New with Questions

Hi!  My name is Karla.  I live in SE Iowa.  I asked my GP to refer me to the U of I Bariatric Center for a consultation.  This is a Wellmark Center of Excellence for obesity surgeryI've wanted to look into WLS for a long time, but my hubby wasn't on board with the idea until recently and I knew that this life style change would be next to impossible without a strong support structure at home.  Anyway, he is in favor of the surgery, now. I am 50 years old.  I weigh 330 pounds.  I have Type 2 diabetes, sleep apnea, hypertension, stress incontinence, lower back pain, and my legs swell every day.  I have Wellmark BCBS for insurance. My main question is, what can I expect?  How long will it take to get approved?  What hoops will I need to jump through?  Will I have to lose weight before surgery?  Do I have to see a psychologist? Has anyone here gone through the U of I program?  Any help will be appreciated.  Thanks in advance. Karla

Hey Karla..well first off WELCOME to OH and congrats on making the first step towards a wonderful experience just lying ahead of you.  Now I dont have the same insurance as you but my advice would be to call your customer service @ your insurance (ask to speak to a supervisor-a lot of just regular customer service reps give all kinds of info that is not always accurate)...call then and ask them what you need in order to get approved for bariatric surgery and find out if your policy does cover it and if there are any exclusions..sometimes insurance companies dont cover RYN but cover Lap-band..I know kinda strange huh?  Anyway, thats what I would do.  Once you gather up that info, you can start doing what they require of you.  Ask for how long it takes to get approved..thats anyone's guess in all honesty..ive heard ppl get approved as early as in 3 days to like over a year.  Your surgeon will tell you that it is your responsibility to call your INS and find out what is needed to get approved.  Hope this helps in some way!  Oh and you may want to post on the INSURANCE HELP forum on here because you may find someone who has your same ins on there..its a pretty helpful forum..again hope I helped and congrats on embarking on this adventure..wish you much success with everything hun!

 

Always,

Tonya

Hi Karla, I had BCBS of NY when I had my surgery 4 years ago.  I had no problems getting it approved.  What I did was to call the number on the back of your card and ask to speak to a case manager.  Explain what you need and she can tell you exactly what you need to do to be approved.  Don't waste your time with the people who answer the phone.  All they can tell you is the pat answers.   I had surgery in Boone.  I was required to provide documentation of a 6 mo wt loss attempt, have a psych exam, a physical therapy evaluation for exercise afterward, and a host of pre-op x-rays and tests.   I would say that with your wt and co-morbids, you shouldn't have too much trouble.  But that all depends on your plan's coverages.  It took about 3 weeks for mine to be approved.   For my program, I didn't need to lose wt before surgery but I was considered a lightwt.  His requirement was that I COULD NOT gain anything.   Good luck with your journey! Lyn

Thank you for your advice, Tonya and Lynn.  I will try to get a case manager on the phone, today.  I'll also check out the insurance board. Karla

Hi Karla -  I've just started the pre-approval process with BCBS.    I going to a surgeon in Central Iowa.   I went to Wellmark.com to find my requirements for approval  ( they've since changed the website) - but also followed up with a phone call to customer service (found on the back of your card).    We are close in size and age - although I don't have the diabetes, hypertension, or swelling.    I don't think I have sleep apnea - but looks like I'm going to have to complete a test to confirm if I do or don't - so that they know for the surgery.  You will have to see a psychologist to meet the BCBS criteria.      I don't know how long the process will take for approval - but just as a clue - I called to set up my psych test today -and the first appointment is June 2nd.   Hopefully - it will be easier in eastern Iowa!  Jody  

Hi Jody H. Iam going through the same office you are but with Dr.Cahalan . I called about my psych test also today  and I have UHC INS. and they said I needed  2- 2hr. appt.and I wondered WHY, what would they need that much time for and is it so they can charge up the u know what.??        Have you seen the dietican yet?  I go on the 20th .  keep intouch , from Ames, MARGO       

The reason for the long psych appointment is because many of them administer a rather long   test that will determine if you have any psychological illnesses. It's actually pretty accurate if the patient answers the questions truthfully. Some of the questions are kind of silly & often repeated, sometimes just worded differently. When my results came back, the psychologist read a description of me. I stopped her halfway through & told her that she was describing my mother, not me.  That's when I realized just how much I was like my Mom. They also will spend quite some time just talking with you to see if they feel that you are aware of the changes that will happen & if they feel that you are capable or willing to handle those changes. They should be able to tell if you are the type who thinks this is a "cure all" for all their problems & if you will follow the physician's instructions for after care. Good luck. Dixie

Well that's interesting.  I called the Mercy clinic on Franklin - and asked for an appointent for WLS screening.   I didn't think to ask how LONG the appoint will take.     My insurance doesn't indicate how many times I need to see the psychiatrist - just that I have to be cleared by one.      I'm pretty sure my insurance will cover it --  for me the cost comes in lost billables.  I am a consultant and get paid when I work, and don't when I'm off.    I haven't been told to schedule with the dietician yet.    Aside from the sleep test tonight, and the follow up from that on the 15th, my next steps were the meeting at Mercy with the nursce on the 21st, and making a psych appointment.       I'm trying not to set expectations as to when I'll finally get to the surgery.