Qualifying for WLS (Newbie post)

Alright, when you apply to have WLS, what steps do you have to go through? Now, I'm assuming it's probably different in the USA, and I'm in Canada, but I'm assuming that if you have insurance cover it, you probably have to go through similar steps.  I know that if it were only up to BMI's, I would qualify for sure, as I have a BMI of about 67 atm. However, I'm recovering from a Binge eating disorder. I haven't binged in more than 2 months, which, when you binged weekly for more than 14 years, is a long time. I've been in therapy, which has really been helping my self-esteem and desire to take care of myself. I've made some really good eating changes, but I'm still always hungry..  What did you have to do to get approved? What is it like to be post-op?  Thanks,  Chantel

Generally one of the criteria for WLS is passing a psych eval.  With your early remission of a long-term eating disorder, it may be more difficult for you to qualify based on their general psych criteria.  However, I wouldn't let that discourage you.  With continued treatment and extended length in absence in binging behaviors, it is possible you would be considered a candidate down the road. Having your binging d/o rectified is important post op due to the fact that if you would have a binging episode soon after surgery, you could really hurt yourself.  You need remember that WLS reduces the size of your stomach and the only thing that is keeping your stomach together in the first few weeks are staples.  If you shove food in that pouch, you can really hurt yourself!  I tried about two tablespoons of yogurt tonight and was stuffed.  Not saying binging isn't impossible post WLS, but it sure would be a very dangerous situation. Good Luck!!  

Hello and Welcome to the board. I am not sure about the way things work in Canada, but I can tell you about how things work here....well my experience.  I am still pre-op, so I can only give you so much information. I have been to two seminars/informational meetings with surgeons.  These are meant to learn about the different types of surgeries that they offer and how they work.  They also talk about their mortality rates and if they have any other problems that come up in surgery.  You are then able to ask questions to them.   Then there are other things that you must do in order to get approved and that is to pass a psychological evaluation.  This evaluation is to make sure that you are psychologically stable enough to handle a major surgery and also to make sure that you do not have other eating disorders that would interfere with your surgery.  (because you have an eating disorder it does not automatically exclude you...it may mean that you will need a longer period of remission is all)  Once you pass that evaluation...then you hand that in to your surgeons office which will then try toget you approved through your insurance. This is where I am in the process.  I have passed the evaluation and I am meeting with a nutritionist (for my insurance) and then the office will submit my claim to the insurance.  I am also different from many of the others on this board because I am getting the Duodenal Switch surgery instead of the RNY.  I researched and have chosen the DS because of my high BMI and high cancer risk in my family.  Everyone chooses a surgery that is best for them and I believe that I have done that for myself. SO anyway....I hope that my information has helped. Good Luck! Jennifer

Some other things to consider besides the psych evaluation people mentioned above - some insurance companies require you to have a 3 month, 6 month, or 12 month physician supervised diet before they will approve surgery.  Sometimes surgeons will require you to lose weight before they will do surgery also.  You may have to have other pre-operative tests as well, including a sleep test for apnea, pulmonary clearance from a pulmonologist, cardiac clearance from a cardiologist, possible placement of an IVC filter if you have clotting disorders or a family history of clotting issues, nutritional counseling, general physical, and pelvic exam etc.  You will most definitely have a least one round of blood work before surgery, probably more.  Everyone's pre-op testing and requirements are different, but those are some things you might expect. You may also want to look on the Canada board to find out what the situation is in Canada.  From what I understand there can be a long wait for the surgery there.  All the best, Jenn

I had my first consultation, yesterday.  I met with the doctor who will do the surgery, the NUT, the surgery coordinator, the Physician's Assistant, and one other person, I think it was a resident.  I have Wellmark  BCBS Alliance Select insurance.  For approval I have to have a psych exam, a cardiology exam, and be able to document 36 months of supervised dieting. I already am SMO with a BMI of 59.  I have the big 3 co-morbidities.  My surgeon doesn't think I'll have much problem getting approved.  Of course, everything could be different for you.  Good luck. Karla

Thanks you guys.. I'm actually looking at the possibility of getting the band instead of RNY surgery, mainly because I'd like to have kids eventually.. But if I ever get in to see the surgeon, I'd be deciding that with him. I wish that I could afford to go somewhere private and have it done.. The idea of waiting a year or more from my referral to when they even contact me.. (I've heard that it might even be longer..) has be discouraged. I'm trying to eat heathier, and every week without a binge is a good week. I've got an appointment to see a dietician at the beginning of july, and I'm going to start working with her..

Anywho... Thanks for all your help!

Hi I'm also in Canada and I hate to be the bearer of bad news but the lap-band is not covered. At the moment there are 3 surgeons in B.C. that do the surgery and 2 in Alberta and a few in Ontario, but the price is around $15,000. As for the RNY there is only 1 doc in B.C. doing it and it's an 18 month wait for a first appt then anywhere from 2 to 4 year wait for surgery. It's a slow process but make sure you get your name on some lists as soon as you can, cause it's going to be awhile.

Actually, Alberta recently started covering a limited number of lap-band sugeries. Therefore, because Yukon's health system is connected to Alberta's, Yukon will cover it in some cases, but it is on a case by case basis. I'd have to have it in Alberta, though, because BC doesn't cover it.  (New Brunswick covers it fully as well, and PEI covers the surgery cost but not the cost of the implement. I also heard rumours that Ontario was looking at covering it.)