New to OH

Hi everyone, I am returning to this site after 2 years, to check into Bypass Surggery again. I was kind of discouraged before because after a consult with Dr. Tersigni, they said that my insurance company wouldn't cover it. I had never sent a pre-auth lettter or anything, the Dr. Office said that they called and was told it was excluded. ANYWAYS,  I recently was put on Blood pressure medication, am taking Lyrica for constant back pain (had surgery 6 years ago) and I am starting to have knee pain, I KNOW that I need to get this done. My PCP is very supportive and has offered to write me a letter.  How do you begin this procedure? My Dr. has ordered a sleep study, and we have a counselor here at work that I can get a psych evaluation from.  What is the best way to start this? Do I have to get a form from my insurance company to fill out? Sorry for the questions, I just think that I have reached the point where I KNOW that something has to be done. Thanks!! Amy

Hi Amy!  Welcome to OH, and especially, to the Oregon board.  The first and most important step is to make certain that your insurance covers weight loss surgery.  Some policies have an exclusion that can bring a screeching halt to your dreams very quickly.  If no exclusion, I would go to my PCP and have them write a letter to Dr. Tersigni (if that is where you intend to go) and then try to schedule an appointment (that is because you have seen them before).  If you decide to go elsewhere, you should call the facility and make an appointment to attend one of their information sessions.  Generally, at those meetings, they give you a packet explaining what you need to do next.  OHSU gave me a form letter to give to my doctor, telling him what he would need to say in his letter (for insurance purposes).  You have to state your diet history, how your weight has been over the years, co-morbidities, etc.  Sounds like you have gotten things well underway, so if you are comfortable with Dr. Tersigni, I'd start there.  About the sleep study -- unless you really feel you have sleep apnea and are bothered by it, I would skip it.  You have sufficient co-morbidities to qualify for the surgery without it and it is extremely expensive.  It's just my opinion, but I went through all that and cannot bear to sleep with that mask on my face.  I have a very expensive machine I cannot use and, I already feel I am sleeping better with the small amount of weight I've lost.  Again, just my opinion, but it's a lot of discomfort, extreme expense, and hassle if you don't need a sleep apnea diagnosis to get the surgery. Linda

I am relatively new to the process too, but I do have an appointment scheduled for my sleep study, then mid August I have two days of testing.   First thing I would do would be to call my insurance directly and ask if I am covered for Weight Loss Sugery.  They can tell you in an instant, and furthermore, they may send you a packet of information about what you need to do to qualify for the surgery.  I know, I have received two packets of info from mine.  The first spelled out my coverage, and the second packet came after Legacy sent in some initial paperwork to find out my coverages.............so I am on my way. Good luck with your journey, and I do hope you are covered too! And welcome to the OH boards.  I have found them to be invaluable.