Eligibility criteria

I have been reading several website about this procedure. I am wondering about the "Eligibility criteria" . Two criteria I have questions about... Have documented failure in several medically supervised weight reduction program within the last two years I have not had any documented failures. I only have the failures of several diet plans. What is documentation looking for; something from my primary physician?

A long history of obesity I have been real heavy for about 7 years now. How long is long? Tina

Tina, when it comes to eligibility for a procedure, there are two things that could mean.  First, whether the procedure is "medically necessary" and appropriate for you.  This is something you can determine by attending an informational session (such as the ones held by Dr. Aranow at Middlesex Hospital) and then having an appointment to meet with the surgeon personally if you are still not sure.  The second thing "eligibility" can mean is whether your insurer considers the surgery "medically necessary" for you.  The insurers each have their own version of the criteria, including whether your BMI and any co-morbidities make the surgery medically necesary for you as well as whether you have satisfied any pre-operative requirements, such as your ability to follow a diet and exercise plan and the past inability to maintain any weight loss.  This specific criteria you should obtain in writing from your insurer.  I see from your profile that your insurer is Anthem BC/BS, which I hear is one of the more liberal insurers when it comes to meeting the eligibility requirements for surgery.  Once you get the criteria from them (which you may be able to obtain from their website) your surgeon's office should be able to give you a lot of information on exactly how their program is structured so you can fulfill all of the insurer's pre-operative requirements.  I'm sorry this response is so long.  I guess your question struck a chord with me both because I am nearing completion of all of the insurer's requirements for having wls and the fact that I work in the benefits field.  Best of luck to you in this process!  Laurie 

Hi I didn't have any documentation but I went on the internet found out info about the surgery and then I  found out about CTsurgical Hartford, Hospital then Dr.Darren Tishler...found the info and handbook,  called the office and they told me about a seminar that would answer all question that he was having..I went then sent up an appointment and went on from there...I have Conneicare   good luck....Dr. Tishler and  his office staff are great and help you all through  the procedure and after..Good luck who ever you  go to just make sure you are comfortable with the  DR. and are able to speak freely about everything.

hi tina   i have anthem b/c b/s, but it is also depends on the company u work for weather they have wls. i needed to be over weight and 1 medical condition. witch i had 2 sleep apnea , diabetic. when u go to a seminar u will be givin  a questionair and u just list the diet u have tried and how long u have been over weight , when they ask u for a  documented  your pcp can put u on a diet for a few months or what ever your insurance recomends. have u called the insurance company and ask what u need? teresa

Hi Tina, I had no real "documented" failures at weight loss, but, Dr Aranow has you complete a very detailed dieting history paper.  I listed from back to 20 years of age until present and showed how much I weighed (approx) how much I lost, and then the next diet, how much I weighed, how much I lost...Kind of like a resume of my dieting. It proves to the surgeon and then the insurance company that diets just don't work for you anylonger.  If you have mentioned to your doctor in the past, and can show in his/her records weight gains and losses, that helps, too. I suggest attending surgeon's seminars on weight loss surgery to get info it.  Learn as much as you can.  Dr Aranow has one on Tues nights once a month.  But you have to call his office to sign up for it, sometimes space is limited.  It's held in the conference room at Middlesex Hospital. There are other docs in Htfd/New Haven that also give free seminars. Here is a link to the web page listing the CT surgeons and their phone numbers. I looked up books on gastric bypass surgery on amazon.com and then went to my library and took them out there.  The more informed I was, the better I felt going into surgery. Good luck! Paula