Hello, I'm Jordan

[Jordanwv216]

Jordanw: After a year of the weight managent program, then you can start the process for applying for bariatric surgery? How long will that take; another 6 months, and then you could still be denied? That’s tough. I recommend you start saving for surgery so if you get denied it won’t be a long period of time before you have the funds for self-pay. And if you get insurance to pay for your surgery then you’ll have a nest egg for something else (e.g. plastic surgery).

That's my plan, save for the surgery if my insurance fails me or if they don't I've got money for other things, like plastic surgery as you mentioned. I found someone through one of the bariatric Facebook groups I'm in who dealt with PEIA and I've asked her approx how long she had to wait from the 12 month mark, she said turn around is about 10 days. She however had multiple comorbidities PEIA wants anyone under 50 BMI to have to qualify, currently it looks like I just have hypertension (which I just learned this weekend!)

 

[Jordanwv216]

You can also try to challenge the requirement for a 12 month diet/10% weight loss, with our help (can't guarantee that it will work, but it might):

https://asmbs.org/resources/preoperative-supervised-weight-loss-requirements

There are no data from any randomized controlled trial, large prospective study or meta-analysis to support the practice of insurance mandated preoperative weight loss. The discriminatory, arbitrary and scientifically unfounded practice of insurance mandated preoperative weight loss, contributes to patient attrition, causes unnecessary delay of lifesaving treatment, leads to the progression of life-threatening co-morbid conditions, is unethical, and should be abandoned.
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You would file a request for a waiver of the requirement, along with a letter of medical necessity from your surgeon or doctor saying that the delay has no medical justification, and would in fact likely cause you serious harm by continuing damage from X, Y and Z.

Thanks Diana, would ask for my Doctor to file the waiver or how would I go about starting that process? Thanks!

 

[Larra]

According to Dr. Nease's website, he offers the DS "selectively". I don't know what this means, but there are other surgeons who will only offer the DS to people with a bmi over 50, and some who will consider someone with a bmi below 50 only if they have type 2 diabetes, so you may want to ask about this before you get involved with any particular surgeon.
btw, I've never heard of this surgeon as a DS surgeon, so you should also ask how many he's done, results, etc.
And I do seem to recall someone else who had your same insurance, and they were, as you said, very difficult to deal with, so make very sure you do everything to the letter with your monthly check-ins (exact days, with the right professional) and make sure everything is documented.

 

[DianaCox]

The best thing to do would be to ask your doctor for a list of reasons why it would be better for YOU in particular to have surgery sooner rather than later - health risks, etc. Damage from diabetes, joint damage, cardiovascular risk, etc. Then we (Larra and I) could help draft a letter for your surgeon to submit with a request for a waiver of the diet and weight loss requirement.

 

[Jordanwv216]

The best thing to do would be to ask your doctor for a list of reasons why it would be better for YOU in particular to have surgery sooner rather than later - health risks, etc. Damage from diabetes, joint damage, cardiovascular risk, etc. Then we (Larra and I) could help draft a letter for your surgeon to submit with a request for a waiver of the diet and weight loss requirement.

Okay, sounds like something that definitely wouldn't hurt to try! I see my doctor again April 9th so I'll talk to him about it then. I'll get back with you after that thanks so much!!

 

[hilary1617]

That's my plan, save for the surgery if my insurance fails me or if they don't I've got money for other things, like plastic surgery as you mentioned. I found someone through one of the bariatric Facebook groups I'm in who dealt with PEIA and I've asked her approx how long she had to wait from the 12 month mark, she said turn around is about 10 days. She however had multiple comorbidities PEIA wants anyone under 50 BMI to have to qualify, currently it looks like I just have hypertension (which I just learned this weekend!)

Have you had a sleep study? Many have the comorbidity of sleep apnea prior to surgery.