FitatFifty

Congraulations on considering weight loss surgery and welcome to the forum. The members are great at sharing information, so I'm sure you'll find answers to your questions. I have thyroid issues too (on full replacement with levoxyl) adn will have the sleeve sometime before the end of the year. I too am curious what others with thyroid issues may have experienced. To our good health-- Fit

CONGRATULATIONS to you all with your success!! A big WOOO HOOO from Washington!

I thnk lurking is a prerequisite to posting! Welcome and I hope you receive your approval quickly! Sounds like you're ready to go. I"m in that process too, I'm approved but likely won't have the surgery until December because of work comittments. Fit

Britt Big thank you for posting your letter on your blog. I used your format with my appeal letter (5 pages of argument and research as to why SG is not investigational) and was successful getting the denial overturned. My surgeon also wrote a letter stating sleeve was medically necessary because I have celiac sprue. It was a one-two punch! Thanks again, and I wish you success in your efforts! Fit

Thanks Mini We Northwest gals have to stick together. I'll know more on Friday about my surgery date. Exciting times! I hope all is well with you and your journey! Fit

Thank you all for heartfelt congratulations! I meet Friday with my surgeon to discuss dates...likely late November for me because of my work committments. Thanks everyone!! Fit

Thanks so much! I've been working on this since February 2010 and it is great to finally have the insurance resolved

Hang in there Carrie! I'd be worried about you if you weren't nervous about the surgery. I can't speak from my own experience, but a friend of mine was sleeved about 8 months ago and it was a pretty straightforward experience for her. Good news too--I won my appeal with Premera BCBS--based on medical necessity. A revision would seem to fit that ticket. Good luck and I'll send good thoughts your way- Fit

This is an update to my post of 8/21/10 in this forum. Today, I received a letter from Premera BCBS overturning thier denial of the sleeve. Thier decision to overturn the intial denial is based on medical necessity because I have Celiac Sprue. If anyone wants a copy of my letter, I'll be happy to email it to you. My new surgeon wrote a great letter, and I meet with him this Thursday. I must admit I'm a little overwhelmed with the news! Never give up! To our good health- Fit:thumbup1:

You can also contact your state insurance commissioner's office for assitance if you still have difficulties with your provider. Good luck!

Carrie I'll keep you posted on how my appeal proceeds. Both my doctor and I wrote persuasive letters based on sound research--especially his! Hopefully, not only Premera, but the other insurers out there will see the light soon. Cheers! Fit

Hope you're feeling better soon. Fit

Thanks Mila-- I'm glad I moved on too! I'm trying not get my hopes up, but Premera has not yet issued a denial letter (the last one was quicker than lightening!!), so I know they are at least reviewing my case. Fit

I used the U.S.National Library of Medicine's website when researching my appeal and found it quite useful: www.ncbi.nim.nih.gov/sites/pubmed If you have difficutly, go to pubmed.gov The site provides articles in abstract form -- great for your letter. Good luck Fit

Greetings all- I submitted my first level appeal with Premera BCBS recently. My appeal adventure resulted in a change of surgeons for me. My initial surgeon, who I was referred to and is well-known in our locale for skills, according to the office staff, would not participate in my appeal. This included an unwillingness to read my letter to simply ensure I was not overstating conclusions found in medical journal articles. I found this attitude unsettling...was I just $$$ in the door--what about after my surgery?? Long story short, with a little research, I located another surgeon closer to my home--and just as highly skilled. Without revealing my story to his office staff, I asked the staff what support if any, they provided for insurance appeals, and she reeled of a list of assitance, including a letter from the surgeon. Since you've been patient and read to the end of my story, the moral of the story is that it pays to switch doctors. My new surgeon wrote a killer letter on the medical necessity of the sleeve for me, I am so much happier dealing with this office, and my husband prefers the new surgeon to the old.:scared0: And for those of you just getting started...be sure to ask what type of assistance the doctor and her or his staff will provide should you need to appeal. Stay tuned, I'll let you know how this turns out! Finally, I'd like to thank all of you who have generously posted thier appeal letters on this site. If I am successful with mine, I too will post it. Maybe you'll recognize a little of yourself in my letter!! To our good health-- Fit

Tom I too am with Premera BC and was initially told they would cover the VSG. However, like others who posted replies, Premera denied my request while approving me for gastric bypass. I am in the process of my level one appeal and have found numerous studies supporting VSG. Go to pubmed.gov and search for lap band revisions or sleeve gastrectomy. You will find numerous studies released since Premera revised its medical policy in November 2009. You didn't state the reason for the denial, but focus on that reason and show them with studies why teh denial should be overturned. Also, I noticed that Premera has revised it policy several times in November, so we may receive an update soon. If Medicare makes the leap, then other insurers are soon to follow. Hang in there! We can work together to solve this issue. Feel free to contact me by email. Catherine (aka FitatFifty (ok I'm trying!))

Once again Tiff thanks for the great information!!:001_rolleyes: Catherine

Hi Looking Up I have sleep apnea and have been on a CPAP for 5 years. I have never experienced the terrible symptoms you have from using my machine--in fact my ears and sinuses hurt when I don't use my machine. My setting is 8 for my machine (Remstar with humidifier). You may want to consider getting a copy of your test and seek a second opinion. The key to resolving sleep apnea is using the machine--and that isn't going to happen if your doc doesn't adjust your machine. Good luck- Catherine

Thanks Lee. Did your doctor recommend the sleeve for you because of the possiblity of Celiac? Catherine (aka FitatFifty)

Thanks for posting all this information. My biggest question is what will life be like 2-3 years out! It's helpful to read how other's are doing and what it takes for maintenance. I'm getting closer to making it happen!

Anyone out there with Celiac disease who has been sleeved? Interested to hear your story and/or challenges.

:biggrin0:Congratulations! I am in the process of making my decision and have also been lurking the forums for information!! This site has been so helpful. Everyone's honesty about the process has helped me to make and informed decision. My husband is supportive, as are the friends that I've told. I will have my nutrition and psych evaluation over the next 10 days...then we'll see how I fare with the insurance folks. Great to hear from the folks who went to Mexico for thier surgery--sounds like a good experience.

I agree with JeepChick and Tiffykins. I am contemplating VSG for myself and when I asked my surgeon how many sleeves he'd done--the answer was 15. But he's also done over 700 bypasses, which demonstrates to me he has the expertise with the stapler.