New Here and Nervous

Hi all. I am new here. I am just starting the process of exploring weight loss surgery. I am 4'11" and 210 pounds. I have pre-diabetes, asthma, reflux, achy knees, etc. I am nervous about not getting approved. I am attending my first seminar next week. I was just wondering if you could share the process of getting approval, etc. I have tried weigh****chers, calorie counting, exercise, etc but I have not been successful. Thanks!!

The approval process depends on your insurance.  It took a little extra work for me to get approved and they almost had to do a peer to peer consult with my Dr. and Insurance company, but then the insurance "found me approved" without the peer to peer.  I had completed all the criteria and expected to have surgery in August.  Due to insurance holdups I wasn't able to have surgery until November. Good luck!

Welcome to our Lightweight Board and Congrats on considering WLS!!!! 

Our stats are pretty close.  I am 4'11" and 203 was my highest weight.  I was in my 50's when I had my surgery.  I'm 6+ years out and I've maintained my weight between 118-120 for over 4 years.  I've went from a size 22 to 4's and Petite M.  

I didn't have any health problems but was on Prilosec for acid reflux (seldom used) but had the prescription and my legs ached.  My Insurance cared more about my BMI than health issues. I had to prove that I had tried for a long time to lose weight...like years of WW.  I also had to go on 6 month 2000 calorie diet and give up carbonated drinks.  I was not allowed to gain during that 6 months.  Fortunately I lost 1 pound a month.

I never dreamed that WLS would have changed my life so drastically!  I never thought I was missing out until I got to goal and realized what sideline Mom/Grandma I was. Check out my before/after pictures and story on my home page.

All insurance requires different things. You can call then and find out or when you go for your first appointment their insurance department should know what your insurance requires. Mine I had to have 6 months of supervised diet instruction before they could submit request for approval. Most require bmi of 40 or higher or 35 with 2 co-morbities. Other insurance might not require as many supervised visits etc. Like I said each is different. Main thing is to make sure your insurance plan allows for wls surgery. Best of luck to you. I started my first visit o 9/19 and went ever 4 weeks to get my 6 visits in. got approved. and had my surgery 3/10 9 days of being 6months start to finish.

I started my process in February with a visit to a surgeon I found.  I had to do 3 monthly visits with the nutritionist, an ultrasound of my gallbladder, EKG (which led to a stress test and nuclear stress test), primary care doctor clearance, bloodwork, psychologist clearance, etc.  I had my surgery July 1, so it took me just over 4 months from beginning to end.

I guess I'd say I was the worst case scenario. I that my insurance covered WLS in February, scheduled a consult with the only doctor they covered, and began gathering the required documents. I had to show 6 months of a supervised weight loss program, get a psych eval, TSH test for thyroid problems all are the typical Milliman Guidelines plus my insurance had 3 outdated criteria that I had to meet also. I met 2 out of 3. Was denied, appealed and when they didn't responded to my appeal in the time specified in their document finally got approved on March 4th and my surgery is scheduled for April 14th. Make sure you know what your insurance requires, work with your surgeon and PCP and most of all DON'T give up. Good Luck and keep reading and posting. This is a great place to get your questions answered by people who were and are in your shoes.

Welcome!  I had the same issues as you're stating but had a sleep test which proved I also had sleep apnea. That is probably what tipped the scales in my favor. Perhaps all the tests will turn up other issues that will count towards the comorbidities needed for insurance approval. The rule of thumb is 35 to 39 BMI with comorbidites, (lightweight by most standards) or 40+ BMI without comorbidites for insurance approval in the US. Good luck and keep us posted. 

--gina

Congrats on considering WLS!  If you decide to go for it, youll love the results! If you do, you'll love this forum, really supportive and not quite so preachy as some of the others. 

My process from start to WLS was about 3 mths.  But my issues were really well documented because I had recently retired from the Navy and they want to know everything that is going on with you before you get out.

I agree with the BMI #'s Major Mom posted, it seems pretty consistant with most insurances.

Thank you all for sharing about the process! I will keep you posted! 

With my insurance I had to try losing weight with the nutritionist for 6 months. And then they sent the paper work out saying how I did and all that. And then they have the final say. But 5 times out of ten they approve you as long as your bmi is over 43. I wish you luck.