Interested in WLS

Hi, My name is Sonya and I'm just starting the WLS journey. I don't have alot of support and would like to meet some people who have just started the process or have already been through the WL journey. I recently attended a seminar given by Dr. Blackstone only to find out my insurance is out of network with her. I was really impressed with her seminar and knowledge on WLS. I would like to know if anyone else could suggest a surgeon and give me some info on the insurance approval process. I have Humana/Choice Plus PPO and WLS is a covered benefit but I need a letter of medica necessityfrom my pcp, 6mnth documents WL and pre-authorization. This seems easy enough, but a little to easy so I need help with making sure of I have the correct documentation and of course picking a good surgeon, plus lots of support. I have ready some awesome stories on this site and can not believe how much support is out there. So can you all please help. Thanks

Hi Sunny, I too was very impressed with Dr. Blackstone, so much that I am scheduled for surgery on 1-12. I can't really tell you much about the insurance process as I am cash paying because my insurance has a "obesity clause" and we could not get around it. I have heard good things about Dr. Simpson and Dr. Juarez. I am sure you will find a lot of posts about these surgeons. Sorry, I am not a lot of help, but love making new friends. I am here if you have any questions. Good luck, Danielle

Danielle, Thanks so much. I loved Dr. Blackstone and I'm sad she is not in my insurance network. I think however I will be going with Dr. Juarez. I'm scheduled for his seminar in Jan 07' so we'll see what happens I will keep you posted. Thanks so much for getting back to me right away. I'm so sorry about your insurance clause that is unfortunate. What is the point in having insurance if you can't take advantage of it when you need it the most. Good luck which the surgery which one are you having with Dr. Blackstone? Well my blessing are with you. I will e-mail again once with more questions. Sunny

HI Sunny: I also have Humana Choice Plus PPO. My surgery is Dec. 27th and I selected to go with Dr.Juarez. Both he and Dr. Fang are in the Humana Network. I understand both Dr. Simpson and Dr.Simon are also in the Humana Network. The Mayo clinic also is in the Humana Network but I have to say there process is extremly long. What I understand well worth it but long. With Humana all you will need is a recommendation from your primary doctor, proof to show you saw a doctor in 2005, and a psych evaulation. I did not need 6 months weight loss. This of course is not all that is needed for surgery which is pre-op testing and pulmonary and cardiac clearance. Those were required by my doctor. Selecting a surgeon is a big decision. You need someone you truly can trust in. But as far as Humana was concerned I really did not have any problems whatsoever getting approved.

Pam, Hi and Congratulations on your surgery and God Bless you, I will keep in touch and see how things are going. It is so nice to meet you and thanks for sending me an e-mail back so soon. I really appreciate all the information you have sent so far. I have alot of questions to ask. I had been doing some reseach on Dr. Juarez and spoke to someone from his office to get scheduled for the Jan 9th seminar. I have been on this site almost every night trying to get info and research the Lap Band and the RNY. Why did you choose the RNY? I'm not as familar with this process as the Lap Band what can you tell me about it and did you decided to have this one or did Dr. Juarez decide which one was the best? Dr. Juarez how did you like him? I have read mixed reviews, but overall I believe he is well experience and has also done alot of both surgeries. You said the process is long, how long I have heard 2-3 mnths just to get scheduled for the surgery is this about right? I'm okay with that as long as I can have it before the summer hits, because it is so hot in Az. I can't believe you did not have to have 6mnth weight loss I called and they said I had to have that not sure why, but I do have it just in case. I was just diagnosed as pre-diabetic and really need to loose some weight my doctor sent me to diabetes seminar last week and I guess you can say it explained alot about how I have been feeling and why it is so hard for me to loose weight. I have tried so many diets and exercise programs. I know this WLS will get me back on a healthy path. Well I talked alot sorry Pam I amso happy you wrote back. I would like to talk more before you have your surgery so please e-mail me back.

When you see your surgeon they will let you know what is required. But one thing for sure. Humana Choice Care PPO did not require 6 months of weight loss. I also agree with Nicole. Just to be sure start that now. Get your paperwork in order. The time will fly. 2-3 months is common since you will have clearances and testing before the operation can be done. On my way to work will email you later on why I choose Dr.Juarez. Will say this. I am very happy with my decision. BUT that is a decision that you have to make. Good luck on your journey. AS for why I choose RNY. I just believed it would work for me. But I do know a lot of people that are also very happy with the Lap Band

Hi Sunny, I would definately start your 6 month supervised diet with your PCP now, get that out of the way so there are not delays in insurance approval (the most stressful part)... as well as getting your Letter of Medical Neccessity and any documentation of attempts at prior weight loss, like Weigh****chers, Jenny Craig, LA Weight Loss, etc. Also any gym members... pretty much anything that will help your approval go smooth. Also get your yearly woman's wellness exam results also. Whichever medical team you decide on using, their staff will worry about the pre-authorization and all that fun stuff. Then when you go to your initial consult with the surgeon, they will let you know if you need other tests like EKG's, Echo-cardiograms, Sleep Study, etc. Congrats on your decision to have Weight Loss Surgery... I wish I would have done it sooner! Also, we are here whenever you need someone. Good Luck! ~Nicole

Nicole, Nice to meet you thanks for the info and suggestions. How has everything been for your WLS? Sounds like you doing very well Congratulations!!!!!! In regards to the WL documentation you mentioned earlier. I already have 6mnths documented weight loss info, I just need to get the letter from my PCP, I have this feeling WLS sensitive and this is why. I have heard of some PCP's that don't believe in WLS. I am a little stressed about that he did prescribed Meridia last May and I went on a WL program that I have now been on for well over 6mnths. He also just schedule me some to attend a diabetes seminar, I just found out I am pre- diabetic so I am going to continue with a diabetic diet for 6 weeks and if no loss then I am moving forward with the WLS. I will be back in his office for that letter he wanted me to try this 1st which is why I think he's a little WLS sensitive. Nicole I do have one question on the 6mnth supervised WL diet what exactly do they want for this as it relates ot you and your PCP, because I did not go in and get weighted every single month. Sunny

When my insurance company required the 6 months of doctor supervised weight loss, they wanted your starting weight, documentation of what was ordered... so what your doctor told you to do. I did Weigh****chers and went to my doctor each month and got weighed. They want to know what your weight was at the end of each month and any notes your doctor may have written or told you what to do. I just got copies of my medical records for those 6 months and gave them to the insurance people at Dr. Blackstone's office... it was good enough! My PCP was never dead set against Weight Loss Surgery, but realizes it is an option. She knew I was getting really fustrated and wanted a better intervention. I am the one who mentioned it to her and she supported me on it. She gave me Meridia back in 99 and it didn't do anything for me but give me diaherria... we tested my thyroid, we did everything. She never suggested it to me... the surgery, I did to her and she was very supportive and happy. I have actually referred a few people from this board to her and they have been very happy... I went and saw her the other day and she gave me a big hug because she was so proud of me. I told her I was referring people to her because I know she the best... so it is important to have your PCP to be supportive of you. I know finding a new PCP is stressful, but you definately want to have someone that will have your back!

Sunny, I work with insurances and the 6 month medically supervised diet must be directed by your primary care physician and your appointments/weigh-in must be documented for six Consecutive months. If you miss one month then that throws the total out. You can begin counting from the time that your doctor made detailed chart/progress notes in your behalf. .... If your primary care doc is not Weight Loss Surgery friendly then it would be worth your time to find a new one who is. Otherwise, you may not get the letter of recommendation or the chart notes for insurance approval that is needed. I know that many folks have posted names of weight loss friendly physicians before and they'd probably be happy to do it again for you if you need one. Insurance is the great "OZ" we depend on their whims to save our lives.......Hang in there though. The surgery is soooooo very worth it. I'm soooo sad I wasn't able to have it a thousand years ago! Huggggzzz, Joyce