lisahg

Hey Amy, How are you feeling and doing?? I hope all went well on surgery day. Like others have said the drain removal isnt too bad and whatever pain you might feel doesn't last long. Just take a deep breath and its over before you know it. The PAs have had so much practice taking them out, their good at it. Have a Happy Easter..

Hey Everyone, About a week ago, I was denied by Highmark BCBS for the sleeve based on it not being medically necessary and appropriate. My BMI is 36.4 with associated Hypertension and Type 2 Diabetes Mellitus. My surgeon did a peer-to-peer review this week but got no where with the physician on the review committee. Based on the fact that the peer review didnt make any progress, what are the chances that my appeal letter will have the denial overturned? I am kind of bummed because I think my chances are not so good now. Thanks Lisa

I had a drain for a week after surgery also. It did cause me more discomfort with each passing day, and if I didnt have the tubing positioned just right it would cause me pain. Many times I just tucked it in my underwear instead of trying to pin it to a shirt, and that worked pretty well. As long as you are not experiencing any weird discharge or look of infection around the incision site, it probably is just a matter of the way your body is reacting to a foriegn object. I couldnt wait to get mine out but considering all of the liquid that draned out, it was probably a good thing it was there.

I felt left shoulder pain as soon as I was awake after my vsg. It was a constant pain not just when i tried to drink. It hurt more than any discomfort from my incisions actually ( so I know what you're talking about) and the only reaon I asked for pain meds while in the hospital. I was told it was a common complaint but doesnt mean something is wrong. In my case it hurt less and less each day and went after a few days.

I had forgotten I had posted one of my appeal letters. I believe it is what I sent for the external appeal. I also sent copies of all of the journal articles and position papers (with relevant text highlighted) I had referenced. Good Luck! I will keep my fingers crossed for you.

Hey I have Highmark bcbs and was denied for the same bmi reason. An independent Review Organization (IRO) who handle external appeals do have the authority to overturn denials if they deem appropriate. That is what happened in my case, so there is still hope..

I drank it straight and then chased it with a bottle of water . It was citris flavored, so made me really thirsty after drinking it. Not great tasting but doable. Much better than that terrible stuff they make you drink for your leak test, Yuk!

It was probably 3 to 4 weeks from the time I got confirmation that the Idependent Review Organization had all the paperwork from me and Highmark.

It is crazy but dont give up! I had to jump through the same hoops from peer to peer - external appeal too with my insurance Highmark BCBS. The Independent Review Organization (IRO) who reviewed my external appeal overturned Highmark's denials and I was approved. You typically get 15 days to submit your external appeal so take your time and write a solid letter and really sell your case. Quote and cite relevant medical journal articles on morbid obesity that support your arguments. http://asmbs.org/ is a great resource. Having the option to appeal to an inpartial (external committee) is a great opportunity because your insurance had no reason/benefit to reverse their decision regardless of what your 1st appeal letter contained. Good Luck!!

I am glad you asked this. I need advise too. I do cardio most days but have noticed sagging in that area as I have lost weight. I think its important to do arm exercises that work on the tricep muscle but I would like to hear other ideas

My first denial was at the end of August and I was finally approved in Mid November. So the process of filing 1 internal appeals and 1 external appeal took just over 2 months. That's not a terrible timeframe compared to some appeals stories I have heard. I would lie, it is hard to wait and for things to be in limbo, with something you want to happen, like yesterday lol. Highmark totally irks me in respect to other things with my health care so i love when I hear they are made to cover services people deserve.

I have Highmark BCBS also. I had a bmi below 40 with hypertension and type 2 diabetes that was controlled with diet. I was intially denied, appealed and denied again before submitting an external appeal. I was finally approved through the external appeal process and sleeved Dec 26th. Sure, it was a hassle and a pain in the *ss but I didnt have the funds to consider Mexico. You are pretty close to the 50bmi requirement. I just wanted to let you know there is hope in being approved going through the appeals process. Highmark is banking on people becoming frustrated and giving up. Good Luck

I am sure you'll really enjoy your new bike. I bought a bike last summer before my surgery to increase my exercise activity options. My town has a pretty nice bike path that travels arounds the town and a college campus. Its been fun getting back into biking. It had been 15+ years since I rode a bike. It was comical when I went to a bike store to try a few out, on a bumpy dirt road in back of the store. I was so hoping that saying about "once you learn to ride a bike you never forget" was true. I was pretty woobley and uncoordinated at first. My 2 sons thought watching their 45 year old mom attempt to ride a bike after so many years was waaaay hysterical. The sales guy said "Why do I feel like this is going to end up on Youtube?" Have fun and dont forget your helmet.

I went home the day after my surgery, but it wasnt until after my leak test so it was early afternoon before I was discharged. I was feeling good and was happy to leave. I am just more comfortable recovering at home as opposed to sleeping in a hospital bed. My surgeon basically gave me the option of staying another night and would I am sure have insisted if I had any trouble like no getting in enough liquids.

Hi I was sleeved by Dr. Hoffman from the Comprehensive Weight Lose Center at Buffalo General Hospital, Buffalo NY. They have a very experienced group of bariatric surgeons and Dr. Hoffman does primarily the vsg's. I would highly recommend him to anyone.

I am glad to hear you are doing well now. You have a positive attitude that will carry you through this time and something great, being sleeved to look towards in the near future.

Once my drain was removed a week post surgery, I started walking on the treadmill for 30min at a 2.0 incline and between 3.0-3.5 speed. I have gradually increased that over the last 4 weeks where now I am using the treadmill for an hour at a 2.5-3.0 incline and 3.0-3.8 speed. My surgeon said to wait until 6 weeks before starting any type of light weights. So in a few weeks I plan to switch things up a bit by adding weight training and using the eliptical for part of my cardio. I usually manage to work out 5 times a week. I feel really fortunate that my recovery from surgery went so smoothly that I felt ready to start exercise fairly soon.

That's awesome! Good Luck!

I had 2 c-sections as well and the recovery discomfort after the vsg for me was much less. Getting up and down out of bed wasnt anywhere as tricky compared to after a c-section. In the hospital after my vsg I used a hot water bottle on my stomach which helped alot and I only took pain meds once and that was for my left shoulder which hurt due to the gas that they pump into your abdomin to do the procedure. It was a weird side effect but I was told it was pretty common. Dont worry. The pain or discomfort is very managable for most people.

I wasnt put on a liquid pre-op diet prior to surgery but my surgeon required me to eat a South Beach phase 1 type diet where you eat only protien and vegs, no fruit or carbs. That lasted about 1 month. Then the day before surgery I was put on a clear liquid diet until the evening when you cant drink or eat anything. I did drink protein drinks prior to surgery to find one I liked to use after surgery.

This is how my appeals process went with Highmark BCBS. Hopefully some of this will help you prepare to appeal if needed. After being denied the 1st time in August 2011 for the sleeve by Highmark because my bmi was below 50 and they considered my request for surgery not “medically necessary”, I began my research to refute their medical policy concerning the VSG as the first surgery in a two-stage procedure for individuals they consider “severely-morbidly obese” +50bmi. What I found was that compared to current standard practices and commonly accepted opinion within the bariatric surgical community, their policy is really outdated. Thus the position statement update, by the ASMBA supporting VSG as a single stage primary procedure. I also had no difficulty finding medical article after medical article concluding the success of vsg for lower bmi patients. In terms of an appeal I feel the fact that Highmark does cover the VSG, albeit only for high bmi patients, is still in your favor because you have a basis for arguing that the 50bmi is an arbitrary number based on current medical data. I proceeded through 2 internal appeals with Highmark which were of course denied before moving on to an external appeal. This involved an Independent Review Organization (IRO). Basically your case is sent out to a panel of impartial professionals who review everything from both sides to make a final determination. If they rule in your favor, Highmark has to pay. I finally received approval as a result of this external appeal in mid-Nov. So the appeals process is definitely slow and tedious. Highmark is betting/banking that you give up by this point. I spent an entire week on google, finding and reading research and medical journal articles to write my external appeal letter because I knew it was my last shot. In my appeal letter, I focused on substantiating my position via the published medical data I found. I addressed their denial reasons point by point including; given my health status, why wls is “medically necessary”, due to personal medical and prescription concerns why the alternative wls (gastric bypass and lapband) weren’t appropriate surgical options for me, how the sleeve is proven effective and even safer for lower bmi patients, and finally the financial advantage for Highmark to approve the sleeve over the gastric bypass or lap band. Everyone’s health status and medical issues are different, so your appeal letter will look very different than mine. The best advise I can offer in writing a compelling one is research for the medical data to refute the specific reasons why Highmark denied your claim and use that data to make citations in your appeal letter to support your position clearly. Highmark nor the (IRO) will care about the emotional reasons why you feel you need the sleeve. I am attaching a list of some of the journal articles I used in my appeal letter. I am sure there are medical articles more specific to your case out there. I would be happy to answer any questions I can. Let me know how it goes. 2.doc

Hey Bananasleever I just got home from the gym and saw your posting from yesterday. I wanted to reply quickly now to say I will write a longer post today about how I approached my appeal that might help you but right now I am off to the shower.Lol Tasherie is correct, ASMBS ( American Society of Metabolic and Bariatric Surgery) www.asmbs.org is a great resource. I used their updated posifion paper Sept. 2011 I believe on the sleeve as part of my appeal letter as well.

Good Luck!!! Sending positive thoughts your way

Good Luck!! Let us know how it goes.

Hi Leona, I cant blame you for skipping the insurance roller coaster ride. My insurance company put me through the paces and then some. I havent been on gastricsleeve.com before but will check it out. I would definitely like to make contact with sleevers from WNY. I dont know of any weight loss surgery support groups in Buffalo because I live too far away to think about attending regulary. But I am sure there must be, due to the fact that there are at least 2 different bariatric surgeon groups just in Buffalo. I have read lots of good things about Dr Alveres. You will be in good hands. If nothing else, going to Mexico would be a great break from the frigid weather in WNY this time of year. Do you have a surgery date yet with him? I head back to Buffalo this Wednesday for my 1 month post-op visit with Dr. Hoffman. I am hoping for a good number on the scale. I really want to be out of the 190s and am holding off on weighing myself until my appointment. Keep me posted on your sleeve journey.