Need some info/advice (5/25/09)

I have been looking into have gastric bypass (RNY) surgery for several years and I have finally made the decision to go forward with it.  I have tried every diet in the book. I've exercised. I've taken prescription weight-loss medication. Nothing works. I am 30 years old, I live in Louisville and my BMI is 44. I do not have any major health problems YET, other than lower back pain. But I have a history of diabetes in my family.

I was wondering if any of you could provide some tips to me as to how to get this thing started. I know I need to call my insurance company to see if it will be covered. I am quite certain it will be. I have mentioned that I am interested in weight loss surgery to my primary care doctor and he has told me that he will sign off on it.

What do I need to do first?

How long do you think this process will take from start to finish?

Thanks in advance for any help you can provide.

You are right the first thing I would do is call my insurance company.  Find out if it is covered and what they require for it to be covered.  Most insurance companies require some sort of supervised diet with a doctor for a period of time.  Also, I would recommend that you contact your human resource person if you work and find out if your company has a set of requirements.  Mine did and it was alot less strict than BCBSIL so it was easier for me to get approved.  Depending on who you have chosen as a surgeon their office may be the best resource you have for getting insurance approved.  I did not have to have my PCP do anything, the surgeons office did it all for me.  I was approved in 6 days.  Some people I have read it takes alot longer some not.  All insurance is different.  Good luck!

I currently have BCBSIL, when you called your human resources deparment what inof did you ask of them to compare to BCBSIL

I actually found out about my companies requirements when I called BCBSIL.  They were looking at the requirements and if my policy covered WLS and the guy told me oh you are lucky your company has its own set of requirements and they are much easier to get approved than BCBSIL corporate requirements.  I asked him to fax me a copy and he did.  I actually got denied after a day and when I had them fax me the denial letter I compared it to my companies requirements and called them right then and said your denial does not match my co.'s list of requirements.  The lady said you're right they evaluated your using BCBS corporate list.  So she re-submitted my information with my companies list and I was approved the same day.  All of this took 6 days.  So I always tell people to check and make sure if you work check and see if your company has a set of requirements for WLS because if they do that over rides BCBS and they have to abide by what your company sets forth.  Good Luck

Hi
Kudos to you for taking control of your weight!!!
I would suggest that you attend MORE than just one seminar. I attended three before I decided on my surgeon.  Picking a surgeon is as much of a decision as deciding which surgery is right for you!! Call around and set up some seminars.
Other things you can do is start by requesting the last 5-10 years of your medical records. You can get any regular check ups out of the way.  Some docs want to see those too.
****the best, absolute best advice I can give you is get a binder and keep everything in it.  Keep sections of the different docs or seminars as well as (and this is hugely important) keep the names, times, numbers, companies and responses you receive regarding ANY calls you make thru this process. That way if you have to call back you will have support info. for your questions.
 

 

Good luck.

teach

OK, I have talked with my insurance company (I have the PPO plan with Empire BCBS). They tell me that I need a pre-determination letter from my primary care physician and a psychiatric evaluation. They told me that I must have been obsese for at least five years and that I can show them that my primary care doctor and I have been working on a dietary plan within the past six weeks.

I asked if I needed a six-month physician supervised medical weight management program before surgery would be approved and they said no. All I need is to show that I have tried to lose weight within the past six months. My doctor has been writing me prescriptions for phentramine for the past two years and I've tried Slim Fast and Weigh****chers the past 12 months.

I have heard good things about Norton's Bariatric Center and even better things about Dr. Geller. I called his office this afternoon and they told me to attend the next seminar (which is June 5). They said they will do the pre-determination letter and that Norton will do the psych/nutritional evaluation. Have any of you had experience with this? If so, please let me know.

My insurance company said it should take about 30-45 days to determine whether I'll be approved for the surgery, but Dr. Geller's office said it usually doesn't take that long.

I would also congratulate you on your decision. However, there are so many options out there that you need to research what those are. Figuring out what doctor you want to go to is also very important. Many people on here have used different doctors so they could give you some opinions. You need to meet with the doctors and see which "fit" with you and your family as they are very important to your success.

Although you know this decision isn't something to take lightly you need to educate yourself the best way you can. Read Read Read, ask lots of questions and determine the best choice for you.

This is a great board and we are always willing to help. Ask away!

Good luck to you and your family.

Arad you need to call Norton Bariatric Center 629-1234 they will set you up for the seminar, tell them that you are interested in Dr. Gellar.   You can download the patient packet on line at www.nortonbariatric.com.  or you can pick the packet up at the seminar.   You will have to fill out the information in the packet and you MUST attend a seminar before you can get an appt with the Dr.'s.  You will need a letter from your primary care physician signing off on medical necessity of WLS.   You will also need 12 months of medical records that will need to accompany the packet.   If you are currently being seen for mental health you will need a medical clearance from that provider also. 

If you have any further questions, just let me know.  I work in the Norton Bariatric Center as a volunteer and verify benefits with insurance companies. 

Vicki