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Found out today that my insurance will cover weight loss surgery if the surgeon & her team feels it's medically necessary... what are the traits that they look for, for it to be deemed "medically necessary?" & other ramblings!
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Hello! I am considering weight loss surgery (probably gastric bypass) for the 2nd time since I (almost) turned 30, but this time I am WAY more serious. The first time was in 2013. I was almost 30 & was going to have lap band. But I didn't follow through with losing weight the 6 months prior to my surgery date so they cancelled my appt.

It is now almost 9 years later & I am rethinking it. I had an upper gi on Friday & when the doc came back (to talk about my results) he looked my mom dead in the face & asked if we've ever considered weight loss surgery for me? My mom explained about what happened the first time & his response was to rethink it. So, I'm rethinking it.

I had an appt yesterday with my pcp about my thyroid & I told her about it & asked if she thought I was a good candidate? I could tell I made her feel a little uncomfortable but she ended up saying yes. We calculated my BMI & it's over 50. I'm 38, 5'10" & 378lbs. My heaviest was 388lbs & I weighed that in February of this year. Not too sure how I lost 10 pounds but I'm glad!

Then, today I called my insurance company to ask if they covered it & if the doctor I chose was in my network, as advised by my pcp. Good news! My insurance covers every penny except for a tiny $3 per night spent in the hospital (up to 7 nights)! I am so glad! I called the surgeons office & made an appt with her team, it's a video call (since I'm almost 2 hours away from the hospital I chose to have the surgery at) so that's just what was more available for me at the time. My appt is in June & I'll just happen to be on vacation then with my family, so I'm thinking about having my mom sit in with me to take notes & be an extra ear.

I figure they'll make me do 6 months of pre op weight loss, to show I can lose & stick to a diet & calorie goal. I am def going to do it this time! I have never felt more ready to change my life for the better! For my entire existence in my adult life (even when I was a kid & teen) I've been morbidly obese. I'm even class 3 on the obesity BMI charts (which is the worst) so I am thinking & hoping that I'll be able to jump through all the hoops they throw at me with ease, prior to the surgery, such as the psych eval & nutrition appts. I read that they could make you have blood work, urine tests, a chest xray, maybe even a sleep study to see if you're ready & truthfully qualify. I honestly don't know how I wouldn't??

I don't have any addictions, I don't drink or smoke or do heavy drugs (I do smoke a delta 8 vape before bed each night, though)! The only addiction I have is being obsessed with a video game I've been playing for 16 years but idk if they'd count that?

I have bipolar 2 disorder, BPD, anxiety & PTSD from my childhood. I have been in the psych ward at least 10 times since I was 21. I used to be a cutter & more recently a burner. But I haven't self harmed in over 5 years. I don't think any of those things would deter them from thinking I was a good candidate? If someone knows otherwise, please let me know! I guess I am just a littler nervous! But otherwise excited for a huge new chapter in my life!

Well, I'm tired & I am rambling but I guess I'm just so happy that I found this subreddit where I'll def feel more understood! I did have a question tho... what are the traits for the surgical team & surgeon to deem my case "medically necessary?" Just curious!

Anyway,, thanks for reading my post :)

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2 years ago