How log of a wait till surgery? Insurance hurdles

supershopper
on 5/30/15 5:00 pm

I've been reading posts for the past several months but now have my first question. 

How long of a wait did you have before you can have surgery? My insurance requires a 6 month physician supervised diet program before approving plus psyc eval etc.

If you had to also go through this, did you use your primary care Dr or weigh****chers or another dietitian? 

How much weight did you lose before the surgery? Is there a requirement to lose a certain amount.

 

Sorry for all the questions.

 

 

White Dove
on 5/30/15 6:52 pm - Warren, OH

I went to the nutritionist at my surgical weight loss center. My surgeon requires you to lose 10% of your body weight.  That requirement depends on you and your surgeon.  I started the process in May and had surgery in October.

Real life begins where your comfort zone ends

CGCL
on 5/30/15 7:06 pm
RNY on 02/19/15

I did everything through my surgical center as well. My PCP has a good relationship with them so they were able to keep my records updated as needed. My first appointment was 7/29/14 and surgery was 2/19/15.

Height: 6'0" HW 5/2013 295. Consult 7/29/14 275. SW 261. RNY 2/19/15. M1:-33! M2:-13.5. M3:-12. M4:-10.8. M5:-9.7. M6:-5. M7: -4.5. Pregnant 8/15-5/16. 10 weeks post partum: 173.

mper714
on 5/31/15 6:54 am - Philadelphia, PA
RNY on 05/26/15

I also did everything through my surgical center as well. my first appointment was 2/9/15 and surgery was 5/26/15. health insurance through my job. bc/bs personal choice. no real requirements through them. but 30lbs requirement and many test before surgery kept me busy where required by surgen.

    

(deactivated member)
on 5/30/15 8:09 pm
RNY on 05/04/15

I did the 6-month program offered through my surgeon's clinic. Every month I checked in with a nurse practitioner and took part in a group class led by one of the psychologists, dietitians, or physical therapists (they rotated). It's actually the specific program required by my insurance, but that's because I work for (and am insured by) the health system that the clinic is part of, so they get to make their employees use their own providers. I started in October and had surgery in May. It would have been closer to 6 months, but my surgeon was on vacation for most of April.

I lost 80 lbs before surgery but had no requirement. I just had to be careful not to drop my BMI below 35 (and I came within 7 lbs of it!). All insurances are different in this regard. Some require loss, some don't, and some just want to make sure you don't gain.

supershopper
on 5/30/15 8:55 pm

Thanks for the feedback. So when you lost the 80 pounds before surgery- were you changing eating habits and exercising? 

 

 

HW 305 SW 278 Surgery weight 225 GW 160 LW: 118.8

RNY 12/15/2015,

GB removal 09/2016,

Twisted bowel/hernia repair 08/2017

M1 Dec 2015-13.0, M2-7.0, M3-14.5, M4-9.4, M5-7.1, M6 9.8, M7-7.6 ,M8- 7.6, M-9 5.5, M10-6.4, M11- 2.2, M12 Dec 2016- 5.8

(deactivated member)
on 5/31/15 6:33 pm
RNY on 05/04/15

Yeah, I started eating high-protein, lowering (but not eliminating) carbs, logging every bite in MyFitnessPal, playing Dance Dance Revolution, and bike riding.

iloveravens
on 5/31/15 5:48 am
RNY on 08/13/14

Mine is not typical.  I decided I wanted WLS in May of 2014.  Scheduled an appt. with the surgeon's office for late June 2014 (orientation & meet the surgeon), got approval in early July 2014 (3 days later)!   Scheduled a date, and had surgery in Aug. 2014.  I could have had surgery in mid-July but it didn't fit with my schedule.  2 months from deciding I wanted to surgery to surgery date.  No pre-op diet, no psychiatrist visit, no nutritionist, ...Another reason I'm very grateful to this site.  I learned much of what I needed to know here.  

I have United Healthcare through a major computer company (if that helps)...

Lanie; Age: 43; Surgery Date (VSG): 8/12/14 w/complications resulting in RNY next day;

Height: 5' 6" SW: 249 Comfort Zone: 135-140 CW: 138 (10/13/17)

M1: -25 lbs M2: -12 M3: -13 M4: -7 M5: -11 M6: -10 M7: -7 M8: -7 M9: -3 M10: -8 M11: -4 M12: -4

5K PR - 24:15 (4/23/16) First 10K - 53:30 (10/18/15)

peachpie
on 5/31/15 8:38 am - Philadelphia, PA
RNY on 04/28/15

My insurance did not require a supervised diet. I saw the surgeon for the first time 3/4/15, did my preop stuff within a month and had RNY on 4/28/15.

 the surgeon didn't require a specific weight loss, but greatly encouraged it to make surgery go smooth. I lost 20#.

 

gracie88
on 5/31/15 11:14 am
RNY on 08/26/15

My insurance also requires six month supervised diet.  I did my six months with my bariatric clinic.  First weigh in was in November.  Last weigh in for diet was May.  Then I have an apt to see surgeon before they will submit to insurance, that apt is June 22.  I suspect surgery will be July/August if insurance approves.  I had to lose 5% of my weigh and show I can follow a low carb diet (south beach). Had to have a stomach scope, blood work and psych eval as well.  I already had sleep apnea so didn't need the sleep study.

 Seminar Sept 2014 - 221

First 6 month weigh in - November 2013 - 220

Surgery Day 8/26/15 - 199

Current Weight (9/1/16) 128.0  RNY  5' 2"

 

 

 

 

 

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