing the sleeve until march 2015. my new employer's benefit provider accepted some of the hoops i'd jumped through previously, plus a gazillion more . . .and i was "sleeved" july 24, 2015.
go for it. there's no need to wait if you do not wish to. you may have to accrue paid time off for healing, but the process takes time so that'll work to your benefit.
Age: 60 | Height: 5'3.5 | Surgery Date: 07/24/15 | Starting Weight: 292 | Surgery Weight: 267 | Goal Weight:150 | Current Weight: 149 | WL so far: 143 lbs
Good luck to you! I got new insurance bcbs of nj in January 2016, I went to weight lost surgeon February 10 for a consultation. He gave me direction for what my insurance required which was 3 visits to nutritionist ( 1 per month). A psychological exam and an endoscopy. I completed everything by June 15. Dr office put paperwork into insurance on June 21. The surgeon called me on June 26 with a surgery date of July 7. So my process went fairly quickly. The only thing I had to do was make sure I lost some weight by final nutritionist visit. Also I had no pre op diet. I hope all goes well for you!!
on 8/15/16 10:26 am
Break this down into smaller steps. When you have so much at once it can be way too overwhelming. Like get a PCP first then see what will happen next. It may take a while. Some planes want you to have 6 months of visits, Which seem like a lot but it's not.
I know it sounds silly but you can put yourself into a tizzy if you look so far out without even knowing if your insurance will pay for it. I would really read your policy. So many are different and some can be very vague.
Best wishes to you. This is a great place to start researching.
There is no reason not to ask your PCP for a referral on your first visit. If you haven't already, have your medical records from your prior PCP transferred. This is particularly important if your prior weight loss attempts are documented. Also, unless there is a specific waiting period on bariatric surgery (this would be unusual), your coverage kicks in right away. The insurance company will not consider time on plan when determining coverage and medical necessity.
Height: 5'7". HW: 299, Program starting weight: 290, SW: 238, CW 138 - 12 pounds under goal!
on 8/15/16 12:53 pm
Thank you all for the help and support!
I recommend calling your insurance company first. Find out if they cover WLS and what the requirements are. Then, once you have the information, talk to your PCP prepared. If you present a person who is calm, collected, and informed, your PCP will be much more likely to support your decisions.
VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)
Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170