need some help plz

hey everyone, i need a few suggestions. so far i am still doing research. i am trying to figure out what is the fastest way do get things doing. like should i go ahead and call a surgeon and get them to send me the orintation packet or would it be best to wait. i am trying to get all of my bases covered as best i can before i actually go see my pcp. that way if he has any questions, i can answer them rather than having to make more appt.s then finally getting to see the surgeon. anything you all can think of will help thanks stormy

Saphire, it all depends on the insurance you have. I had to see my PCP first, go on a 16 week weight loss plan, then I made an appointment with the surgeon, etc.. We have a whole team dedicated to the WLS here in Daytona. But it all started with my PCP because she is the one who had to refer me in the first place. Good luck to you and keep us posted! Kathy~

You have to get everything started through your PCP. The Wls has to be medically necessary. Your journey is just starting. Do you have full Medicade or are you in the share of cost program?

Stormy, Call your insurance company to find out what their requirements are for the surgery. Some require a psych eval, so don't; some require a medically supervised documented diet, some don't. Once you know what you need from the insurance company, go to your PCP with all your ducks in a row, proving you've done your research, know the risks, etc. You'll need them to write a letter of medical necessity and get copies of all your records for the surgeon. I've even known people who had gotten their PCP to prescribe the same tests that their surgeon also needed. So when they saw the surgeon, they brought their RECENT bloodwork (thyroid panel), echocardiogram and diet records all ready for the surgeon's office. That is of course is if they felt comfortable with the surgeon and wanted to move forward. If not, they held on to them for the surgeon they chose. Some surgeons require special tests depending on your age, comorbities, etc. Typically, the psych eval is not covered by insurance, but some companies will cover it. I paid $250 for mine and got my referral from the surgeon. Bottom line, check with your insurance company, then the surgeon. If you can go to an info session because they are very informative and someone always asks the questions you forgot to ask. Good luck Amy

Medicade will cover the Wls 100% unless you have share of cost. However YOU MUST HAVE YOUR PCP START EVERYTHING. Why pay for something when you can get it covered by Medicade?

Hi there It's truely up to you how you want to start things. Like me personally, I have not even talked to me PCP yet, but already have most of my testing scheduled. I have a presciption to get the blood work done this week as well. I plan to meet with my PCP the first week in May though. I just hope he is willing to give me the referral I need and write the letter of Medical necessity. Perhaps, I did things backwards, but this seems to work for me so far. One thing you may want to do first though, is make sure you know what is needed by your insurance company and make sure there is not an exclusion. Good Luck with your journey!! Michelle.

Medicaid "share of cost" turns into straight Medicaid if you've met your share of cost for EACH month. (Example: $75 is your share of cost) If your meds or doctor visits cost MORE then $75 EACH month, Mediciad will pay them in full. Just try to get your doc appts scheduled for the BEGINNING of the month or fill your meds. Then everything else the rest of the month is covered. They do pay for WLS as long as you meet the "share of cost" EACH month. You are considered "medically needy" if you have "share of cost" and do not need a referral to get testing done.

I went thru the surgeon first by completing the packet received at an informational meeting. Included in it was a generic referral letter for my PCP. I also wrote a little note to her asking that she didn't need to endorse the surgery but just explain my past weight history, my health risks and that they would significantly improve with weight loss. I did have to go for my preop exam with my PCP. I was approved in four days. I'm still not sure if my PCP favors the surgery but she definitely recognizes that I am healthier 4 1/2 mos post surgery and 78# down. Good luck.