Damn Insurance (╯°□°)

6 MORE months. Really? I have done 5 years of diets, read all the books the dietitians gave me last time. The problem isn’t that I don’t understand emotional eating and how it affects me. The problem isn’t that I don’t understand portion sizes. food choices or calorie intake but because some idiot putting together the insurance policies decided they could weed out enough people from getting the surgery and save the insurance company money, they decided to delay treatment for an illness 1/2 a year.

I am more than a little bugged. UHC has policies that allow for 6 months ORdocumentation of a diet and exercise plan for 3 months but because the committee that was formed by ADP/CDK to decide bariatric benefits didn’t have anyone suffering from morbid obesity on it.

And so it goes. It looks like there is no other choice if I want to get weight loss surgery. Of coarse I can lose weight without the help of WLS. It is not the solution, it is a tool. But would you frame a house if you only had a spoon available for the next 6 months to drive in the nails or would you wait the 6 months until you could get the hammer?

Weight-Loss Surgery and My Insurance – Episode 1

Here is my first episode, of what I expect to be many, documenting the ins and outs of what it takes to get my insurance company to pay for my weight-loss surgery. Each insurance company has it’s own requirements. I can only provide my experiences with United Health Care (UHC) but hope to provide enough information that it can help others with whatever carrier they are dealing with.

I am fortunate to have a friend guiding me through the process who has experience with UHC and meeting the qualifications for receiving pre-approval for the procedure. This is the documentation my friend provided me from UHC about the requirements.

Something almost all insurance companies are going to require is a history of documented attempts to reduce weight. For UHC, the documentation that was provided and successfully submitted by another person resembled the following example to the right.

I have a very detailed history of my attempts at weight loss and am in the process of summing it up in a journal such as this for submission to my insurance via Rocky Mountain Associated Physicians (RMAP).

After submitting all your information to RMAP, I expect to have to call on a regular basis until I receive approval. According to others who have gone through the procedures via RMAP, it will likely take many phone calls to get the approval required from UHC.

Another requirement I must meet is a psychological evaluation. Tomorrow I will schedule an appointment with my primary care physician and will ask him for a referral so that I can schedule that out as soon as possible.

Moving Forward With Gusto

The informational seminar was exactly what I expected. A lot of information was provided about the different procedures. The seminars are led by one of the 3 surgeons who perform the procedures. My session was led by Steven C. Simper.

Steven C. Simper, M.D., F.A.C.S

Steven C. Simper, M.D., F.A.C.S

After reviewing the profiles of the 3 available doctors, I have chosen him as my my preferred surgeon based on his extensive experience. From a very reliable source, I have been told that his bedside manner kind of stinks compared to the other doctors available but that he is the best surgeon.  I am not interested in hand-holding and am not looking to my doctor to be my source of emotional support. I want the Chuck Norris of surgeons and let’s just say the mustache doesn’t hurt the metaphor.

Gastric Bypass

Gastric Bypass

After attending the required information seminar with Rocky Mountain Associated Physicians I have decided that the Roux-en-Y Gastric Bypass is the best fit for my situation and, among the 4 procedures offered, will serve as the best tool for my weight loss journey. Simper did a thorough job explaining each procedure, carefully listing the risks, benefits and general costs associated with each procedure. I appreciated the direct approach he took in answering questions asked

List of the 3 surgeons practicing through Rocky Mountain Associated Physicians.

List of 4 procedures offered through Rocky Mountain Associated Physicians.

After gaining back the majority of the weight I lost I am turning to weight-loss surgery

It’s 2015. I have been gone from blogging and gone from weight loss. I am 475 lbs now and am looking into weight loss surgery to help me achieve what I had before. I have proven to myself I can lose the weight, now I just need to do it as efficiently as possible without putting the rest of my life on the back burner like I had to last time.

I am attending a meeting tomorrow with Rocky Mountain Associated Physicians tomorrow @ 10am.

This is the information you will get via email after signing up.

Weight Loss Surgery Presentation Invitation Reminder

Dear Patient,

Thank you for registering for Rocky Mountain Associated Physicians Weight Loss Surgery presentation on Saturday August 8th, 10:00 AM.  This FREE seminar is taught by one of our Surgeons, as well as the Education Director.  Together they will discuss FOUR different weight loss surgeries in detail, addressing the risks and benefits associated with them.

The Seminar lasts about an hour and a half.  Feel free to bring along a friend, however, we ask that no children attend.  This is a “no pressure” informational learning time.  Your questions are encouraged.

If you have already decided that you would like to proceed with the surgery and would like to get the process going as quickly as possible, please complete the attached document.  Bring it with you to the seminar, along with your health insurance card, and give it to the education director before the seminar begins.  We’ll then inform you of your next step at that time.

Please let us know if you are unable to attend so that we may offer your seat to another guest.

Directions to our office:

Salt Lake City

Head East on 3900 South to 1160 East (south side of the road)

We are in the NORTH tower of St. Marks hospital

Elevator to the 4th Floor – Right down the hall to the end Suite 4200