NY Fidelis Care Approval Process

I have searched these forums and find several different answers, none of which are consistent.  Or, I find responses to the question that aren't actually answers at all.  SO.. my question is, if you had WLS in NY (gastric bypass), how long did it take you from your FIRST dr. appointment to obtaining a surgery date?  Does Fidelis require months of pre-op testing, etc., before surgery??   Hoping to get set up for surgery soon, and am curious.  Thanks in advance.  Also, did anyone have theirs done at Wilson in Binghamton, or Lordes??

Hi there,

You might want to call the 800 number on the back of your insurance card.  Everyone's insurance policy is different depends on where you work, what state, what policy, what country, etc.  Where is Wilson in Bringham, or Lordes?  Good luck

Hi! I am from NY, although I don't have Fidelis. I just wanted to say that some of the pre-op testing is required by insurance, and some is required by the surgeon. I think the only things required by the insurance where medical history and medical necessity, the meeting with the psych evaluation, whi*****luded my history of weight loss and diets as well as 6 months of weights from Doctors. Luckily I had been into the Primary over the winter and had a colonoscopy at the hospital and they were able to use those weights too. I went to A doctor's seminar end of April, first appointment May 6th, surgery July 23rd.  I had for pre-op testing: Pulmonary eval and tests, Cardiac eval and tests, endoscopy, had to go to a support meeting, meeting with nutritionist and pre-surg weight loss... and I forget... there was probably more... Good Luck!

There's no "simple" answer; it varies from insurers to surgeons.

First, you have to check your policy to see what your insurer requires - many times an insurer will require a six month supervised diet (mine required 12 months) and see what their other requirements may be.  Check BMI requirements (35 with comorbidities; 40 with no comorbidities). Also, be sure you are going to one of their surgeons - some require you go to a COE surgeon/facility.

Then, assuming your surgeon has an orientation meeting (as most do) they will review their requirements (meet with their medical doctor, appts. with psych, nut., sleep apnea testings, group informational sessions, etc.).  Also, if you have other issues, you may require additional tests (I had to have my cardiologist clear me, so that included some extra tests).  Most surgeons will be able to give you a rough timetable. I didn't even meet my surgeon until I had completed all the other steps.  Once I saw him, I was scheduled for surgery two weeks later.

Generally, it seems six months is an "average" time frame from orientation session to surgery date.

The process can be very frustrating, and you may find yourself having to jump through hoops.  And, you will see some conflicting information. Surgeons differ in their pre-op and post-op procedures.  But in the end, all the hassle is well worth it!

Good luck.

the reason you were not able to find a conclusive answer is because there is no conclusive answer. 

Every employer that buy Wls coverage for their employees has a different set of criteria. Then each surgeon often has a different set of requirements. 

There is, unfortunately,no conclusive way to answer your question. 

Thank you all for your responses, they have been helpful.  :)    Looks like it is going to be a long journey, but judging by your weight-loss "tickers," one that is worth the wait.