Good News!! I think??

Friday I received another packet from OSU's Bariatric Program. It said I was selected for a comprehensive evaluation for WLS. I have an appt. with the dietitian and the psychological evaluation Sept. 7th. They also said they weren't happy with my diet history so I have to complete a professionally supervised WL program for 12 weeks or more. They require a few other things too like additional blood tests, etc. They said once this was done then my case would go before the committee. The letter said once all of the requirements were met they would file with my insurance company. The thing I'm worried about is that my insurance won't pay for the initial appointments, especially the supervised WL program. Would any of you out there please share your experiences with OSU's Bariatric Group? Thanks, Peggy

Hello Peggy! I think a lot depends upon your insurance. I had Cigna and had to do a 6 month physician supervised diet in order to get insurance approval. So the 12 week diet at OSU would not have worked for me. I would check out what my insurance requires for approval before I embarked any farther on this journey. There are a lot of good bariatric surgeons out there that do not require such stringent requirements. If you want to go to Columbus for surgery....there is a good program at Mt Carmel or you could check out the programs in Toledo. But I would look at what my insurance requirements first. Sandy

Hi Sandy, Thanks for replying. After I read your post I pulled up info on the Mt. Carmel Bariatric Center. I truly love Mt. Carmel hospital, I had my hysterectomy there and was very pleased with the service. I'm going to call them tomorrow to find out more information about their program. I wished they would have listed the doctors who perform the surgery but they didn't. Oh, by the way, my insurance is BCBS of NJ. My insurance does cover WLS. There are a few people who work with my husband who had it done and the insurance covered it. I'm going to call them tomorrow to see if they will shed some light on what's covered and what's not. Thanks again, Peggy

Let me get this straight--You have to jump through hoops just to get them to decide to submit your information to insurance. I can only wonder--why bother? OSU isn't the only capable and skilled WLS center in Ohio. Why not chose one that won't make you beg?? (Insurance will probly make you do enough of that, so why set yourself up for more?) Best of Luck!!

I'm sure thats just to provde the best care they can. They want the patients to be successful (it not only is better for the patients, its better for OSU's statistics too). I had to do the 12 week LEARN program, have a psych eval, am now starting with the 4week "how to eat after surgery" classes...it really is all about knowledge. The more we (the patients) know before going in - the better the transition for everyone. The "HOOPS" are for her own protection...

I have surgery with the OSU Bariatric group on the 30th. Much of what they require is required by many insurance companies. The only thing I had to do that my insurance company did not require was meet with the dietician. I do recommend that you contact your insurance to see what they will and will not pay for. The OSU program does have some hoops to jump through but it is an excellant program and their patient education iand post operation suport excellant. Good luck. Dianna

Thanks Dianna, I plan on calling my insurance company tomorrow to find out what will be covered and what won't. They told me originally they want a letter stating medical necessity for me to have the surgery. OSU wants a letter from the insurance company stating they will cover it, sort of like Catch 22. Good luck on your surgery Aug. 30, it'll be here before you know it. I'll be thinking about you. Peggy

Peggy: These are all normal steps that your insurance co. will most likely require. I went through OSU and was very pleased with the program. At first I felt "miffed" to go through hoops but I am SO GLAD I DID! I have noticed postings on this website from people who obviously didn't get a good education from their provider on some basic nutritional information. I went through a friend of mine who is a Dietician to cover the 12 week requirement but I met others at OSU during the 4week pre op education that went through the LEARN program and did very well. You can call your insurance and ask about the requirements and chances are they will tell you you need a Psych consult and the 12 week, in some insur. cases 6 mths Dietician followed diet. It went like this for me: 12 week diet, met with Dietician at OSU to review my records to make sure I was ready Met with surgeon to discuss type of surgery set surgery date took one class once a week for 4 weeks for post surgery diet instruction surgery Dr. Needleman's office is very professional and kind. I also had a very good experience in the hospital. The Nurses were knowledgable and I liked being at a hospital versus a clinic in the event of something going wrong. If you have any more questions, feel free to e-mail. PS: My insurance didn't pay for the private dietician, I don't think they would have covered the LEARN program either. I have Aetna. Mel

Thanks for replying Mel. This is what I was looking for. I plan on calling my insurance company tomorrow to see what they are going to cover. My insurance does cover WLS. It's sort of like a Catch 22, the insurance asks for a letter stating the medical necessity for the surgery and OSU asks for a letter from the insurance stating they will cover the surgery. I feel like I'm caught in the middle. Hopefully my insurance will shed some light on the situation. From the looks of it by the time I complete all of the requirements that OSU wants it shouldn't take long for my insurance to give their approval. (Hopefully) Thanks again, Peggy

I too am going through OSU's bariatric program. I have jumped through the "hoops" without any problems. I did Physician's Weight Loss for a year so that must have sufficed the insurance company's diet requirements. I start the nutritional classes on Thursday. The insurance part of OSU stated that I should hear back from the insurance company in 2-4 weeks, so by the end of the nutritional classes I should be getting to meet with the surgeon. I have Anthem too. They denied coverage for the psych eval but I was told sometimes they will go back and pay after they see it was for wls. They also did not pay for the dietician visit, but that was only $100, which is more affordable than $700!!