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Old 08-20-2012, 11:10 AM   #1
pocahontas
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How long was your WLS approval process?

I have been seriously considering WLS for a while now. I have BSCA HMO, they cover WLS and my only expense OOP is for the hospital stay. I have to go through my PP for a referral to the WL surgeon, then they start the approval process.

How long am I looking at? I am 34 now and have been overweight for nearly half my life, I want my life back.

I am interested in VSG. Just to throw a curveball into the mix, DH and I have been TTC#2 for almost 7 months now. I know that is not long but I had no problems conceiving DS at my current weight but I fear its my weight is now a problem. Should I wait and see how TTC goes? Or should I get the ball rolling on WLS?

I know, so many questions! I will be 35 in a few months and I dont want to see another year go by at this miserable weight. I constantly have swollen ankles and feet, no thanks to my desk job.

Suggestions? Words of wisdom?
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Old 08-20-2012, 11:50 AM   #2
tybeeanna
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hi, first check to see the hoops the ins co might want you to jump through. My BCBS IA BMI over 40 or over 35 with 2 other med problems ,sleep apnea, diabetes, there are others. also 6 mo Dr supervised of weight loss/management, every mo I had to see the Dr just for weight. Then go from there.Wishing you all the best.
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Old 08-20-2012, 11:58 AM   #3
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I called my insurance first and found out all the necessary requirements. I did not have to go through a six month supervised diet. I then found a surgeon, they required you to attend their seminar. From the seminar to surgery was two and a half months.

My surgeon required a pulminary, cardiac and pysch clearance. It was up to each Dr. to decide what the needed to clear me. They would not submit to insurance until they had all the clearances which I got pretty quickly. The longest wait was for my surgeon to give me my date since he was so booked up.

As for TTC they say to wait a year after surgery so only you can make that choice.
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Old 08-20-2012, 12:15 PM   #4
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My insurance required a 3 month supervised diet/exercise program (in addition to all other requirements) so mine was 3 months minimum. Then in took 3 more months before I could arrange a good time to take a month off work.
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Old 08-20-2012, 12:16 PM   #5
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And I would recommend NOT getting pregnant anytime soon after WLS, so I would put one or the other on hold.
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Old 08-20-2012, 12:26 PM   #6
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So it sounds like the requirements differ a bit. I will have to get more info on that. I do belive my BMI is over 40. I will talk to DH and see what he thinks about timing and TTC. This is going to be a very personal decision. Thanks for the advice!
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Old 08-20-2012, 01:22 PM   #7
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I had the same insurance in 2010 and they did not cover the WLS I wanted (sleeve) so I went to Mexico... no approval process, just had to get a passport card and money from my 401k lol

I think at the time if I had wanted RNY it was a 6 mo supervised diet first, but things may have changed in the last nearly 3 years.
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Old 08-20-2012, 01:34 PM   #8
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Quote:
Originally Posted by Maryposa View Post
I had the same insurance in 2010 and they did not cover the WLS I wanted (sleeve) so I went to Mexico... no approval process, just had to get a passport card and money from my 401k lol

I think at the time if I had wanted RNY it was a 6 mo supervised diet first, but things may have changed in the last nearly 3 years.
Im actually leaning towards this. I dont want to deal with 6 mo waiting period and I know I want the sleeve. I have been 100+ lbs overweight for nearly 10 yrs now. I cant do it anymore. LC works great for getting 25-30 lbs off but I cant seem to get further than that. I have no problem maintaining though! When I first started back in 2001, I had 65lbs to lose. I lost 45 and was so close to goal. I have never been able to get back there. Now here I am with those 65lbs again and another 45lbs on top of it. I am actually 25lbs less than my all time high too. Its just so sad and I am tired of the daily struggle.
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Old 08-20-2012, 02:31 PM   #9
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Quote:
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Im actually leaning towards this. I dont want to deal with 6 mo waiting period and I know I want the sleeve.
I believe this route is self-pay though, hence no waiting.
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Old 08-20-2012, 03:22 PM   #10
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I believe this route is self-pay though, hence no waiting.
Yep, no prob. I think it would be worth it.
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Old 08-20-2012, 05:54 PM   #11
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WLS totally changed my life - it has given me my life back. I have been overweight ever since I can honestly remember - at least since 5 years old...(I'll be 45 tomorrow.) When I think of all the life I didn't live because I was so consumed with my weight (being self-conscious, worrying about how others viewed me, not enjoying myself places, etc...) it makes me so sad. Good news is, though, that I have my life back - and it is a life I never experienced before. Going into dressing rooms and having everything fit... Fitting into chairs and booths and not worrying if chairs are strong enough. Having my kids put their arms all the way around me and actually running and playing with them... All of this is priceless. I would only say I would think getting pregnant too close to WLS could be very difficult and you should consult your doctor(s) about this.

My WLS was covered without the waiting process, but I did have to have the psych eval and nutritionist appts, too. I started seeing the doc in July 2010 and had surgery in November 2010.

I wish you the very best!!
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Last edited by Hot Tamale; 08-20-2012 at 05:58 PM..
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Old 08-20-2012, 10:10 PM   #12
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statistically there is no benefit of the 6 mo diet vs those who did not have the med supervised 6 mo diet. In fact, learning how to eat the food pyramid had zilch to do with life as a post-op. Kaiser went from 6 mos (a long time ago) down to three, the again down to SIX WEEKS!! It's called "Options" class. And they cover the sleeve. That makes 100X more sense to me.
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Old 08-20-2012, 10:12 PM   #13
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PS if you find sleeve still isn't covered I highly recommend Dr. Aceves... $8750 covers everything but your flight or drive down to San Diego. Clean, beautiful hospital and some of the best medical care Ive ever received. Even today they still answer my questions and offer second opinions on tests... if I wanted to, I could have gone down and had my GI tests for $80, no doctors fees.
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Last edited by Maryposa; 08-20-2012 at 10:14 PM..
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Old 08-21-2012, 04:00 AM   #14
Chrissykin
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Quote:
Originally Posted by Maryposa View Post
statistically there is no benefit of the 6 mo diet vs those who did not have the med supervised 6 mo diet. In fact, learning how to eat the food pyramid had zilch to do with life as a post-op. Kaiser went from 6 mos (a long time ago) down to three, the again down to SIX WEEKS!! It's called "Options" class. And they cover the sleeve. That makes 100X more sense to me.
My surgeon agrees with this. He worked with Blue Cross of IL and they no longer need the six mo diet.
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Old 08-21-2012, 01:40 PM   #15
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Quote:
Originally Posted by Chrissykin View Post
My surgeon agrees with this. He worked with Blue Cross of IL and they no longer need the six mo diet.
That's awesome!
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Old 08-22-2012, 07:31 PM   #16
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Someone already mentioned Mexico. I went to Dr Almanza in Tijuana. Made the appt right before Memorial day, flew in on June 27th in the afternoon, they did a special pickup for me - did the tests that afternoon / evening - went to the hotel that they paid for that nite. Surgery the next morning at 9 (Thursday) - up walking by 10:30. Went to recovery hotel and slept. Went to the hotel the next morning and went shopping to get out walking. Did the rest of my tests on Saturday morning and was on the plane back to Phoenix by 2 on Saturday morning. 4500.00. I am going back once i lose all the weight to have lipo next. No tummy tuck for me since I scar horribly.
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Old 09-05-2017, 05:26 PM   #17
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I have UHC insurance and they require 3 months diet consult.
also echo and stress test, phyc eval, and because I also have Muscular Distrophy my Dr wanted clearance from a neurologist. all that is completed and insurance gave me clearance to have surg any time after the 19th of this month. so just waiting for surgeons office to set my date.
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227/227/150???
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Old 09-06-2017, 05:08 PM   #18
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Quote:
Originally Posted by soontobesexy'ntx View Post
I have UHC insurance and they require 3 months diet consult.
also echo and stress test, phyc eval, and because I also have Muscular Distrophy my Dr wanted clearance from a neurologist. all that is completed and insurance gave me clearance to have surg any time after the 19th of this month. so just waiting for surgeons office to set my date.
That's exciting. It is a little quiet around here nowadays but you can try posting on one of these for more interaction. The last post on this one is from 2012!

http://www.lowcarbfriends.com/bbs/sh...d.php?t=885779
http://www.lowcarbfriends.com/bbs/sh...d.php?t=883642
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my youtube channel for my post-op weight loss surgery (VSG) journey
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