Hello! I'm new and have many questions!

Hello! My name is Nina. I'm 21 years old. I have a 1 year old daughter. Last month I discussed to my doctor about wanting to lose weight. I am 10 lbs away from hitting the big 300! She immediately asked me about weight lost surgery. I never thought of it because of my insurance.. I'm on state insurance and I'm not 100% sure if they will cover it. She sent a referral to a surgeon and everything. Now I just have to make an appointment. My first question is, should I first call my insurance to see if they cover any weight loss such as surgery? OR should I make an appointment and go from there? I'm not sure how all this stuff works to get approved by insurance and get a surgery date. I know there are a lot of tests you have to go through and it will take a while. I've heard of people being denied but still fight for it and then get approved. I'm very lost with that concept. Why would they deny you then all of a sudden approve you? Also, should you get everything you need done for surgery ( pysch, sleep study, labs etc) Then see if your insurance approves of the surgery? I'm not sure what to do first ... can anyone help me? I'd love it!

Thanks!!

First, you should contact your insurance to make certain surgery is covered. There isn't much point in going for a consult and finding your surgery isn't covered. You will also be able to ask what requirements you will have to meet if the surgery is covered.

Second, denials are overturned because additional clinical information is received by the insurance company. When an insurance company denies a covered service, you, the insured, have the right to appeal that decision. Usually the requesting provider, in this case the surgeon's office, will appeal on your behalf. If it is not a covered service in the first place, you have no appeal rights.

Third, I recommend a therapist. We all have many more reasons beside hunger for eating ourselves to obesity. It's good to explore those reasons and have strategies in place to deal with them. Surgery affects a physical change-an important one-but it will not do anything for our brains.

Good luck and let us know how it all goes.

Thank you sooo much! I actually called today and they told me they cover it 100 %.  I just need my doctor to send them a prior authorization. 

Hi Nina,

That is great that your insurance covers it at 100%. Now you definitely should go for your consultation. Here you will learn all of the requirements the surgeon has plus they may go over what requirements your insurance has as well. I'm just getting started with the whole process and am getting as much done and out of the way as possible. My insurance requires me to do a 6-month weight management program which I started in January. I also had to meet with a psychologist, physical therapist, nurse practitioner, and dietician. I had to do an EKG, lots of blood work, and a sleep study all of which I have completed. I have an appointment later this month for an endoscopy. After that, I just have the 5 months left of the weight management program. Come the 1st of July, my surgeon's office will submit to insurance for approval and I'll hopefully have surgery scheduled shortly after that.

Good luck to you!

Nichole

With your insurance saying you have to do a 6 month weight management, did you have to see a dietitian or did you just start eating healthy? I will ask my insurance tomorrow but, if they do say I need that I'm not sure if I have to see a dietitian   first? Or do they offer specific management programs?? 

I had to meet one time with a one-on-one consultation with a dietician (the same as the physical therapist, nurse practitioner, and psychologist). Her and I came up with a plan and some goals. The weight management program I'm doing is through the same office I have all my appointments at. The one I'm doing is a once monthly meeting that is about 90 minutes long. Other people that are going to be have WLS are also in the group and it's lead by a different professional each month. There are certain topics they discuss as well as people sharing different things related to WLS. Before the meeting starts you do a weigh-in as well.

Was that one on one time with the dietitian before or after your first consultation with your surgeon?? 

The very first appt I had was a "Welcome Group". There was so much information given at that session. Before I left the office that day, they scheduled me my six months of the weight management group. I had all of my one-on-one appts and my blood work done and my sleep study scheduled before my formal consultation with the surgeon.

Oh okay. I'll definitely call my insurance to see if I have to go through that. So I can set up my appointment with my surgeon.