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5. Hoops


By now you’re probably wondering what hoops you have to jump through to have bariatric surgery. I can’t emphasize this enough: Your Insurance Dictates Everything. Unless you’re paying out of pocket,  you have to meet the requirements set forth by your insurance company. The information below are the requirements I have to fulfill to have my surgery covered, and I have no idea what those requirements might be for anyone else.

  1. Medically Supervised Weight Loss. For insurance purposes, I am required to complete a supervised weight loss program for 90 days consecutively with a physician or dietitian. The first and last visit must be 90 or more days apart, and there must be one visit each month. In addition, my doctor requires what they call a “comprehensive nutrition seminar” with their own dietitian. I cannot gain weight during this period.

  2. So far, I’ve found this helpful, as I was given a lot of information up front to know what foods I can/cannot have before and after the surgery. See post #6 for full details on the nutrition guide.

  3. Psychological Evaluation. I had to be cleared by a psychologist as a safe candidate for a procedure. The doctor’s office gave me a few doctors to choose from, or I could choose an online (video) visit.

  4. This part scares a lot of people. As a long-time therapy patient, I wasn’t too concerned, although I was a little preoccupied with what to expect. I found the evaluation to be brief (about 20 minutes, although it can take an hour) and pleasant. The goal of this evaluation is to find out your weight loss history, what you’ve already done to prepare for surgery (e.g., changing habits, emotional self-maintenance), and what your support network looks like. My take on bariatric surgery is that it’s not just a physical change. There are a lot of psychological and emotional changes that happen, and you need to be ready to deal with them. If the psychologist feels that you aren’t ready to make the necessary changes or don’t have any support, they may deny you for the time being and provide suggestions on how you can prepare.

  5. EGD. Also known as an endoscopy, an EGD is required so the surgeon knows there are no pre-existing conditions that will increase your risk during surgery.

  6. My doctor’s office scheduled the appointment for me at their hospital.

  7. 24-Month History of Obesity. My doctor had to send them two years of documentation of my height and weight.

  8. Pre-Op Class. In this class, they will provide information so I can understand what to expect the day of surgery and afterward.

  9. EKG. They provided an order for an electrocardiogram without abnormalities within one year of surgery.

  10. Since I’m already under the care of a cardiologist, and can take the order to my next appointment with my cardiologist to have it done.

  11. Labs. They also provided an order for a whole slew of bloodwork that must be done within 90 days of surgery.

  12. Medical Clearance by Primary Care Physician. This needs to be provided within 30 days of surgery.

  13. Pre-Surgical Appointment. Must be within one week of surgery.

And there you have it! Some of this has been done, but most of it is coming up. Stay tuned!


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