No insurance requirements, Dr requirements?

Hello everyone :). I have my first consultation with my surgeon in a little over a month. I cannot wait to get it all started and I'm excited. This is something I thought about and tried to do on my own for years and I feel as though I'm ready to now use vsg as a tool to help me be healthy and happy now at 35 years old.

With that being said, I called my insurance twice to make sure (I have Northwell Direct -ppo ) that they will cover all bariatric surgeries (especially vsg in particular) and to see if they have any pre-approval requirements. According to the two people I've called and spoken to, any bariatric surgery I choose is 100% covered since my bmi is 45, including everything associated with the surgery before and after. Also they both claim that there are no requirements on my plan from my insurance company to get do to be approved...(no weighs-in necessary, no 3 month or 6 month programs, no steps to take.) With that being said I'm assuming that it will be all in my surgeons hands, no?

Has anyone been told that their insurance only requires a bmi of over 40 or 35 with comorbidites, and than had a surgeon who had minimal requirements?

Has anyone had no requirements (besides bmi) from your insurance, but your surgeon still had you on weight monitoring and/or a 6 month plan?

Has anyone had no requirements (besides bmi) from your insurance and been fast tracked with your surgeon?

I'm sorry for all the questions, I'm just new here and to all of this and through my months of research it seems to be that the standard for vsg is at least getting bloodwork, getting a pysch evaluation, meeting with a nutritionist and a lot of the times getting a sleep study and/or seeing a cardiologist.

I have a ppo therefore I don't need pcp approval to see specialists. I'm hoping to get some feedback for others experience since I can't find one article, post or video on the internet about Anyone who has my health insurance and getting bariatric surgery so looking for tips or insight from others under my exact insurance has been a dud. :/

Welcome!

Congrats on starting your journey - that's a big deal!

So...Different surgery, different insurance. The insurance wasn't the one with requirements for me, it was my employer. And mine was pretty fast tracked. They did require a referral from my PCP (April 2022), consult at the clinic (May 2022 first open appointment), whi*****luded all the bloodwork and lab testing they needed from me in one day. At the very least, there should be coagulation and other testing to ensure safe surgery, but maybe yours follows a different process. I didn't have to get an endoscopy or any specialist tests but had no co-morbidities officially other than sleep apnea. No history of GERD.

My starting BMI was 43 and change.

My employer required a psych eval and three nutritionist appointments, which could practically be completed back-to-back.

All of that to say...my initial consult with the clinic was May 24, I think. It took two weeks for them to approve everything for me to be a candidate after finishing the few requirements by June 8th. They called at the end of June to schedule and I had surgery July 15th, 2022. That's a pretty accelerated timeline compared to a lot of what I hear unless people are self-paying in Mexico.

On the other side of that, it puts a much bigger burden on us to move so quickly. Surgery is for our bodies but doesn't change our minds. A lot of the lead time is to give you a chance to make the long-term changes needed to succeed after surgery. My clinic did reinforce that I was moving at lightning speed (by their standards), and that did leave a large burden on me to do the work. It's a huge reason why there are often such long lead times.

Hope this helps, and it's good to ask all of the questions!

here's the thing. Just because your insurance company covers bariatric surgery, doesn't mean your employer bought the rider for its employees. If your employer didn't buy bariatric surgery coverage, your insurance won't cover it.

be sure to check with your insurance contact at your job to make sure they bought the rider.