starting the journey

adelissa
on 8/10/11 12:44 am
 I officially told my dr I want weightloss surgery and vsg in particular.He listened to my reasonings and the research I had done and agreed with me that this sounds like my best option. My question is I have heard it can take 2 years for insurance to approve, what is likely the next step and how long should it take? I have every comorbidity on the list bmi 48 only thing i don't have yet is diabetes (and from what I hear that is a rather expensive disease for insurance companies, u would think they would want to prevent that if they could)
Anyway, settling in for a potentially long wait just wondering what comes next and how long that would take.
tristak
on 8/10/11 12:51 am, edited 8/10/11 12:54 am
Alot of your answers will be dependent on your insurance coverage.  I highly recommend calling your insurance company and asking the following:
1.  Is WLS covered by your policy - and in particular is VSG covered (some insurances consider VSG investigational).  What qualifications does your insurance have for WLS?
2.  If your insurance does cover WLS/VSG then next questions would be what are the qualification steps you need to take.

Advocate for you!  Don't wait on others to take care of you...

So all this being said I started this process in April 2010 and had surgery October 2010 - my insurance required 3 months of nutrition appointments, two seminars, a battery of tests, a pysch evaluation and no weight gain.  6-9 months seems to be the average from what I see here.

I have read many stories here on OH where folks are terribly disappointed when they find out insurance doesn't cover WLS or they only cover RNY or Band.  Before I even spoke to my PCP I checked my policy to make sure I wasn't setting myself up for sadness and frustration...

Just my recommendations.

Best of luck


5'2"
HW - 310/SW 300/Day of Surgery 293.2/CW - 182.2 (2/26/19), fleur de lys abdominoplasty 2/12/19 - removed 8lbs of skin from abdomen.

adelissa
on 8/10/11 1:22 am
 Thank you for your reply. I did call them and they gave me a vague answer when I asked are there any wls they don't cover and they said they would consider any my dr recommended...I already did one of their nutrition classes to save time. I don't mind waiting as long as I am getting feedback that the ball is rolling and not stalled, taking a heck of a time getting my sleep study approved to prove I have sleep apnea but my dr is positive that I do, anyway, just getting antsy.
wert
on 8/10/11 3:46 am - MN
If you're getting vague answers call again and ask to talk to the insurance company's bariatric specialist. Then, get everything in writing or ask where, specifically, in your policy you can find coverage for bariatric services. You'll probably have to keep on it yourself. Don't rely on anyone else to promote this for you. Keep the ball in the air. All insurance is different. Even the same insurance company will offer different coverage based on what your business is willing to pay to cover. You won't get any definite answers here - only what each individual has experienced. Your mileage WILL vary. Call and keep at it.

5'5"  Age 63  HW 212  SW 200 Currently 8 pounds below goal
Jacque 
    

anninva
on 8/10/11 3:36 am - Arlington, VA
VSG on 01/10/11 with
Welcome!!!!

it's definitely a journey, but not necessarily as long as you may have heard.  i'm lucky b/c i had been going to a nutrtioinist for years and she could put a packet together so i didn't need to go thru the nutrtion classes.  i basically started investigating WLS and VSG in August, talked to ins co and found out that they covered vsg with a certain bmi required, picked a program in oct had date within 1 day of program submitting my info to the ins co, made date in january.  but that's my individual experience.

so, have hope!!!  and keep reading posts, you'll learn a lot!  also search vsg faq in the search box in the upper right hand corner of this page and you'll find tons of answers!

good luck!

  Ann             LW-Apple-Gold-Small.jpg image by PlicketyCat           

 

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