When do I start the PROCESS?? Please HELP!

I am a teacher in Georgia. My state merit insurance does not cover RNY, but the HMO for my county does. I will be switching in April and it will take affect July 1. My question is this - Do I start doing my pre-op appointments now (psych eval, consults, etc) or do I have to wait for my insurance to change over? Thanks for any help! Mandy

Have you chosen a surgeon yet? If so, his/her office can help you figure out the timeline for the pre-op consultations. Surgeons have different guidelines on how recent each test must be. There's also a question of who performs the pre-op tests. Some surgeons/bariatric programs require that you use their preferred providers for some or all of the tests, others do not. Just as an example... I'm getting RNY through a hospital's bariatric program. The program has its own mental health and nutritional professionals; I could schedule those anytime after my initial consultation with the program's surgeon. I can choose who does my medical pre-ops, but they must be done no sooner than 30 days before the surgery date; it's recommended that I not schedule those tests until I've gotten insurance approval. If your surgeon's office says you can start your pre-op tests, ask them about the insurance issue. If your current insurance doesn't cover the RNY, they might balk at covering the pre-op tests.

I would start the stuff after the change over. If they cover WLS, they probably will recognize the standard things required for it. But you could go to the WLS seminar that many Dr. require and start attending the support group meetings. They are very educational, and will help you know what to expect after surgery.

Hi Mandy: ASAP..choose a surgeon, your primary care doctor usually can recommend one. THE MOST IMPORTANT THING I CAN TELL YOU IS THIS: Every and any Doctor you go to, tell them you are going to have the WLS and let them know the importance of RECORDING in your records any referrals they give you for alternative weight loss procedures, example: Weigh****chers, or any others, AND ALSO RECORD your progress in those same records for you. My insurance company requests this information for at least 6 months. My insurance company is Aetna, their criteria is very very strict. I was not aware of their criteria, so once you have your insurance changed, request of them yourself or through your Dr., a copy of their criteria. You may, as I have had to do, start all over again just to have proof to the insurance company that I have tried alternative ways to lose weight. My Dr. DID have me join WW's and I had my records and my progress charts, but they would not take that as proof with it being recorded in my medical records. I also had to have physician controlled exercise program documented in my records over a recent period. Also I have to show proof that I have had dietician teachings on nutrition etc. Good luck. Rhondda, Apache Junction, Arizona