My main question is who/what qualifies for the exercise consult part if I'm doing the 3-month.  A trainer?  If so, do they just do a write-up to include with the approval packet? Or do their notes go to the PCP? 

I'm just trying to fast-track this a bit.  I have a consult with the surgeon on Feb. 22 (soonest I could get).  I've had a nutritionist that I've seen occassionally for about a year, and I saw her this month, and saw my PCP this month, so I was thinking that if I can add the exercise part, I knock off the first and second month before I've even seen the surgeon. 

The other option I suppose is to just wait and use only the people that the surgeon suggests, but then I don't get started until the end of February.  

Also, I've been paying for a trainer at a gym that I haven't really been using :(  It is still potentially a plan to get all of the stuff done for approval, but with exercising and following my nutritionist's plan, if I feel like I'm losing weight, I might just wait on the surgery.  But I have done so much research on it already and I am somewhat desperate to lose weight.  

I had a sleep study done a few months ago and I do have apnea (now have a CPAP machine).  BMI is 43, and I have 5 year weight history (with BMI at or above 40) so at least those are covered.  



My other question is regarding success vs. failure on the supervised weight loss.  If I lose weight, will they deny me? Or am I supposed to lose weight to show that I can be successful after the operation? 


Thanks for the help!

I had to pay a near 8k by the end of my surgery in co pays.  However some of the funds were eventually refunded.  The healthcare process is definately a maze these days.  Keep in mind deducting expenses from your taxes as that was a help to me.  Perhaps the facility or Dr. would consider a payment plan?  Deductibles can be for any other health needs that can be applied to it per insurance specific regulations.  Best of luck to you!!

Wow.. and I thought my $5K ded was bad!

You know, if you don't have your heart set on bypass but a sleeve instead, it would actually be cheaper to go to Mexico. :o/

Sleeves ROCK!

Congratulations on the new job!

First, since this is a work plan, usally there is NO pre-existing condition clause. Which means, once your policy goes into effect (and provided WLS is NOT excluded) you can start the process (or continue in your case). On March 1st, call UHC and asked to speak with the Baratric Resource Service. The department specializes in WLS and what is needed to get approved so you will know what you still need as far as pre-op testing.  They will provide you with MUCH better information that you will recieve through regular customer service.

Second, most UHC plans only allow surgery at a Center of Excellence. So make sure your surgeon and hospital are on their approved list. If they aren't on the list, look into some that are so that your approval process goes through quicker.

Third, pull out a copy of your policy. Since this is a HDHP, make sure you know what your deductible is as you will have a portion to pay before the insurance kicks in (hopefully your company provides some asistance with this through a HSA). Also, make sure there is no max that they will pay for WLS. (it is best to be prepared before surgery)

As for "fast-forwarding" the process, the only things I can think of would be to schedule your appointment with your surgeon for as close to that date (after Mar 1)  as possible.  And make sure you are up to date on your annual pap and mammograms (if your not, scheduled these now for right AFTER Mar 1st so they will count toward your deductible)

Good luck!

 

Thank you so much for your response and insight. This was very useful information. I do know that once my deductible is paid that I don't have any copay, and everything would be covered 100%. I just have to come up with a way to pay the deductible.