Question:
I was wondering what the first step would be for WLS?
I have insurance now as of 4/1/00, I dont know if i am to see my pcp first and have him check my comorbidys (if i have any) then refer me to a bariatric surgeon, or do i just have him give me a referrel to a bariatric surgeon and the surgeon does the rest. Do i need to have established comorbitys before i can see a BS? any input would be a great deal of help in this process and steps i need to take. thank you all. Amy — Amy B. (posted on April 3, 2000)
April 3, 2000
Hi Amy! Your first step really depends on the guidelines of
your insurance company. What I did (and this made the whole
process very easy) was I first picked the surgeon I wanted
(that was the most important thing to me), then I asked that
surgeon for the name of a WLS-friendly PCP in the same IPA/Medical Group,
then I registered
through my HMO with that PCP. I made an appointment to see
the PCP as soon as I could, and got the "official" referral to
the surgeon of my choice. It's called "going through the
back door", and many health care industry professionals do it
in order to see the specialist of their choice. Heck, it
worked for me! Please feel free to write to me if you have
any questions.
— Kim H.
April 3, 2000
Amy... Kim is the insurance guru around these parts, so listen to her.
Something I might add, however, is that you research all kinds of WLS. You
can get a lot of good info here about the RNY. You can check out
www.duodenalswitch.com as well. For the Bilio-Pantcreatic Diversion with
Duodenal Switch (DS), we have patient stories, pics, published medical
reports, etc. Hope you find what suits you the best!
— Kris S.
April 3, 2000
I know it depends on your insurance co. But usually you see
your pcp and get a referral to the bariatric surgeon. He will
in most cases do the rest. He will find out what type of risks
you have, by tests or other means. I know I went through, a
psych eval, ultrasound for gall bladder, and a dietician. I
know others go much more, like sleep disorder test, bone density
test, any many others that I am not sure of. I know others
on this site will help you with that. You will have blood
tests. I know that not all pcps are favorable to the surgery.
But be persistant if this will be the case for you. Go for
it all and stick to your guns. I know I had to wait to get
insurance before I could finally go for the surgery. I was
so happy when I finally got insurance. My pcp did not want
me to have the surgery but I persisted and got the surgeons
name from her and used that to make my own referral. I wish
you all the best of luck. My surgery was 2 1/2 years ago. Now
my dr. think it was a great idea for me. Go for it all.
— chris M.
April 3, 2000
I choose a surgeon from this site first, and contacted their office. The
surgeon's office sent me a packet to fill out on my medical history and
dieting history. I returned this and then called the surgeon's office to
make an appointment. Once that done, I contacted my PCP and made an
appointment with him. I had him refill some Rx's for me and told him I
needed a referral to Dr._________ for an appointment I had with him on
______. My PCP had no experience with bariatric surgery, but I just told
him what I wanted and he complied. He didn't need to write me a letter
saying I needed the surgery, just give me a referral. The surgeon wrote
the letter of recommendation himself. While I was there, I got copies of
my medical records from my PCP to take with me to my surgeon's office. I
had two other doctors- a neurologist and a cardiologist. I called one
office and asked them to fax the surgeon my records and I picked up the
records from the other and carried them also to my first appointment. The
surgeon had all my medical records to review which made the whole process
faster. Once I saw the surgeon, he sent a letter into my insurance
company, and I eventually scheduled surgery. I went ahead with surgery
before my insurance approval came in because I was going to have surgery
regardless of what happened. Insurance ended up approving and have covered
the surgery. Hope this helps. Good luck.
— Shar /.
October 4, 2002
Hi Amy, I'm just starting also. When I became interested in WLS I first
contacted my ins co by E-mail. To see if this op was covered by them.they
got back with me by letter. because I couldn't explain myself pro like. lol
I printed out info explaining what I was tring to get. she called me and
told my step by step what I had to do. She even had called my primary
doctor and asked for a surgen close to where I lived. After hanging up from
her I called that doctor. made a appt. they told me to get my referral from
my primary dr. which I did. and on Oct 16 bring med list, referral,ins
cards. What's next I have no idea. GOOD LUCK
— Naes Wls J.
October 4, 2002
Hi Amy...I'm just starting to get the ball rolling. My profile is very
detailed so feel free to look at it. But basically here's the steps I
took:
1. Do tons of research-read Carnie Wilson's book Gut Feelings. The Medical
Guide to WLS is also a good one. I got them at Barnes and Noble. Also this
site and others are great resources.
2.Find a hospital-I'm also from NH. Dartmouth is the only one in NH that
does it. I found though that Dartmouth's a very very long process. You may
have to wait over a year. I'm going to Beth Isreal-there's lots of
hospitals in MA that you don't have to wait as long. Go to a
seminar/support group...surgeons as well as post ops are usually there to
discuss everything and answer questions.
3. I do medical billing so I know it depends on your insurance plan if you
need a referal or not. I have BCBS HMO so I did. POS or PPO plans usually
don't require one, but the surgeon usually needs to be in their network. Go
in armed to your PCP appointment. I was very lucky my PCP was
supportive(actually thrilled)but some aren't. I don't have any co-morbities
but my BMI is sky high and I have a strong family history of fatal diseases
some triggered by weight.
4.After your PCP sends a referral you usually have to fill out a
questionaire to the hospital and then the surgeon's office will contact you
and schedule appointments. I'm going for my first pre-op tests 12/2/02 and
I'll probably have surgery 1-3 months after.
Hope that helps you! Feel free to E-mail me-I also joined a local WLS
support group that meets once a month. Most are post-ops but anyone can
join. I can give you more details. Take care :)
— mzcath
October 4, 2002
Hi Amy...I'm just starting to get the ball rolling. My profile is very
detailed so feel free to look at it. But basically here's the steps I
took:
1. Do tons of research-read Carnie Wilson's book Gut Feelings. The Medical
Guide to WLS is also a good one. I got them at Barnes and Noble. Also this
site and others are great resources.
2.Find a hospital-I'm also from NH. Dartmouth is the only one in NH that
does it. I found though that Dartmouth's a very very long process. You may
have to wait over a year. I'm going to Beth Isreal-there's lots of
hospitals in MA that you don't have to wait as long. Go to a
seminar/support group...surgeons as well as post ops are usually there to
discuss everything and answer questions.
3. I do medical billing so I know it depends on your insurance plan if you
need a referal or not. I have BCBS HMO so I did. POS or PPO plans usually
don't require one, but the surgeon usually needs to be in their network. Go
in armed to your PCP appointment. I was very lucky my PCP was
supportive(actually thrilled)but some aren't. I don't have any co-morbities
but my BMI is sky high and I have a strong family history of fatal diseases
some triggered by weight.
4.After your PCP sends a referral you usually have to fill out a
questionaire to the hospital and then the surgeon's office will contact you
and schedule appointments. I'm going for my first pre-op tests 12/2/02 and
I'll probably have surgery 1-3 months after.
Hope that helps you! Feel free to E-mail me-I also joined a local WLS
support group that meets once a month. Most are post-ops but anyone can
join. I can give you more details. Take care :)
— mzcath
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