Considering VSG, don't know if I qualify?

Hi everyone,

im considering VSG but haven't had an appointment yet. My insurance provider is Kaiser. I know they cover the surgery but I want to know what their process is so I'm prepared. I haven't seen much about al the steps leading up to approval.

Can someone share their Kaiser approval experience with me? I have tried a few different diets and numerous exercise routines but haven't been successful. My BMI is 39.something. I don't think I have any of the comorbidity issues that are mentioned in the numerous posts I've read.

Just looking for some direction.

Thanks in Advance.

V

I suggest you call the Customer Service number on the back of your insurance card. You can confirm coverage for the surgery, and also get the information regarding what pre-op steps they require. And double check the coverage will be the same after January 1st. Your surgeon's office may have additional requirements.

Everyone's plan has different requirements; even someone else with Kaiser may not have the same requirements that you do.

Find a copy of your benefits book, you can often download it online or you can check with HR. That should include coverage guidelines. Alternately, you can call the customer service number on the back of your insurance cards.

Speaking in general, most people have to fulfill a series of requirements to be approved for insurance. These may include a medically-supervised diet (3 and 6 months are quite common), get proof of comorbidities (sleep study, cardiologist visit, etc.), and rounding up historical medical records. It is also very common for surgery to only cover surgey for BMI between 35 and 40 with one or more comorbidities.

As mentioned, your insurance will dictate the requirements (along with any a specific surgeon might have). Generally with a BMI between 35-39, you need comorbidities. Sometimes that is not necessary at 40 BMI and above. Some insurance companies require a history of being at the qualifying weight prior to starting the process, but some just use the weight at the time of initiation. If the latter, sometimes pushing your weight over 40 BMI might help. I was under 40 but had comorbidities. Sleep apnea sometimes qualifies as a comorbidity and you might not know unless you had a sleep study. My surgeon had me do a sleep study and I did have it (but was previously unaware).

I have Kaiser, but their program requirements vary from state to state. How it worked for me:

Pcp sent referral

I had to attend two of the surgeons information sessions

3 different weightloss classes

6 month supervised weightloss. Maryland doesn't require actual weighloss, but most states require 3% of body weight

Closer to the end you will have to get an upper GI series or Endoscopy depending on what your surgeon requires, h. Pylori test, other labs, chest x ray, and EKG pre-op.

I'm not exactly sure of the BMI requirement as I well exceeded requirements with a BMI of 59.

It was quite a stringent process, but doable. You'll definitely have to be patient.

Best wishes to you!!!

Some insurances go by the weight you are at the first appointment, some go by what you are at time of surgery. Besides looking at benefits yourself, the Surgeon's office or doctor usually also checks it out.

If you are 39. -something... the difference to be a 40 BMi depending on your height may a couple of pounds. So if 39-something is naked on the scale first thing in the morning- you might be 40BMI at the Doctor's office in the afternoon after a normal day of eating and drinking. Just putting that out there since early morning weigh-ins are the norm for most of us.

40 is usually the cutoff where you don't need comirbidities.

Not sure about Kaiser, but usually there's an informational seminar with the doctor you can go to.