How to start the WLS process?

I am on state insurance that does cover Gastric bypass but I am unsure of where to start and how the process takes. I am currently in California. I have been overweight for more than 5 years and have had weight related issues when I have been pregnant in the past (I now have Essure) My BMI is 46. I am wondering how can I prove I have tried to lose weight, i.e. Gym memberships, diets etc. and how do I start the whole process. Thanks and sorry if I rambled at all!!

My insurance doesn't require a referral so I went to a free information session. I filled out an application while I was there which just had my basic info along with insurance. A couple of days later they called me and started scheduling appointments. If I were you I would get a referral from your PCP. I didn't have to prove that I've tried to lose weight in the past. They just asked me about previous diets and what I had tried. They document it and send it with all the paperwork to insurance for approval. Different insurance companies have different requirements. Mine requires me to go through a 6 month weight management program which I started just this month.

Good luck to you. These forums have provided me with a wealth of information.

Nichole

Thank you for your help =)  I will make an apt with my PCP and ask about a referrel.

Which plan do you have and where in California are you? Is it Medi-Cal or an Obamacare plan? I am in San Diego, have an HMO, so I had to get a referral from my doc to a surgeon. They referred me first to someone who didn't take my insurance. There are a few main docs that do the surgery here, so I called around and found one that was willing to work with my plan. Called my PCP back to refer me to that Dr, whose office had to write a letter saying they would work with me. A lot of red tape to just get a consultation, but that was the hardest part. Once I got to see the surgeon, there were tons of tests, appointments, etc, but I was approved on my first try to the insurance. I didn't have to do the six month diet, but I know some plans require it, and others will take it as part of your history. I worked for Jenny Craig for two years not too long ago, and I included that information, but was never asked to prove it. I only had high blood pressure when I started the process, but the testing uncovered two more co-morbidities, so it is important to do it all. Good luck and feel free to ask me any questions. Good luck!

I have straight Medi-Cal but I am transferring to IEHP which is an HMO. I'm in San Bernardino right now but all of my doctors are in Riverside. I have tried different weight loss programs too and diets which would only work short term and I would regain quickly.

Thank you for your help!

I would look on the IEHP site, see if they have any bariatric surgeons, or you may need to look under general surgeons and do a little more work. I'm not familiar with the programs up there, but Google local Bariatric Surgeons or weight loss surgery, etc. to find out who is up there, does the surgery you want, best reviews, etc, whatever is important to you. Find out which ones work with your MediCal plan, there probably won't be that many, but I don't know for sure. Different plans work with different programs. If you are comfortable with the surgeon who works with your plan, ask your primary care to refer you. You may ask your PCP office first to see if they have a specific plan they refer to. HMOs will always require the referral. I had to follow up for the referral a lot. If you have already contacted the program, they will be waiting for your referral and once they get it will start the process. Most programs will require you to go to a seminar of some sort to get familiar with the surgery, ask questions, etc. The prosess can be long. So many tests and referrals. Do what you need to, follow up as necessary and be flexible. It's frustrating, but worth it. Good luck!!!

Also, if you don't like any of the Doctors that take your plan, or find a doctor that takes a different one, you can change your plan to one they do take. I don't have MediCal, so I don't know how long their approval process works, but I have an Obamacare plan, which is also an HMO, and I went through a lot of, we don't take that plan. Keep at it until you have a doctor and plan that will work together and you feel comfortable with.

How did everything go? I am on my 3rd nutritional class with IEHP surgery center... Im just wondering what happened after you finished your classes.

Insurance requirements differ so greatly, it's your best bet just to call them and ask for specifics.  Some will take those diet program receipts, while others insist that your doctor or a nutritionist be involved in your weight loss attempts and everything be meticulously documented.  The last thing you want to do is guess at it and lose precious time and have to start over again.