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  1. #1
    Gastric Sleeve Member VSGtheNP's Avatar
    I have not had a gastric sleeve.
    Surgery date
    07/12/2018
    Surgeon
    Dr. Chandra Hassan
    Join Date
    Oct 2017
    Last Activity
    11-04-2018 09:53 PM
    Location
    Illinois
    Posts
    40
    Said "Thanks" 22 Times
    Was Thanked 19 Times in 16 Posts
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    Blog Entries
    2

    Default New Insurance Requirements for ME....WHAT?! :-)

    Hope everyone is well. I just wanted to share my experience thus far.

    In November 2017, I decided to attend a Bariatric Info Session. In December 2017, had my first weigh in, met the surgeon, and first nutrition visit. I was automatically switched to County Care Health Plan and the following are specific requirements for bariatric surgery:

    6 nutrition visits (NO referral needed)
    Cardiac stress test
    EKG
    CHX
    Pulmonary test
    Endoscopy
    CBC / CMB
    Sleep study

    I had the option to select my own health care plan if I did not want County Care Insurance. Therefore, I researched and compared plans based upon the services/co-pays/hospitals/physicians and in January 2018, I selected Illinois Blue Cross Community Health Care. I just called the insurance coordinator to confirm if I needed a referral for the psych evaluation. The coordinator explained, as of 2018 Blue Cross Community Bariatric requirements are:

    6 nutrition visits (no referral neeed)
    psych evaluation (no referral neeed)
    letter of medical necessity
    1 support group meeting (surgeon requirement - I attended three)

    WHAT?!!! THAT'S IT!? I was still crossing off requirements based on my previous health insurance. So, in two weeks (same day appointment) I will have 6th nutrition visit, pysch evaluation, surgery date, and finally weigh in prior to insurance submission. Quite sure surgeon wants a cardiac stress test. Absolutely no problem. I did have blood work, ekg, barium swallow, physical therapy, and a sleep study. I was diagnosed with mild sleep apnea. I asked the coordinator if the sleep apnea will deter the surgery date. She said the anesthesiologist will review the sleep apnea results and determine if further measures need to take place.

    So my final stats and comorbidities are:

    Ht: 4'11"
    HW: 225.6 (BMI 45.6)
    CW: 213.8 (BMI 43.1)
    mild sleep apnea
    high cholesterol
    back pain
    knee pain

    I really wanted to post in the event someone in IL may have the same insurance and seeking answers. Although I highly recommend contacting your health insurance representative and obtain updated and accurate information for your concerns. Thank you for reading my rant. I wish you all success and infinite happiness throughout your journey.



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  4. #2
    Gastric Sleeve Member Stacey03's Avatar
    I have had a gastric sleeve.
    Name
    Edie
    Surgery date
    11/07/2017
    Surgeon
    Dr Phil lockie
    Join Date
    Oct 2017
    Last Activity
    04-27-2019 09:56 AM
    Location
    Australia
    Posts
    1,961
    Said "Thanks" 854 Times
    Was Thanked 1,179 Times in 902 Posts
    Said "Welcome to Gastric Sleeve" 0 Times
    Blog Entries
    34

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    Very best of luck on your journey :-)


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  6. #3
    Gastric Sleeve Member VSGtheNP's Avatar
    I have not had a gastric sleeve.
    Surgery date
    07/12/2018
    Surgeon
    Dr. Chandra Hassan
    Join Date
    Oct 2017
    Last Activity
    11-04-2018 09:53 PM
    Location
    Illinois
    Posts
    40
    Said "Thanks" 22 Times
    Was Thanked 19 Times in 16 Posts
    Said "Welcome to Gastric Sleeve" 425 Times
    Blog Entries
    2

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    Thank you very much Stacey03.



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  8. #4
    Gastric Sleeve Member AnnieG's Avatar
    I have had a gastric sleeve.
    Name
    Annie
    Surgery date
    10/05/2017
    Surgeon
    Dr. Ryan Heider
    Join Date
    Oct 2017
    Last Activity
    11-29-2020 11:18 AM
    Location
    NC
    Posts
    1,572
    Said "Thanks" 3,565 Times
    Was Thanked 1,143 Times in 760 Posts
    Said "Welcome to Gastric Sleeve" 271 Times
    Blog Entries
    2

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    You're on your way! Congratulations! And yes, everyone has to watch their insurance!
    [I]HW: 240 lbs SW: 199 lbs GW: 140 lbs

    1 MO = 167.0 2 MO = 156.4 3 MO = 148.4 4 MO = 140.6
    5 M) = 136.0 6 MO = 130.0
    1 YR = 122.0 2 YR = 140.00 2.5 YR = 139
    Happy with my weight; happy with my size; over-the-moon with my health!

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  10. #5
    Gastric Sleeve Member VSGtheNP's Avatar
    I have not had a gastric sleeve.
    Surgery date
    07/12/2018
    Surgeon
    Dr. Chandra Hassan
    Join Date
    Oct 2017
    Last Activity
    11-04-2018 09:53 PM
    Location
    Illinois
    Posts
    40
    Said "Thanks" 22 Times
    Was Thanked 19 Times in 16 Posts
    Said "Welcome to Gastric Sleeve" 425 Times
    Blog Entries
    2

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    Thank you AnnieG. I am excited and nervous, however, and making sure I am mentally and emotionally prepared for this journey.



  11. Gastric Sleeve Surgery With Weight Loss Agents
  12. #6
    Gastric Sleeve Member
    I have had a gastric sleeve.
    Surgery date
    10/07/2013
    Join Date
    Sep 2013
    Last Activity
    Yesterday 02:29 PM
    Posts
    4,662
    Said "Thanks" 1,091 Times
    Was Thanked 3,657 Times in 2,237 Posts
    Said "Welcome to Gastric Sleeve" 164 Times

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    You are lucky to have insurance, many of us didn't. All those hoops will be worth the money you will save. Best of luck to you!


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  14. #7
    Gastric Sleeve Member VSGtheNP's Avatar
    I have not had a gastric sleeve.
    Surgery date
    07/12/2018
    Surgeon
    Dr. Chandra Hassan
    Join Date
    Oct 2017
    Last Activity
    11-04-2018 09:53 PM
    Location
    Illinois
    Posts
    40
    Said "Thanks" 22 Times
    Was Thanked 19 Times in 16 Posts
    Said "Welcome to Gastric Sleeve" 425 Times
    Blog Entries
    2

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    Hi Sraebaer. I am truly blessed to have insurance whether state or through employment. I purposely scheduled a check-off list and attended each appointment, nutrition visit, diagnostic exam, physical therapy, and support group. I have a binder with every scheduled appointment, meal, exercise, referal, exam results, personal note and medications consumed that I carry with me to each visit including my PCP.

    I was adamant about meeting the requirements for my previous insurance and not missing an appointment and I did not realize there may have been different requirements for the new insurance. I just wanted to keep everything well organized with complete and accurate updated information throughout the six months pre-op. I thank God for this blessing. I will prepare my post-op binder and supplies next week.



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  16. #8
    Gastric Sleeve Member Christie13's Avatar
    I have had a gastric sleeve.
    Name
    Christie
    Surgery date
    11/03/2016
    Surgeon
    Dr. Wright
    Join Date
    Nov 2016
    Last Activity
    09-12-2019 04:13 PM
    Posts
    5,169
    Said "Thanks" 978 Times
    Was Thanked 2,940 Times in 2,192 Posts
    Said "Welcome to Gastric Sleeve" 1,465 Times
    Blog Entries
    97

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    That is awesome! Looks like you will be getting a surgery date soon! Yay!!!
    PS-I'm 4'11" too!



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  18. #9
    Gastric Sleeve Member VSGtheNP's Avatar
    I have not had a gastric sleeve.
    Surgery date
    07/12/2018
    Surgeon
    Dr. Chandra Hassan
    Join Date
    Oct 2017
    Last Activity
    11-04-2018 09:53 PM
    Location
    Illinois
    Posts
    40
    Said "Thanks" 22 Times
    Was Thanked 19 Times in 16 Posts
    Said "Welcome to Gastric Sleeve" 425 Times
    Blog Entries
    2

    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    Christie 13 thank you. I love being 4'11". I can't wait to wear heels too. I haven't had on a pair of heels in about 10 years. Although I did wear platforms last summer and fell as soon as I took the first step off the porch. No, I haven't put platforms since that unfortunate tumble.



  19. #10
    Gastric Sleeve Member SoniaSouth's Avatar
    Join Date
    Sep 2020
    Last Activity
    Yesterday 06:38 AM
    Location
    Victoria Mornington
    Posts
    63
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    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    I hope that your surgery went well and you are happy now. You are indeed very lucky to have insurance, many people still have this problem. The medical system in the US is too expensive. Therefore, I don't know how people without insurance deal with those prices. Also, I heard about HL7 which is a set of international standards used to provide guidance with transferring and sharing data between various healthcare providers. Besides this feature, I hope that soon, our healthcare will improve and help people in need and those without insurance.

  20. #11
    Gastric Sleeve Member Williamrush's Avatar
    Join Date
    Apr 2021
    Last Activity
    04-22-2021 09:07 AM
    Posts
    15
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    Was Thanked 1 Time in 1 Post
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    Default Re: New Insurance Requirements for ME....WHAT?! :-)

    how are you doing right now?

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