happy1957

I was denied because of a low BMI in 2009 when working with a trainer. I had started out the year at the correct BMi and my only weight reference is the on line weight chart where I started the guided diet and training and it ended abruptly when I stopped. I had lost enough weight to fall to a BMI of 32. I quickly regained the weight, but all they see is the 32 BMI. :-( AETNA) I would like to improve, high blood pressure, recent high blood sugars, high cholesterol, joint pain, strong family history of diabetes (death of dad) and stroke, death of brother and mother (who is institutionalized) . I appreciated your help... any suggestions is great!!

Hello VSG Talk. I have been here for nearly a year now, first lurking, then excited as my journey unfolded and hanging out quite a bit. Then after my first insurance denial I slowed down on my visits. I appealed and was denied a second time and haven't stopped by at all. My surgeon has appealed yet again and this coming Tuesday the 13th I am scheduled for a second and final appeal. I have been invited or a representative to join the meeting (impossible due to distance) or via phone conference. My surgeon has no offered to join in and has wished me luck. I assume that means I'm on my own. Has anyone here joined in on one of these appeals? What is it like? Should I be prepared with anything other than my records? The letter said NOT to be intimidated and I'm usually not, but telling me NOT to be, is like saying don't eat or want that cupcake. Help.............

Congratulations...... I do not have BCBSIL, but my 3rd request to Aetna was mailed out yesterday. I am hoping for a very Merry Christmas approval. :-) You have given me hope... I wish you the best of luck with your surgery.

Congratulations to all that have been approved. Aetna has denied me yet once again for that one low BMI in 2009. I will appeal again and hope that my documented weights at the beginning of the year when I was heavy and had started the training program will be enough, if not, I have to wait 6 months and start the entire process all over again. So I guess stay fat, wait another 18 month before doing something about it.. Doesn't that seem insane?

I suspect that celebs have all the money in the world to travel the world where this surgery has been going on long before it ever hit the US. So they can travel, vacation, hide their identity and pay for silence. I honestly think that only time will tell. Kirstie Ally is pretty old to be losing such a substantial amount of weight "again" in such a short amount of time. Her success will reveal the true answer as we all know, the chance of successful weight loss and keeping it off is about 2.5% and she has given it a heroic effort many times over. Again, health is the real issue and if it can be done and kept off in a healthy manner, fabulous!!! If I had the financial backing, I would fly to the ends of the earth to have this done. I am so envious of all of the successful sleevers here. I enjoy reading and seeing your successes... Thanks to all of those who share.

I too have Aetna... My BMI was right at 40, I was denied because I lost weight in 2009 and fell below the 40 BMI, my co-morbidities are high cholesterol/ high blood pressure/ and reflux, which are not considered true co-morbidities to Aetna. I am appealing the decision based on prior weights of 40 BMI's in 2007 and 2008, but that one low year, although it is close to 24 months., still isn't the 24 consecutive months needed. My experience has been nothing but negative with Aetna, from lost documents, to miss filed documents to lack of returned phone calls etc. They are hoping I go away. If I am denied this time. I will go direct to the the state Insurance commission to file the next appeal. I hope your experience is better..Never give up!!

I am writing this with complete sincerity. I am so overwhelmed by your progress, you are beautiful!!. I personally have been denied by my insurance, but you give me hope and inspiration to proceed with my appeals. You should be so proud of yourself and the hard work you have put in. You look amazing and I can read how confident you feel, you're just beaming with pride. I am also amazed with your hair, it actually looks thicker. With a huge weight loss in such a short period, you would suspect some thinning, did you experience that, if not, did you do anything to prevent it? Keep up the good work and keep wearing that beautiful smile!!

You look fabulous! Keep up the good work. Spoil yourself and buy a special (show the world) outfit for the holidays. I am soooooo envious. :-) Be proud of your accomplishment.

I can relate and feel your pain. I too was denied, although by Aetna last month after 7 months of hoops. They denied me based on my lower than required BMI of 40 in 2009 while working out with a trainer and dieting. God forbid you show that you have sincerely tried. This was addressed in a letter beforehand but they ignored it . I am still waiting for my surgeon to do a peer to peer . I meet all other requirements with the exception of the 24 month continuous 40 BMI. I was ok in 2008 and 2011, had no documentation for 2010, but 2009 killed me. Next stop INSURANCE BUREAU!! Don't waste your appeals by yourself. God to your states insurance bureau and get an advocate, it may help. Good luck..

I feel your pain, I too was denied by Aetna this month. They pay for the sleeve under my plan, but it's because I had dieted in 2009 and was below the 40 BMI I needed to prove for 24 consecutive months. Although my weight was clearly above the 40 BMI in 2008, partially 2010 and currently. Will your plan for RNY? Have you given that thought? I am sick thinking I have to remain this weight for a few more months to pacify their needs when they have 23 years of weight records that clearly show my roller coaster weight history of cycle dieting. It is disheartening. They are hoping you will just go away, but don't give up. Write a nice letter of appeal, being heard but not over bearing. You never know what could happen. I wish you the best of luck!

Be proud of your success. You look great and I'm sure even feel better. I assume your life has changed now that you are free from those pounds and can do things you haven't been able to do in a very long time. You look radiant. Keep up the good work, I hope one day my insurance approves me and I can be right there with you.

I met the current Aetna requirement of 40 on my insurance, but it had to be steady for 24 months so I was denied. I had of course dieted during that time and fell below. I need to maintain the 40 until next year, but will appeal.

This is a very serious and important message to everyone. My sister who was sleeved on 08/30/11 without any prior complications or red flags, nor any surgical complications was told that a tiny tumor was found on the portion that is sent off automatic for pathology evaluation. Her pathology results came back two days ago and unfortunately it was a very rare form of stomach cancer, not seen inside the stomach during the required pre-EGD, but as a tiny bump on the outside of the removed portion the stomach. Her sleeve was LIFE SAVING in more than one way!!! Had she not had the Sleeve, this cancer could have been been devastating before it reared it's ugly head. She has many things to overcome on her journey, hopefully all will be ok. If you're at all curious, http://www.gistsuppo...hat-is-gist.php, The photo of the removed stomach is amazing. It looks like they ate a full course meal.

What exactly does 5500.00 cover? Air fare? surgery? Complication insurance? A massage boy? :-) I was just denied by my insurance, just curious, I am still planning to fight the battle.

At this point my Dr will do a peer to peer appeal and I'll hope for the best. If my track record of cycling with the same 30-50 lbs every 3 years isn't going to fly, then I guess I die fat or hope for an anonymous donation for a Mexican trip... I will also get a good nights sleep and maybe chat with the insurance bureau on how to be my own advocate in the appeals process. I am not ready to quit yet. No need to worry, I have absolutely no control! :-( It's my party and I'll cry if I want to ....

Don't wish for a fast response. My information was submitted on Monday to Aetna and I have already received my answer today. My VSG was DENIED!!! I was under 40 BMI in late 2008-early 2009 when working with a trainer and dieting which was just one of my many successful cycles of dieting, exercise but without successful retention. Just another bump in this journey. Had I known the road would be so rough, I would have spent the extra money on some good touring tires.

Hate is a strong word. Kids can make you crazy at times but there is no greater love than the love of a child. Yes, they hate you from age 15-25, but after that, it's another renewed, kinder, stronger, more appreciative love that comes back to you. Don't knock it until you try it. I too had just dogs for ten years before a child, there is absolutely no comparison.

Thank you to all that have replied to this post with genuine concern!! It looks like I am fine. I met with my surgeon today who said that all the biopsies came back normal without any dysplasia or Barrett's. I am elated! She told me about all the potential risks associated with reflux and the sleeve and many are an educated guess since there is no long term documented histories to go by. She compared my personal issues, the benefits and the risks associated with both the sleeve and the by-pass and said ultimately the surgery type is up to me. I will go with my "GUT" no pun intended since I have been a believer in the sleeve since day one and will move forward with that. Thanks for the support.

Thanks for your replies, I did write this note when I was feeling frantic. This news was sandwiched between two deaths in my family. I have to say this was not a good week for me. I typically am not a person of great anxiety, but this was totally unexpected and I was so focused on the sleeve and as you all know, it's such a long journey and "hope" of a better future is so close at this point. . Long story short. My surgeon called today, they have the results of my biopsies and she wants to see me in her office Monday morning to discuss them with surgery options. The secretary couldn't tell me any more, said that she had gotten an e-mail from the surgeon who was in surgery today, requesting that she contact me. I did feel encouraged with the word "options". Overall, I am in a better place emotionally, have thought about a lot of options and will listen to her on Monday and meet with my regular provider on Thursday to get some more "warm and fuzzies". Thank you all for caring enough to take the time to listen. Does this mean if I no longer am a potential sleever, I am no longer welcome here? :-(

I have been on the journey to the Sleeve since Feb. I have done every class, every insurance requirement, every physician requirement and finally, my EGD yesterday was my last hurdle. I have been focused on the sleeve and nothing but the sleeve. I have a BMI of 39-40 ish. I didn't want any rerouting of my body parts, no mal-absorption etc. I have an artificial shoulder with neck issues and love my Advil since Tylenol does absolutely nothing for me and you can't take Nsaid's with by-pass the sleeve was my only focus. Yesterday my Sleeve world was turned upside down. Upon waking from my EGD I was told that the surgeon had to take 5-6 biopsies of my Esophagus and 1 in my Duodenum, (no explanation why) but that I should go home, research the by-pass and possible make an appointment to discuss the bypass with the surgeon's partner who is a world renowned robotic bypass surgeon. I work in a Dr's office, so I assume that they found something that looked abnormal, possible Barrett's Esophagus? I recently started re-flux medication after I regained weight because I typically get re-flux or nighttime heartburn when I'm heavier. I am soooooooooooooooooooooooooo disappointed, sad is actually the word that comes to mind. I am smart enough to know that if a surgeon I trust completely, feels the sleeve is a bad decision, then it apparently is a bad decision. Right now I can not even fathom a by-pass since I see so many people who look and feel less than optimum from the results. Is it healthy to accept a surgery you had no desire to have? or do I stay me and accept the fact that I am still on my own as I have been for my entire life.

OMG, what do you have for insurance? I would be so upset.. I would definitely give them a prodding. Have they corresponded with you at all? I thought they had 30 day to make a decision. My EGD is Wednesday and then things go off to the insurance company. I do not want to wait many more months. :-( Fortunately my Dr is part of an elite group and has special credentialing, she would not even send it to them for approval until every thing she thought they would want had been done like the EGD and Holter monitor. Good luck, I'd be curious to know the hold up.

Hello ladies or spouses of ladies who have experienced this, I am 54, and am on Estrogen replacement. I have read many stories of how people leave the hospital after surgery and are told to abruptly stop many, if not all medications. I am reaching the age of the natural change of life, although went through surgical menopause at 29. If anyone has had the experience of stopping HRT as part of the surgery, I would like to know the effects. I personally think using old, stored calories is enough of a challenge to start with, yet do I take advantage of this time to stop the HRT? I do not want the effects of menopause (lack of libido, hot flashes, vaginal dryness, mood swings etc.) to come crashing down on me on top of all the physical and emotional changes associated with VSG. Help!!!!!!!!!!!!!!!!!!!!!!!!!!

Hello ladies or spouses of ladies who have experienced this, I am 54, and am on Estrogen replacement. I have read many stories of how people leave the hospital after surgery and are told to abruptly stop many, if not all medications. I am reaching the age of the natural change of life, although went through surgical menopause at 29. If anyone has had the experience of stopping HRT as part of the surgery, I would like to know the effects. I personally think using old, stored calories is enough of a challenge to start with, yet do I take advantage of this time to stop the HRT? I do not want the effects of menopause (lack of libido, hot flashes, vaginal dryness, mood swings etc.) to come crashing down on me on top of all the physical and emotional changes associated with VSG. Help!!!!!!!!!!!!!!!!!!!!!!!!!!

Please, Please, Please explain how that works. I can't find anything on Google Chrome? Thank you!!

Good morning.... What makes me happy as a woman is usually the simple things in life. Make a picnic lunch and head out to a place that has a view, ocean side or even river bank.. Enjoy each others company and just take in the view. No phones (leave them in the car) and just pay attention to one another. Maybe you coul dfind a few wild flowers along the way. Happy Anniversary... ! :-)