If you haven’t read Part 1 or Part 2 of this article series, I would urge you to do so. The previous articles detail my history with weight-related problems, and ultimately why I decided to explore the gastric sleeve procedure.
Following the first meeting with my doctor, I decided that this was something that would give me a better chance at living a longer and happier life. I immediately contacted my insurance company, Florida Blue, and began dissecting the specifics of my health care coverage. After a nearly 40 minute conversation with the representative assisting me, it was determine that my plan did indeed cover weight loss surgery, should the claim be submitted with all of the necessary documentation. It was at this point where I was given a long list of things I would have to do in order to get approved.
First, I had to acquire all medical documentation from the previous three years that detailed my weight, and any weight related actions performed by me or my doctor (i.e. Did I consult a nutritionist, join a gym, etc.). This took me quite a while to procure because in the previous three years I had lived in three different states — NY, TX, and TN. Because I had only seen doctors when I was ill, and hadn’t been regularly getting ‘physicals’, getting the appropriate documentation for Florida Blue was challenging. Eventually though, and after nearly 3 weeks, I had successfully contacted all of the doctors and medical practices I had visited over the past three years, and was able to get all of the documentation faxed to my insurance carrier.
Next, I was required to go see a physician regarding my present health. I needed to get lab work, and a note from my doctor detailing very specific parameters that needed to be met before my insurance carrier would deem this step complete. This process took another week or so; but was eventually completed.
Following this, I needed to schedule an appointment with both a nutritionist, and a psychologist. The point in going to the nutritionist was so that they could more comprehensively detail the specifics of life following the surgery (i.e. How much protein I needed to consume, how many calories, how many ounces of water, etc.). The psychologist only had to determine one thing, which was whether or not I was mentally stable enough to go through this procedure. This took another two weeks to get everything scheduled, and another week following that to get all of the results and recommendations from each doctor.
Some insurance carriers require that the prospective patient be immediately put on a 6-month documented diet with a healthcare professional. This would have required me to see a nutritionist, and partake in a physical exercise program for six months to try and lose the weight ‘naturally’. My particular health plan carrier did not require this; but yours may. If so, add another 6 months to the timeline.
That was it. Now, all that needed to be completed was the review of all of the paperwork, and the insurance carriers approval. After three weeks I had heard nothing, so I called them, waited on hold for 34 minutes, and finally got through. After nearly an hour of research, the informed me the claim had been denied because the operating surgeon did not provide the necessary documentation. I called my surgeon’s office, and they attested that they absolutely sent everything over. So I called the insurance company back, had to get them to re-open the case, and had to get them the information.
Three more weeks passed and I called again. They were still missing some required documentation. I asked what they needed, they told me, I called my doctor, and they sent it over. Two weeks later, I finally got word that I was approved for surgery, and the insurance would cover it.
The process was incredibly challenging, and in the end the only thing I can recommend to you is to stay on-top of both your insurance company and the doctor’s office. Ultimately, you have no idea what either of their competencies are, and you are blindly leaving your fate in the hands of strangers.
Once approved, my doctor’s office could begin the preparatory processes to prepare me for surgery. First, was an extensive round of blood tests, an EKG, x-rays, an ultrasound, and an EGD (upper-endoscopy). Everything went perfectly fine, and the most challenging item was the EGD. It is an outpatient procedure, but you are sedated and require transportation to and from the hospital. The procedure did not cause me any discomfort before or after, and the results came back clean.
It was at this point where I was scheduled for a surgery date of September 30, 2013. Please continue to my fourth article First-Hand Experience with the Gastric Sleeve, Part 4, for an in-depth look at the surgery, as well as how I am faring four days later.