newbie... With ALOT OF ?s

I am seriously considering WLS... Have debated for about 5plus years, but have felt like I could do it myself.. To NO AVAIL... Lose a few, gain a few plus a few more. So I'm not really sure where to start ... I have a primary and secondary insurance, who both require:

• Attending physician documents adherence to a non-surgical weight loss program (e.g. dietary management, behavior modification, and/or exercise) with ALL of the following:

• • Most recent attempt was within 2 years of request for surgery

  • Participation was for a minimum of 6 months

  • Failure to achieve and/or maintain adequate weight loss (i.e. 10%) by conservative means

So do I need to go to doc at this point and tell them what I'm doing before I even find a surgeon, so it's documented... Or can I just tell my doc what I have been doing and that covers it? It's very confusing! And I'm ready to get the ball rolling! I sure don't want to wait 6 months! I'm so miserable now, I can't stand it! I am ready to be able to be an active momma and wife! 

I am new as well and also miserable. My pcp is having me start a plan all over because it must be medically supervised... as in I have to go in each month and weigh in and discuss my progress. This is going to be a "process" for sure!

Yeah, it gets tedious, but it's better than thinking you're OK, submitting everything to insurance, and then having them turn you down because you didn't have enough documentation!!

I'm willing to guess that you'll need documentation of participation for each of those 6 months-- that's what it seems like for a lot of insurance companies that people have around here. Just saying "I've been on diets before" isn't enough. For my insurance, I ended up recording my food and exercise and checking in with my GP each month to cover the "supervised diet" portion.

There's no reason why you can't go ahead and talk to a surgeon now; I did that, before starting my supervised diet (3 months for my plan). I got all of my surgery information and a list of things I needed to do for both insurance and surgical clearance, including gathering up doctors' records, getting bloodwork, that sort of thing, the diet was only part of it.

Grrrr.... All the red tape! I wish the fact that I can't walk due to my feet can't take my weight anymore was a co-morbidity! Lol 

I agree with the prior post  -  there is no reason to wait to contact a surgeon.  It may take 6 months anyway to get everything done and you can probably get some stuff done while you are on the 6 month diet.  The surgeons all have information meetings once a month - go to a few before deciding.  The surgeons have 'navigators' on staff that help navigate the prerequisites that are required for good medical care as well as for the insurance approval.  (The bloodwork required 9 vials - I thought that even if WLS was not right for me, that I got a decent physical.)

 My navigator was terrific - I had no idea how much testing etc was required.  She helped me get the tests scheduled.  Also, I did all the stuff and then it was submitted to insurance for the surgery approval.         

Good luck,

As soon as you have confirmed coverage, I would contact a bariatric surgeon's office - do you need a referral from your PCP?  The Surgeon's Office likely has monthly Orientation Sessions where they review their process and what their requirements are.  It may be the Surgeon's Office requires you to go to their six-month supervised diet -- rather than doing it through your PCP.  The Orientation Session should answer a lot of your questions -- and they are used to dealing with various insurance companies too.  Things will fall into place -- keep reading here, and ask questions as they arise.  Did you read all the information under "Resources" at the top of the page?  There's a lot of info there to digest (no pun intended!).

Welcome aboard the train to a great new life -- it's a wild and crazy ride  -- with a wonderful destination.

Mary

I did my 6 month supervised diet with my surgeons center.  Start right away.  My first visit was Nov 3 and surgery is scheduled for Aug 26 as long as my approval comes back ok.  It can take a while for all appointments that are required.  Best of luck, it will fly by!

My insurance waived the 6 mos thing due to my comorbidities. I told them all the diets I'd tried in my life, provided a weight history for 5 yrs, I think.  I was shocked when they waived it. I had diabetes, reflux with Barrett's esophagus and borderline high blood pressure. Very grateful!!  Point is, nothing is set in stone, I guess. The surgeons office will have people to help you navigate the system. Good luck!