WeekendWarrior

Looks like they are a bit more restrictive on who they allow to have the sleeve.

Looks like wellmark is covering the sleeve as of today.

LINK

Sleeve gastrectomy, as a stand-alone procedure or when combined with a malabsorptive procedure, may be considered medically necessary for patients meeting the above general criteria and one of the following weight criteria:

•BMI ≥ 40 kg/m2 for at least 3 years

Or

•BMI ≥ 35 kg/m2 in conjunction with one of the following:

◦Hypertension requiring medication for at least one year

◦Diabetes mellitus type 2 requiring medication for at least one year

◦Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment

◦Documented cardiovascular disease

◦Pulmonary hypertension of obesity

AND one of the following:

•History of transplant, i.e., any solid organ or allogeneic or autologous stem cell

•Chronic corticosteroid use

•Anti-platelet therapy, i.e., aspirin, Plavix® (clopidogrel bisulfate), Ticlid® (ticlopidine hydrochloride), Effient® (prasugrel)

•Inflammatory bowel disease

•History of gastritis or peptic ulcer disease

I see wellmark just changed their policy today.

LINK

Sleeve gastrectomy, as a stand-alone procedure or when combined with a malabsorptive procedure, may be considered medically necessary for patients meeting the above general criteria and one of the following weight criteria:

•BMI ≥ 40 kg/m2 for at least 3 years

Or

•BMI ≥ 35 kg/m2 in conjunction with one of the following:

◦Hypertension requiring medication for at least one year

◦Diabetes mellitus type 2 requiring medication for at least one year

◦Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment

◦Documented cardiovascular disease

◦Pulmonary hypertension of obesity

AND one of the following:

•History of transplant, i.e., any solid organ or allogeneic or autologous stem cell

•Chronic corticosteroid use

•Anti-platelet therapy, i.e., aspirin, Plavix® (clopidogrel bisulfate), Ticlid® (ticlopidine hydrochloride), Effient® (prasugrel)

•Inflammatory bowel disease

•History of gastritis or peptic ulcer disease

WeekendWarrior, did you ever hear what the announcement was or if it was made? I don't see any changes in the policy on the Wellmark site, but that hasn't necessarily been updated.

I'm really hoping they would have a timely policy change, hehe.

Thanks!

I haven't heard. I'll try and call the Dr. again next week sometime.

I just called my Dr. office and and asked them if they have heard if Wellmark is covering the sleeve yet.

Their insurance person said that there is supposed to be an annoucement next week some time.

I just called my Dr. office and and asked them if they have heard if Wellmark is covering the sleeve yet.

Their insurance person said that there is supposed to be an annoucement next week some time.

So you might want to start getting your paperwork ready, you could be the first person approved by Wellmark!!!!!!!!!!!!

Wellmark currently will not cover it due to it's "investigational" status. I don't know if anyone has tried to submit to them lately though. Your Dr.s Insurance specialists might know more than anyone.

If you haven't I would start working on the 6 month suppervised diet requirement.

I've lost 60 pounds during my 6 month diet so far, and I am now kind of waffling on if I should continue trying to lose or not.

My BMI was 50, and now it's 41. I can get down to 35 and still be approved as I have several co-morbid conditions.

Yeah!

They finally released a MFP app for android phones!

:eek:

Forgot to add that I needed to go out and buy a new belt, and a new pairs of jeans as I have lost 6 inches off of my waist.

I guess it's time for another update. Four months have passed, and I am down 40 pounds. BCBS still doesn't cover VSG but it is supposed to update their policy in September.

My daughter and I have been walking 30 min. almost daily. A few times on the weekends we have been walking 3 miles in an hours time.

My daughter and I just purchased a couple of bicycles today. Hopefully we can switch up from the walking and get a little more variety in our exersize.

I am starting to wonder what I want to do if I continue to lose weight. Should I continue with the diet and not get the surgery?

I know I've failed on countless other diets, but this time we have been tracking our calories on myfitnesspal, and it's made a huge difference. I now see how easy it was to eat a little bit of this and a little bit of that and hit 2 to 3 thousand calories a day.

Well I'll report back again here in 2 more months. Hopefully i'll be down 60 pounds and we will find out if Wellmark BCBS will be covering the sleeve.

I really like myfitnesspal. It's got about every food know already in the database, and is easy to add stuff if it doesn't.

It also allows you to save whole meals, and add all the items at once, and then tweak the quantities or remove things. You can also enter your recipes using the food database and it will calculate the calories.

It also will track your excersize and calories burned.

I've been using it for my 6 month diet, and so far I've lost close to 40 pounds in 3.5 months.

It also has an iPhone app if, and best of all it's all free!

Your body can synthesize glycogen from fat, complex and simple carbs and Protein, but you body can not synthesize Protein. If your protein intake is too low, then your body will canabalize your muscles including your heart to get the required protein.

Most sleever's eat from 60 to 100 grams of protein a day. 100 grams of protein is only 3.5 ounces, so you would be a long long way from getting any sort of protein poisoning on a normal sleeve type diet.

The whole reason they tell sleever's to eat "protein first" is if you don't, you will be full and not be eating enough protein, so too much protein is usually impossible for a normal sleever to get.

If a high protein diet is causing kidney problems, you need to see your Dr. ASAP as this is a sign of kidney failure.

As with all forum advice, take it with a grain of salt or a Protein shake, and please ask your Dr. if you have any serious issues.

You would have to eat 6 pounds of rabbit and nothing else for weeks on end to get Protein poisioning aka rabbit starvation. As long as you eat some fat and carbs you should be OK. I would also doubt an obese person would get it due to them having fat stores to live on.

Surgical staples are made of titanium which has a low electrical signature which is very difficult to detect with a metal detector.

Secondly if the detector were set so sensitive as to detect the tiny amount of metal in these staples, your zipper in your jeans contain more metal and would set it off before the staples would.

Some employers have an open enrollment period where you can change insurance coverage and avoid any pre-existing conditions.

Some states also exclude any pre existing conditions as long as you have continually been covered by health insurance.

I've read that Soy can interfere with the absorbtion of thyroid medication for people with hypothyroid conditions.

Calcium suppliments can also interfere with the absorbtion of thyroid meds also.

Here's a list of some items thought to interfere with thyroid meds.

Walnuts

Soybean flour

Cottonseed meal

Iron supplements or Multivitamins containing Iron

Calcium supplements

Antacids that contain aluminum or magnesium

Some ulcer medications, such as sucralfate

Some cholesterol-lowering drugs, such as cholestyramine and colestipol

Hypothyroidism diet: Can certain foods increase thyroid function? - MayoClinic.com

Hypothyroidism: Can calcium supplements interfere with treatment? - MayoClinic.com

Soy: Does it worsen hypothyroidism? - MayoClinic.com

I am pre surgery, but I read the forums daily. I don't post a lot.

I did some searches of some other BC/BS and it looks like bad news for Regence of Oregon, Utah and Idaho.

Bariatric Surgery

They updated their policy as of 5/1/2010 and still consider VSG investigational.

Arkansas updated in march and still considers it investigational.

Coverage Policy Manual - Arkansas Blue Cross and Blue Shield

I believe there are over 39 different BC/BS companies, and they each have their own WLS policies.

You also have policies that differ between employer's. The insurance company may cover a procedure, but your employer may "opt out" of WLS coverage.

I've talked to Iowa Wellmark 3 times and received different responses depending on who I talked to. Their current official policy is that VSG is investigational and not covered, but your particular brand of BC/BS could be entirely different.

Appeals are another topic. These can differ from state to state. Lots of it depends on if your company has an indemnity type policy where the insurance company pays, or a self funded plan where the employer pays, and the insurance company just manages the policy. I've heard the state of california insurance appeal board almost always finds in favor VSG appeals where some other states almost never finds in your favor.

I had to talk to one of the insurance reps who specialized in bariatric surgery as the general insurance reps thought it was covered when it wasn't.

I think within the next year though that a majority of the BC/BS companies will start covering the procedure just because it's a much much cheaper option in the long run than any other procedure.

Most sleep center's will let you exchange your mask after a few weeks. I've tried several and only like the nose mask type. I like the nasal pillow type, but I always seem to knock it lo0se as I tend to roll from side to side as my low back pain doesn't allow me to sleep on my back or sides for more than 30 minutes at a time.

I won't even take a nap now without it.

If you aren't already doing it, I would join a food tracking site like myfitnesspal and log EVERYTHING you eat and drink.

It's amazing how much stuff can sneak into your diet if you don't pay attention.

I was probably adding an extra 1200 calories a day just grazing on Snacks between meals before I started to track everything.

I also think carbs can cause a rebound hunger to occur when your blood sugar levels spike and then crash.

If you stick to the Protein first and try to avoid carbs it should kick start your weightloss and help with the hunger.

I started out playing asheron's call, and played that until the beta of AC2 played that until release. I then got into the beta for WOW and played that until after the release of burning crusade. I also was in the beta for Lord of the rings online. I played it for about a year after it came out.

I really haven't played any online games since. I really love to play, but they can become like a 2nd job.

I started my 6 month Dr. assisted diet 2 months ago, just after my last update.

So far I've lost 20 pounds. Just losing 20 pounds has helped my back pain a lot.

I've been using myfitnesspal and pretty much pre plan what I am going to eat each day. My daughter monitors my progress so I can't cheat.

I started at 1840 calories a day and currently at 1720 per day now due to my 20 pound loss.

My daughter and I have started walking every day. I had problems just walking the 2 blocks to the local park. Luckily they have benches all along the way and I could sit and rest several times.

The last couple weekends we have walked 3 miles non stop on Saturday and Sunday. I was pretty amazed I was able to walk that far.

My 6 month diet will be done in September, and I am hoping that Wellmark will also update and approve the sleeve at that time. They last updated their policy in September of 2009, and they update it at least once a year, so I am pretty confident they will start approving it by then.

So 4 more months to go.

I have a digital scale and it pretty much reads the same as my Dr. expensive scale.< /p>

The instructions for it says that you must calibrate it if you move it.

To calibrate mine you must step on the scale, and then quickly step off. It will read 0. You then wait for it to turn off, and then step on it again.

Mine was doing the same sort of thing until I read the manual and figured out how to calibrate it. It also states to use it on a hard surface only, so I use it on the hardwood floor.

I pretty much do the calibration every time I weight as I don't know if someone has moved it or not.

It's still considered investigational according to their current policy.

Here's a link to their policy.

Bariatric Surgery for Morbid Obesity*

I have also heard they are currently reviewing their policy. I am hoping they join all of the other companies that are covering it. I am pretty sure they will as it saves them money in the long run.

I started my 6 month diet last month. I am still unsure if a full 6 month supervised diet is required as I have had conflicting information. I've called wellmark 3 times and never get the same answer twice in a row.

I did find a form the Dr. must fill out stating you have tried a supervised diet, but it doens't list any timeframe.

http://www.wellmark.com/Provider/CommunicationAndResources/PDFs/P5341_PhysCertMorbidObesity_IA.pdf

I haven't really decided on a surgeon yet either. I don't think anyone in the Des Moines area has done more than 12 last time I heard. I am thinking I would be much more comfortable with a surgeon who has a few hundred.

I know quite a few people have gotten other BC/BS companies to approve if they need to take NSAIDS, so if they are still not approving it by the time I have my 6 month diet done, I will try and appeal and get it approved on that basis.

Send me a PM if you hear anything!