Hi! I'm new and have SO many questions!

[nymom2017]

Hello everyone!! Where to begin?

This is the 3rd time I consider surgery, and this time I intend to go through with it. The first time, I was 21, and did not make it past the seminar. The second time was 3 years ago. I was a little over 300 lbs. I lost enough weight while doing the pre-op requirements that I decided against surgery, and dropped to 190 lbs. However, due to degenerative disc disease, I had to slow down and have gained back 40 lbs.

So, here I am again. I am 31 years old with 2 kids. I walk with a limp due to my back and hip pain. I feel awful all the time. I also have high cholesterol, which I have had since my 300 lb days. Even with diet and exercise during the last few years, it is still high.

My BMI is currently 36. My seminar date is next Tuesday. I'm hoping you guys can help me prepare by giving your opinion on the following:

-Is degenerative disc disease considered a comorbidity? Combined with the high cholesterol, and a BMI of 36, what do you think my odds are of getting approved?

-If my weight drops reasonably during the pre-op preparations, will I get denied surgery last minute?

-I am a smoker. I know I should quit. I have tried and will continue to try. However, if I am unable to quit, or only managed to cut back, will I be disqualified for surgery?

Thank you in advance for sharing your wisdom

[DesertGal]

I'm planning on the surgery in the next couple months. My insurance requires a BMI of 35 with 1 or 2 comorbidities; or a BMI of 40 or more. Also required is supervised diet by the nutritionist and 3 classes. I was weighed at the first class and my stats were written down. Any weight I lose now wouldn't count against me (so the nutritionist told me and the class.) My seminar is next week and I see the doctor shortly thereafter. I don't smoke, but you have to wait six months before surgery under my insurance.

[jamma]

Both my sisters were smokers and were told they MUST quit at least 30 days before surgery and they would be tested and denied if they did not quit. So they did. Both sisters ultimately went back to smoking afterward, but then quit again.

[Connie4]

u need 3 out of 5 things..called metabolic syndrome... look up that. There will be 5 conditions ins is looking for.
1) waist size over 35 inches I believe
2)cholesterol
3) high BP?.... do you have this?
No smoking, very serious about this.
Wish you the best

[BelleKreyol]

Or if you are considering traveling abroad for the surgery and self-pay you won't need to meet as many of those requirements put in place by insurance companies. BMI 30+ and history of struggling with your weight would suffice. Although the type of WLS would be determined based on your health etc. I opted to go to Mexico because I probably could get my band removed by insurance but would likely not get the VSG revision covered.

Belle

[Bufflehead]

Which conditions are considered co-morbidities varies according to each insurance company and plan. If your member benefit handbook does not spell out what the acceptable co-morbidities are, call your insurance company and ask them for written documentation of their list. The insurance coordinator at your surgeon's office should also be knowledgeable about your specific policy (no one here on a message board is) and be able to help you figure that out as well as the weight loss question. Usually the cigarette smoking issue is a policy set by the surgeon rather than the insurance company, but that can vary a lot too. Definitely get with the appropriate people at your surgeon's office and they will help answer all your questions. Good luck!

[Bagawk!]

Hello everyone!! Where to begin?
-Is degenerative disc disease considered a comorbidity? Combined with the high cholesterol, and a BMI of 36, what do you think my odds are of getting approved?

Refer to this linked list for an idea of possible qualifying co morbidities. DDD, depending on your payer's policy and how advanced it is may be considered in your authorization. In my case, it was but I had a couple other conditions/family hx in addition to the DDD.

Hello everyone!! Where to begin?
-If my weight drops reasonably during the pre-op preparations, will I get denied surgery last minute?

Once you are approved, your payer will not be checking on your pre-op weight. You're good to go.

-I am a smoker. I know I should quit. I have tried and will continue to try. However, if I am unable to quit, or only managed to cut back, will I be disqualified for surgery?

I believe the anesthesiologist would have a problem with this and may refuse the surgery based on this alone so you need to be committed to no smoking during the time they specify. I nudge you to discuss that one with your surgeon for a solid answer and be totally honest with him/her. It might not sound important to you but it is a very important factor when a patient is to undergo general anesthesia.

[Christie13]

It's pertinent that you find out the requirements from your insurance company. Every insurance is different. I'd also find out what your out of pocket will be. It may be cheaper (and quicker) to go to Mexico. Smoking is definitely something that you'll have to give up. Good luck.

[nymom2017]

Thanks everyone! I'm really hoping for the best and feel motivated to quit smoking to get this done. I just filled my rx for Chantix and am going to give it another go this month.

[Ann2]

There are some great success stories on this board about people who accomplished great weight losses AND stopped smoking. Needless to say, they're very much healthier than they were pre-op.

Very, very best wishes to you. And welcome.

P.S. The comments above about checking with YOUR insurance company (or having your surgeon's office do that) to find out which and how comorbidities apply to your approval process are spot-on. Someone else's experience / policy may have zero correlation to yours. Again, best wishes.