Worried about getting approved for Surgery. I need ADVICE

on 5/2/17 11:58 pm

My name is Sarah and I'm 22 years old. Im currently 394 lbs and 5'9. I recently just went to my first consultation for bariatric surgery, I'm leaning towards gastric bypass. I am very excited to begin my journey and i feel like this is the best option for me. The insurance requirements seem easy enough. 6 month supervised diet,nutrition classes and 5 years of documented weight and height. I have united healthcare and what worries me is not having the complete five years of documented weight. I have 2014,2015,2016 and 2017 but do not have anything from 2013. I didn't have insurance at the time and hardly saw a doctor due to it being to expensive. I have been overweight my entire life and my BMY currently is 58. Has anyone been denied for not having all 5 years? Im just so worried I'm going to get denied, this is my last option. Thanks for reading and please let me know your experiences..

on 5/3/17 7:52 am
RNY on 09/01/17

Hi Sarah, I'm in Canada so our process is different. I just wanted to say welcome. Wishing you much success. Stay strong and believe. :)

Sparklekitty, Science-Loving Derby Hag
on 5/3/17 8:10 am, edited 5/3/17 1:10 am
RNY on 08/05/19

My insurance also required annual documentation. Did you see ANY doctors at all? A check up with your gyno, a trip to the walk-in clinic? The insurance company may be able to take a medical record from someone other than your GP.

I was in the same boat, I didn't see my GP one year and I was able to use a note from urgent care when I had a sinus infection. All they needed was some sort of medical record where they'd taken my weight.

Alternately, if you can't scrounge up documentation from 2013, couldn't you just wait until 2018 to have surgery?

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

on 5/3/17 9:49 am

I was only 18 in 2013 and I didn't have insurance. I called all the places I could think I might have been and no luck. I could weight but it's something I've been wanting to do for a long time. Thank you for the response!

Sparklekitty, Science-Loving Derby Hag
on 5/3/17 10:39 am
RNY on 08/05/19

If you want to do it now, but insurance doesn't pay, you could be facing upwards of $20,000 to do self-pay. I can absolutely understand being in a hurry to do this, but it may be worth waiting if it saves you that much money.

Sparklekitty / Julie / Nerdy Little Secret (#42)
Roller derby - cycling - triathlon
VSG 2013, RNY conversion 2019 due to GERD. Trendweight here!

on 5/3/17 10:58 am

I actually just talked to my drs office and because th they found documentation from 2012 that as long as I have 2015,2016,2017 that I should be fine. Especially because I have state insurance

on 5/3/17 8:19 am
VSG on 08/01/16

You should call your insurance and ask them and talk to your surgeon's office. The staff deals with insurance and usually knows what will cause a denial. The worst thing that can happen is you have to wait until 2018. If you have to wait, then use that time to start changing your habits and prepping.

Sleeved 8/1/16

HW 285 / SW 276 / GW 160



* Nicole *
on 5/3/17 10:30 am

Welcome Sara.

I cant help much with the insurance requirements, but if you have weight proof for even more than 5 years(that shows its been a problem) should work.

I was 22.5 years old when I had my DS in 2005, and my stats were on par with yours I had hit 402lbs, I was 390 when I had surgery. Im 5'9.5". I do not regret it one bit. But I must say be as honest with yourself as you can, know where your weaknesses are and work on thoes. Spend time learning about the 3 major surgeries, bypass, DS and sleeve. You know you, so choose a surgery that is best for you.

Having surgery when younger has its positives but you have to beable to take the vites, eat right for life, NOT when your body collapses on you (since we tend to think we are infallable in our 20s). While my obesity wasnt driven by food, I still have rules to follow too.

There is so much, but I wouldnt trade it.

DS Aug 15th,2005 @ goal, living life and loving it.

"An Arabian will take care of its owner as no other horse will, for it has not only been raised to physical perfection, but has been instilled with a spirit of loyalty unparalleled by that of any other breed."

on 5/3/17 5:27 pm - Middletown, CT
VSG on 09/28/16

Hi Sarah,

I'm 5'5'' and weighed 484 and a BMI of 80 when I started with my surgeon and 455 the day of surgery. I didn't have 5 years of documented weight loss programs but did have weights taken any time I went to a dr. appointment. My insurance company accepted this. Even if you didn't see a doctor often did they take your weight?

I hope everything works out for you. Good luck keep us posted.

5'5" HW: 484, SW: 455,CW: 325

Surgeon, Darren Tishler

on 5/3/17 5:34 pm

I didn't go anywhere. I was 19 at the time and even checked the claims with my insurance company. I did call my doctors office and they told me to not worry about it specifically because I have state insurance. Thank you!!

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