My new insurance covers bariatric surgery!

I'm pretty excited about this. I first joined Obesity Help years ago. Maybe 2007 or 2008. So long ago I couldn't remember my user name or password and must have used my previous work email so I couldn't get logged in until it dawned on me to open a new account. I never could afford to pay out of pocket so I could only read and learn and covet what other people had. During that time I also tried many other weight loss diets and lost and gained back lots of weight. The silver lining to that cloud is that I found out about the DS during that time and decided that if I ever could get bariatric surgery I would get the DS or nothing.

So now I have new insurance, it covers bariatric surgery and I'm coming here to ask for encouragement and guidance through this process.

My insurance is Aetna HMO. I'm in Southern California and I have been in contact with Dr. Keshishian's office. My insurance authorized a bariatric surgical consult but it was specific for a surgeon at UCI who does not do the DS. Can someone tell me how I can convert that authorization into an authorization to see Dr. Keshishian?

I'm aware that Aetna requires 6 months of medical diet and I hope to have enough documentation of my diets to cover that - fingers crossed.

I believe they also require a psych eval. Can someone recommend a bariatric friendly practice for this "requirement"?

I have a referral for a sleep study, in case a co-morbidity is needed but I think maybe the osteoarthritis in my knees will work for that too.

Is there a way to get referrals to a specific doctor? My PCP's staff told me that my insurance would decide for me but it seems to be such a waste of time to get a generic referral to someone in their "network" and then having to spend time trying to get it all changed to the correct surgeon of psych. How does that work?

I have waited so long for this and it would be so great to be able to avoid spinning my wheels and instead get good enough traction on this process to have surgery before the end of the year.

Please forgive me for just jumping in here so boldly when you really don't know me - but I am now 56 years old and I don't want to needlessly waste another minute of my life away with obesity. I would be so grateful for any support and guidance anyone might offer whether professional experience, personal experience, links to pages where this has been previously discussed, anything at all!.

Thank you,

Betty

Betty, you need to get a copy of your EOC (evidence of coverage) to determine what your coverage really is, what the specific requirements for bariatric surgery are, how to go about going out of network if necessary, appeals rights if any, etc. This is a long document, like about 100 pages, not your summary of benefits. For example, you may have coverage for "bariatric surgery" that doesn't include the DS - I don't know, maybe you know, but bottom line, never trust what some low level insurance company employee tells you over the phone. They don't care about this. You do.

I will send you more info in a pm but get started on getting the EOC.

Larra

I very much appreciate your response Larra. I've called the insurance company and they have sent copies to me - but none of them actually say they are "Evidence of Coverage"! A couple of the documents they sent clearly indicate they are "summaries" but one other document is titled "Aetna HMO CA Plan Design and Benefits" and that particular document also includes the employer's name and the effective dates. Do you think that might be the same thing or should I call them again and flat out insist on a document that declares itself to be an EOC?

I'll also check for you pm. Thanks, again

Betty