|Note: Benefits are not available for commercial weight loss programs; see page 34 for our coverage of nutritional counseling services.) − Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise − Evidence that attempts at weight loss in the 1 year period prior to surgery have been ineffective − Psychological assessment of the member’s ability to understand and adhere to the pre- and post-operative program, performed by a psychiatrist, clinical psychologist, psychiatric social worker, or psychiatric nurse (see page 85 for our payment levels for mental health services) − Patient has not smoked in the 6 months prior to surgery − Patient has not been treated for substance abuse for 1 year prior to surgery |
Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the following pre-surgical requirements: − Diagnosis of morbid obesity (as defined on page 52) for a period of 2 years prior to surgery − Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (
That is the list straight from my insurance book of everything I had to do before I could even SUBMIT anything to the insurance! Now, I realize that I need to be grateful that I even have insurance that will cover this and I AM, TOTALLY, but, like I said before, once the decision is made, it's hard to wait. The truly crappy part about it was that most of this stuff I had already done over the past 20 years but I was not medically documented so it doesn't count. Well, ya gotta do what ya gotta do, so I took the 2nd step (after the initial seminar) and made an appointment with my GP. We set up a 3 month weight loss plan and he made sure to document every time I came in. During this time I also saw a dietitian, Amy Cain, who was wonderful and very helpful. She gave me a lot of resources and had me keep a food journal for at least 2 weeks. I highly recommend this for anyone trying to lose weight, whether you're having surgery or not. When you write down everything you eat and keep track of calories (there's an app for that!) it really can help you pinpoint some of the problems in your eating habits. So, lets see, we've started the 3 month medically supervised diet, met 3 times with a dietitian, now on to the psyche eval. THIS I was worried about! If they found out how crazy I was, they probably wouldn't let me do it! Really, I'm not crazy, in fact the shrink told me I was one of the best candidates he'd ever interviewed (not surprising, I always ROCK at interviews!) but, honestly I really was doing this for all the right reasons. Having this surgery will save my life. The end. I'm not doing it to look hot in a swim suit (with all this skin, that will NEVER happen) and I'm not doing it to improve my self esteem (those of you who know me, know I already think I'm awesome) and I stopped caring a long time ago what people thought of me physically and I love myself. I'm doing this to see my children grow up and have babies of their own. I'm doing it to stop hurting all the time and I'm doing it to give my family the opportunity to learn, from me, the way to become healthy and happy themselves. Long story short, I passed with flying colors and was highly recommended for the surgery! Finally I had everything (except the last month of the medically supervised diet) and could make the appointment with the surgeon! My mom and I went down to St. Marks, had a little class a mini version of the seminar, and then met with Dr. Smith. He was impressed that I had, at that point, already lost 50 lbs and said he was excited to see my further progress. I was impressed by his bedside manner, most surgeons are cold and indifferent, but Dr. Smith seemed to really listen to my questions and made me feel completely at ease. Yet another sign letting me know I was on the right path. That brings us to 7 weeks ago. Everything was complete (it only took about 4 months of agony) and lovely Paula, the patient advocate at RMAP, was ready to send my file into the insurance! WOOHOO! I was thinking, maybe a week or two and we'd be ready to rock and roll. I was mistaken. 6 weeks later after I called and harassed Blue Cross, I received the phone call from Paula. My heart started to race and all the hairs on my arms stood up, this was IT, it was HAPPENING! 3 hours later I got the phone call to actually schedule the surgery and it was in 2 weeks! It actually could have been sooner but I had stupid training at work and then Dr. Smith was on vacation but it was ok, at least I knew for a FACT that it was happening so the last 2 weeks have pretty much flown by! So, there it is. It's now Saturday, June 18th and my surgery is scheduled for Tuesday the 21st. 3 days away. All this waiting and now it seems to be going in high speed. I am ready. Bring it.