Medica Insurance in Minnesota?

Hello all,

I'm starting the journey towards the sleeve. I'm been a yo-yo dieter since college. I'm going to be 40 this year, and diets just don't help anymore. I'm on a CPAP for obstructive sleep apnea, have GERD, my joints hurt, and I just feel like poo most of the time. I realize I'm a lower BMI than some, but I'd really like to liver long enough to be a grandfather and great grandfather! Bariatric surgery is covered by my employer, but does anyone know anything about the Medica approval process. I'm going to my GP next month to discuss this further. I'm a little nervous, because I havent seen him in 2 years. My last weigh in with him was 190, because I was on a meat and cheese diet. How much weight history will they need? I realize I'm in this for the long haul, but I feel sort of lost on how to even start. Do I start with my GP, or just make an appointment with a surgeon right away?? Ugh!

I can't speak to your insurance but I would caution you against getting the sleeve if you already have GERD.

GERD can be made worse by having a sleeve and can cause GERD if you didn't have or pre op.

the best way to get info is actually to call the number on the back of your insurance card. They can give you all the qualifications for surgery.

good luck.

I also had GERD, have sleep apnea, joints hurt, just like you. I went straight to a surgeon and got evaluated and asked the specialist if I was a candidate. The staff was very knowledgeable on insurance issues and I read over my policy well. I know it is recommended to not choose the sleeve if you have GERD but I had other reasons I thought it was my best choice. I am 4weeks post op and no problems so far.

Every person's insurance requirements are different, so nobody here can provide accurate information on your situation. Your very first step should be to track down a copy of your benefit book, or call the customer service number on the back of your insurance card. They can tell you what the specific requirements are.

As previously mentioned, if you have GERD at all it is NOT recommended to get the sleeve. Anecdotally, we're seeing a LOT of people here on the forums who need to have revisions from VSG to RNY because of acid issues.

Each plan is going to vary, probably, so I would call the number on your card and ask. I'm on Medica, and their requirements were 1. BMI/co-morbidities, 2. that I complied with the orders of my surgical/medical team, and 3. that I used one of their 'Centers of Excellence" - at least for my plan. There are 10-12 Centers of Excellence in MN.

Getting the approval from my medical/surgical team took 9 months before they even contacted Medica for the pre-approval. I went to an info session the week after new years, and I am having surgery this Friday.

I would say to call Medica first and ask what the approved center in your area is, and then find out about an info session there. I didn't even talk to my GP, just went straight to the bariatric clinic.

Thanks for the helpful info everyone. I suppose I should preface the GERD comment with the fact that it isn't a daily occurrence... It's triggered by certain foods like coffee and spicy. My primary areas of concern are the sleep apnea and joint pain from the weight. I would prefer not to go the bypass route due to the malabsorption. I take medication for depression that I have been stable on since 2008. I'd rather not have that messed with.

I plan on just going to straight to the surgeon instead of the GP. They have info sessions where one can learn more.

I would talk to your gp 1st as he should be able to refer you and if for no other reason, he will be apart of the process and you want him to be on board with the process. Most programs start with an informational seminar. You should be able to google "bariatric surgery" and the area you would want the surgery in and find ample choices. Most will have their schedule for informational seminars & phone # to call. One of the best things to make sure of is that the program/hospital is considered a "Center of Excellence". It means that they have been checked by the national/international programs and have good records. Also research the surgeons.

Most insurance companies require a BMI of 40 but they will usually go as low as a bmi of 35 with at least 2 co-morbid conditions such as sleep apnea, arthritis, high blood pressure, high cholesterol and a bunch of other things. You will most likely have to see a psychologist and a few other specialists, be on a medically supervised diet for 4 to 6 months.