HELP! new to this please help so many questions!

So I just requested a referral from my Pcp for bariatric surgery about a week ago, major resistance on her part I had to talk for my life basically to get her to send the referral! So I'm just scared of not getting approved, they keep saying it may or may not get approved, we don't know. All I know is it's being sent to UC Davis (if anyone is familiar) in California for approval. I have Molina insurance thru Medi-Cal and I know medi-cal pays for the surgery! Ok back to my main concerns which is not getting approved, I have a bmi of 78 I'm 5'3 weight 428 I have been large all my life. I don't have a history of any medical conditions just anxiety,depression and anemia, I believe I might have sleep apnea but it's not diagnosed I have been on a dr dr approved weight loss program for the last 6 months, I've tried everything under and over the sun to lose weight and have failed, I'm wondering being that I don't have any "life threatening" medical conditions will that stop me from being approved? I'm scared to death of a denial and my Pcp was so resistant and just had no sympathy or concern for me, it's like she basically did it because I kept bugging her! I feel like my life is on the line and I'm not going to be around if I don't get this surgery I'm 34 and scared to death!! Any advice or what do you think?? Plead HELP.   

I don't know how much help I can be but If your particular insurance covers bariatric surgery then you should be fine.  Most insurance companies require co-morbidities if you are under 40 bmi.  If you are over 40 bmi then the co-morbidities should not be a problem.  Why don't you call your insurance company, give them your specifics, the doctor/hospital you plan to use and they can let you know what coverage you have.  They will also let you know their requirements (3 or 6 month nutritional visits, mental health evaluation, endoscopy etc---all doctors/insurance companies are different).  Relax and enjoy the journey--you'll be starting your new healthy life before you know it!

Lisa

I think you should probably be ok. With your BMI, if you don't have comorbs they will come shortly. Trust me, they snuck up fast on me, and we are the same age with high BMI. Your BMI along with already doing the 6 month supervised diet should be enough. I would google your insurance company's requirements, of course the surgeon's office should also be able to help you with that.

I would say that anxiety, depression and anemia are medical conditions, so don't discount those.  If you are tested and have sleep apnea, that is considered an obesity comorbid condition.  Have you considered switching PCPs?  The only way to know if you will get approved is to go through the process.  You do need supportive physicians to help though.  Don't assume you won't be approved since it is possible you could be approved based on your BMI alone.  Have you tried calling your insurance company to determine what they require for approval?

I'm not discounting my conditions, they make it seem as they are not "life threatening" I honestly don't know what the hell is wrong with my damn doctor (excuse my language) but the ***** just acts like she is plan stupid!  I wish I could change my Pcp but you can only change once a year and I just switched to this new office! But thank you for the help!

I know it sounds ridiculous, but some people with really high BMIs like yours have a hard time finding a surgeon to operate. Being very large increases the risk of complications and makes the surgery much more difficult. Some surgeons just don't want the risk.

You do have a life threatening condition -- super morbid obesity. If your insurance covers WLS, you should certainly qualify. A good surgical program will know how to navigate through the paperwork process.

Stick with it. It will be worth it. When they ask you to jump through hoops, jump. Keep the ultimate goal in mind.

As long as your PCP made the referral, that's what matters.  Once that is done, from your BMI, I'd think you would be approved. 

Have you selected a surgeon that accepts Medi-Cal?  If not, here's a link for reviewing surgeons in California.  You can also call Medi-Cal to obtain a list of bariatric surgeons in your area that accept Medi-Cal.  If you call Medi-Cal and obtain a list, you can email Member Services for our help to assist with researching the surgeons.

Thank you! I don't know anything but I called medi cal to check on my referral and they told me to call Molina. I'm going to call around to get some specifics on who I need to be in contact with because it seems like right now it's Molina that's handling the referral but again thank you for the link!

Good for you pushing your PCP for the referral!  The worst that can happen is the surgeon and or/insurance company says no, and you don't know until you try.  My insurance company required a BMI or 40+ without health conditions or 35-40 with.  Mine was 39.7 without any comorbid conditions, and I got approved.  Also, make you sure you have documentation of your diet program; that may help!  

I'm sorry you had to go through that with your PCP.  When I went to mine for help with my weight struggles (after trying everything), mine suggested hypnosis.  Seriously, lady?  You were smart to push for this!  

Do any of the surgeons in your area do information sessions?  That seems to be the way many of them get a great deal of information to their patients.  You should check one out!  It will answer a LOT of questions, and you may get a sense for whether you like that particular surgeon!!

Good luck to you!

Thank you! I felt like I was talking to somebody who had a gun to my head and was about to pull the trigger for that referral! I'm trying everyday to get as much information as possible!