Brand new member Looking for some advice

Hello everyone! I am brand new to this I found it after reading a few blogs online. And this looks like just the right place to help me get some information and support while I attempt to get surgery. I have not yet started the process exactly. I did contact a local doctor here and they did let me know that my insurance will cover this type of surgery. That made my heart do happy flips :)

There are some things of course that need to be done first, basically everything, lol. So the advice I am looking for is this- I just got the information on who my pcp is. i have not set up an appointment to see him yet. I haven't really had a pcp since I was a teenager. I only had a regular ob back before I moved to AZ. I am not sure how to set up the first appointment. Do I just tell them it is for an evaluation, do I mention when I set the appointment that I am looking into WLS? I have never made an appointment like this. Any advice would be beyond helpful.

My other question is how do I bring this up to the dr? I mean when he sees me he will be aware of course that I am obese. No hiding that. Do I just come right out and say I want a referral for the gastric sleeve?

Anyone who has any advice for me I would appreciate it. Hopefully none of you will get bored with all the questions I may ask :)

Call insurance first and ask what exactly they require for pre=approval.  It may be a referral, or even just a note from the doc supporting your decision. They may also require a psych eval, etc.  For your new PCP, set up an appt for a physical since you're new (they'll want that) and you can work that into your conversation.

I did find the information online for most of what the insurance requires.  

• BMI 35 or greater with one comorbidity
• Documentation of Severe Obesity for 2 years (documented weight history, 2-3 office notes per year)
• Dietician or Nutritionist Consult
• Psychology Consult (MMPI required) preferred within last 90 days
• Documentation of Medically Supervised Weight Loss by PCP for 6 consecutive months within the past year
(including daily food log or food journal for 6 months)
• Normal TSH within last 6 months
• Cardiac and Pulmonary Consults mandatory if age 50 or greater or BMI 50 or greater
• Cardiac and Pulmonary must be approved by Mercy Care Plan; preferred within last 90 days

Maybe calling them would give me a better idea of what I need. I will give them a call today and then make the dr's appointment. Thank you for your advice. 

You've got some work ahead of you, which is what I expected.  Specifically, or your weight loss - call them and ask exactly what they want documented.  I've seen some rejected because the PCP didn't keep good enough records.

Thank you! I will find out all the exact details. 

Insurance requirements are the tough part.

While they may cover the surgery, meeting their requirements is not so easy.

I agree about the physical with the PCP and going from there.

But not having had a regular Dr. for years might be difficult.  I had to have 3 yrs of weight history, but in 2012, I had not gone to a doctor at all.  I had to find pictures with date stamps that showed I had been MO for 2012 (like I had lost it all from 2011 and then regained it for 2013.

But at this point, all you can do is see the Dr., find out the requirements, and go from there.

Thanks for your reply. I did have an Ob/gyn because of some issues. So there is some documentation from those times. I definitely have date stamped pictures if they need the proof. 

Thank you!

Also coverage is set up by your employer. They may exempt WLS because they can do that. That is why calling is so important. I am a direct person so I would just look the PCP in the eye and say I want WLS can you refer me? They may want a few visits first to get to know your history.

My plan is actually not through an employer, it is state  insurance. I have been searching for a job for a year :( Turned down or not called back at all from 100's of places. So at this time I have basically medicaid. Which I was actually shocked by the fact that they do have the coverage. 

I don't mind waiting or going through a few visits. Even 6-12 months of supervised diet/exercise. 

I think what you say is best just tell them what I want and cross my fingers they say ok :)

Ahh okay and you need to find a surgeon that will take the state insurance. Medicaid has horrible pay back to doctors so many do not take it. I did not use medicaid but my surgeon takes it not all do. So when you call get a list of practices that accept it.