Advice for a beginner?

Based on several different calculators, my BMI is 61 and having tried every diet known to man (and woman), I recently decided to get WLS, and am early in the process of figuring it all out. I have an appointment scheduled for next week with my regular doctor to discuss WLS options. I've just found out that my husband's insurance probably doesn't cover the surgery (United Healthcare), but I may be able to get back on my employer's insurance during open enrollment in November, and they do cover it as long as they authorize the treatment in advance as 'medically necessary and appropriate'. **I was hoping that some of you can give me advice on the most 'proper' way to get the ball rolling to get the least resistance from my doctor, insurance, etc. and to get this done as quickly as possible... Does anyone have a checklist? Suggestions on what NOT to do/say? Anything I need to be doing ahead of time?** Thanks in advance for your help!

HELLO I'M CHERYL I'M GOING TO OSU. I CALLED THEM AND THEY SENT ME A PACKET TO TAKE TO ME PCP. AFTER THAT IT'S A WAITTING GAME. I'M NOW WAITING FOR A DATE WITH THE SURGEON. THE BEST ADVICE I CAN GIVE IS TO KEEP TRACK OF EVERY DIET YOU HAVE BEEN ON DR SUPERVISIED OR NOT.. OSU NEEDS A 5 YEAR DIET HISTORY, IT'S NOT THAT HARD TO DO. ALSO IF YOU HAVE HIGH BLOOD P. SLEEP APNIA. BACK PAIN . KNEE AND JOINT PAINS. GOOD LUCK

Start with your family doctor, write down EVERYTHING that your obesity interfers with. I never thought about telling my doctor that my knees hurt or my ankles. (Just thought well thats part of being overweight). List all meds your on if any. Have your surger/cholesteral/and general blood work checked. Do you have sleep apenea, heel spurs, edema ect. I know this is personal but my "checklist" said to list social, personal, including your sex life!!! EEEKKKK! I personally would not list if you are having trouble getting pregnant, as I was told this would be a reg flag as your wanting the surgery to get pregnant. (More claims to the insurance) But if your cycles are messed up due to your weight mention that. I had United Healthcare first, and they would not even consider my claim. I have also seen the names of obesity lawyers on this site. I hope this helps, be strong and take charge. Good Luck.

Hi Tatyana, I also have United Healthcare and I called them earlier this week to check on coverage. My policy does cover it if its medically necessary. I think it is based on the employer and the specific policies they will allow. Good luck, I'm at the same stage in researching WLS as you are. Denise

You're right, it has to do with employer-specified exclusions... my husband's employer specifically excludes any weight-related assistance... Odd that they have been paying for my Optifast program at CONCI for almost 3 years... that's why I think I will still apply through them first, I'd like to avoid having to pick up secondary insurance if it can be avoided (my husband's is free). I notice that you live in Powell, so potentially we are neighbors.

Tatyana, If your husband's employer is who excludes it, they also have the ability to override that exclusion. Talk to the benefits manager in HR. Best of Luck Nancy

i guess one question is how wls friendly is your pcp? some are so dead set against - next- have you considered where you wish to have surgery? i had mine at barix in groveport ( used to be BTC) and dr stelmack is my guy! i highly recommend them! many ins companies require a date and weight from most recent 5 years of doc office- ANY doc office- some ins companies require a 6 or 12 month supervised w loss attempt- some surgeons want a cardiac clearance -specially if you did redux or phen phen...a sleep study if apnea suspected- a pulmonary function-- i have not read your profile- i went into this with a strong history of diabetes back at least 50 years and the sleep apnea was what put me thru-- good luck to you- be informed and stay on top of it!make copies of everything you send anywhere and keep records of phone calls (who when why what)etc- ins companies can be so wonderful to deal with! never assume anything either--i found that asking the "right" questiosn got me farther than just asking questions- i have med mutual - maybe they are trained diff !!!! anyhow- good luck! as others have said- list your meds, your comorbidities, your aches and pains...your dieting history- did you do phen phen or redux? weigh****chers tops etc etc etc basically the medical necessity is there you just have to prove it! i know that stinks- the world is not fair right now...

It depends on the individual policy. I have United Health Care and they did delay in the approval but I was persistent and called them at least once a week. I was approved without ever having been rejected. Also total out of pocket cost to me was less than $100 for the entire surgery. Just make sure you have good documentation and are persistent. Good Luck

Hi! Tatyana! We are having a series of information sessions for OSU on Bariatric surgery. It will include a surgeon, a nutritionist, the program director, and a successful patient. They will go over all kinds of information as to how and where to get started. This will be a good stepping stone for a lot of people. If you would like, I can email the information to you, just send me your email. It is a long and sometimes frustrating journey. Unfortunately insurance holds the purse strings and they make us dance like puppets. Your BMI alone should indicate medical necessity. But, everyone is right, start getting all your documentation in line. Write down and copy everything you can get your hands on. I know at OSU we have personnel who deal with the insurance companies. I think we have a great program. Very comprehensive from start to finish and beyond. We also have support group meetings twice a month and I can send you info on that too if you would like! Good luck, hang in there. It will be very worth it in the long run! Valerie Curry, RN Lap RNY at OSU 07/10/2003 268/172/145