Thinking about surgery...have questions...

HI to all, I just found this website. I'm seriously considering surgery (100 lbs plus to lose), but my insurance says it's excluded. However I've seen people on this board who say they've appealed such a decision and won - anyone have experience with that? Thanks so much!!!!

Hi Paula, Welcome! What insurance do you have? Weight Loss Surgery is an exclusion in my policy, but it was approved with all necessary documentation.

Hi Nicole - THANK YOU so much for replying so quickly! I have United Health Care through my husband's employer, OfficeMax. But -- he told me that UHC is the plan coordinator, the company is self insured, I have no idea if that makes a difference or not. It is specifically excluded in the policy, how did you go about getting documentation? My primary care physician is very supportive (100+ lbs to lose, sleep apnea, yada yada yada..., not to be flippant, but a lot of related health issues... Anyway, if I can ask - what kind of documentation did you need, what did you do, where did you start? THANK YOU!!

Hi again... I first went to my doctor and told her I was interested in Weight Loss Surgery... after a few months of thinking about it and then attending the seminar at Scottsdale Bariatric, she then wrote me a Letter of Medical Necessity. I called the insurance company and told them what I was interested in doing and they informed me I needed the letter of the doctor, documentation of weight loss attemps (weigh****chers, jenny craig, etc.) any documentation of weight loss medications (I tried Meridia for a while), gym memberships... any documentation of attempts of weight loss pretty much! Most insurance companies now require 6 months of doctor supervised weight loss... so if you haven't already you may want to start that. Have you decided on a surgeon yet or attended a seminar. I would highly recommend Scottsdale Bariatric. Dr. Blackstone is wonderful and so is her staff. She is currently in the process of hiring new surgeons so there is a wait at the moment. Check out the website... www.scottsdalebariatric.com There is also lots of information on here too about different insurance companies and the experiences people have had. Good Luck! ~nicole

Hey Paula, I agree with everything Nicole has said, I went thru the same and am having surgery 11/8 at Scotts Bariatric as well. I also have UHC thru the State of AZ and they told me on my initial call that they didn't cover it, call your bariatric surgeon and ask if they've had patients with your type of ins. and had it covered, in this case no doesn't always mean no. I was denied because I hadn't had a sleep study, which Dr. B's office had referred me for but they sent the paperwork without the results, I had had it scheduled two days later and sent my ins. comp. the results and got an approval letter several weeks later. From what I've heard UHC is one of the easier ones to deal with. Find someone in your husband's comp or on this website that has had it thru them. Best of luck! Katie

Hi Paula, My husband and I have UHC and it's excluded from our plan too, however, if your primary care doctor gives you the diagnosis of morbid obesity and you meet the BMI index requirement, it goes through. We started the process in July and they scheduled and obtained approval by September for us. Our surgeries are next month. The Primary care doctor needs to write a letter to whom it may concern to state the diagnosis, the bmi index and why you would benefit from it. Even if your slightly low on the BMI index, if you have health issues from obesity that is a strong compensating factor for them to approve the surgery We were amazed at how easy the process with the insurance company was. Good luck, your health isn't going to improve without a signficant amount of weight lost, and even though you might be able to follow a diet and loose quite a bit, it's the keeping it off that needs to be maintained, that's what I think is such a positive about this process. Hope this helps, Carole M

Thank you ladies SO MUCH for your info - my husband, too, is very overweight, but much more nervous than me about the surgery. I think life is simpler for overweight men versus o/weight women... Anyway, this is great info. I signed up for a seminar with Dr. Blackstone in November to get more info, and decide 100% for sure if I want to pursue this - which I'm at 99% sure right now...:) My doctor, who is great by the way, has already told me that she would support this if I wanted to do it, and (unfortunately) my BMI works and I do have other help issues related - sleep apnea, BP, etc. Another question - how/why are you both going thru it at the same time? I can see it both ways - go thru everything together, but on the other hand, who will take care of you if you're both just out of surgery?? Again, THANK YOU - appreciate very much the info... Paula

Paula, We are scheduled about 3 and 1/2 weeks apart just for the reason you mentioned! He's Nov 6th and I'm Nov. 29th. We turned in our packet of information at the seminar, we were sure we wanted the surgery. I do have sleep apnea and take BP medication. In fact I need to go back thru the sleep study so I can test one of those masks that helps you breath. They are concerned about my ability to breath easily at the moment. With sleep apnea I guess it's common for it to put extra stress on the right side of your heart, the surgery and losing weight should help with all of this. I may have the sleep apnea because of the weight. With the mask you bring it with you to the surgery so that afterwards when they remove the breathing tube they put that in place to avoid any complications. We're both having lap-band and not bypass, which they tell us is much less stress on your body but a slower weight loss. The slower weight loss I think is a positive because I don't want to have problems with skin tone, by increasing my activity level it should minimize loss of muscle tone, plus it's why they want you to eat protein first after surgery. You'll like this web site because you'll hear first hand what we all go through, I don't think anyone goes into this without some hesitation. Mine is more about life after surgery and coping with the new way of eating. With so many people sharing their fears, and concerns about the same things, you won't feel alone while your still considering this. Wishing you good luck, Carole M