mountain_lover

I previously posted this following message on the Pre-Op forum on here, I decided to copy it and paste it on this new thread about Insurance & financing. If you find it interesting, you may want to show it to your surgeon. I tried to put it down in the terms that I understand them to be, but maybe whoever is appealing your case can put this in addition to all their other information, to try to get you approved for the sleeve. PLEASE READ THIS: Re: Unapproved for Sleeve - Ready to CRY -------------------------------------------------------------------------------- Quote: Originally Posted by jsm Thanks Mountain_Lover! I am on pins and needles! I'm so nervous not knowing what the outcome of the appeal will be. I thought I would have an answer by last Friday from my surgeon's office on his peer to peer appeal. Apparently that has not happened yet. I left a message late Friday and just a little while ago. I probably have gone from a PITA (pain in the arss) to a full blown Hemmorrhoid calling his office so often. I'm also afraid to bug my insurance company, since I know my surgeon will be doing the peer to peer appeal. I'm about 2 weeks away from my scheduled surgery date, and should be starting my liquid diet on Wednesday. Again, thanks for your thoughts, prayers and good energy. I will post as soon as I hear anything. Hugs, JoAnne Hello JoAnne, I posted the following item earlier, I don't know if you noticed. If not, please read it very carefully. It may be difficult to understand. I was thinking that maybe if you were to show this following message to your surgeon, he might find it very interesting. I am sure due to the fact that he is a surgeon, that he would understand what the message is all about and he could possibly use some of it to help in your appeal. It may not help, but it might be worth trying. I am understanding from my surgeon Dr. Husted here in Somerset KY, that the vertical sleeve procedure is now being coverered by Medicaid for some patients. Just a few months ago when I went to my consult with him, they were not being approved by Medicaid, but he told me he was going to be speaking with Medicaid about getting them approved here in KY. He must have been successful or something has changed, because recently a few of his patients have been approved for the sleeve by Medicaid. I sure hope all this is true, because it has so much to do with me being able to have the sleeve done in my situation. Maybe if it is true, then other States will make it possible for Medicaid patients to get approved for a safer surgery. Also people could stay in there own area and not have to go elsewhere if they find a good surgeon who accepts Medicaid for their sleeve procedure. PLEASE READ THE FOLLOWING AND POSSIBLY LET YOUR SURGEON READ IT IF YOU THINK IT MIGHT HELP IN YOUR APPEAL!!! JSM---------- Note: this was included in your insurance policy *Biliopancreatic bypass with duodenal switch *Sleeve gastrectomy, performed either as a stand-alone restrictive procedure, or as a first stage procedure of a planned biliopancreatic bypass with duodenal switch for patients with a BMI exceeding 50. Hello jsm, I would like to point out something that maybe someone is overlooking or is misunderstanding at BlueCross/BlueShield. I may be wrong, but it is something for them to consider. If you notice above the Biliopancreatic Bypass with Duodenal Switch is approved, and it says nothing about any requirements on the BMI. But notice that when the Sleeve Gastrectomy is performed as a "FIRST STAGE PROCEDURE" of a Biliopancreatic Bypass with Dueodenal Switch, it is only approved for "PATIENTS WITH A BMI EXCEEDING 50. However, the Sleeve Gastrectomy is approved when performed as a "STAND-ALONE RESTRICTIVE PROCEDURE", it does not say any specific BMI . It stipulates that it is EITHER, Or. --------------------------------- " performed EITHER as a stand-alone restrictive procedure" "OR as a first stage procedure of a biliopancreatic bypass with duedenal switch for patients with BMI exceeding 50" -------------------------------- As I stated in my post earlier that I learned that the Duodenal Switch was being performed on patients, but if the patient had a very high BMI and health problems which made it more risky to have the Duodenal Switch, then doctors would perform the Sleeve (Which is the First part of the duodenal surgery and only restrictive), hoping that the patient would lose weight down to a SAFER, LOWER BMI, then the other part of the Duodenal surgery which is Malabsorptive could be performed without all the risks that were present before the Sleeve, so that the patient could lose more weight to reach their goal. ------------>>>>> What many doctors were discovering was that many patients continued to lose the weight and was reaching their goals with only the Sleeve, and the second part of the surgery did not need to be performed. So then many doctors started performing The SLEEVE as a STAND-ALONE RESTRICTIVE PROCEDURE. Now the sleeve is becoming a more sought after surgery by doctors and patients, because it is a less expensive, less evasive, and less risky surgery. Also the doctors know that there are less complications and healing time is faster with the Sleeve vs. the other procedures.--------------->>>>>>>> Medicaid and Medicare are now approving some Sleeve procedures. As I stated in my other post, WHY PAY FOR MORE IF IT IS NOT NEEDED. When the insurance company pays for the duodenal, the sleeve is the first part of that surgery. People with LOWER BMI and no severe health issues other than obesity, are having success with only the sleeve; so why have people put at more risk just so that they have a covered procedure according to what the insurance company understands the terms to be. Could the insurance company be misunderstanding or misinterpreting the policy coverage, because they might not have all the facts or they might not be reading the sentence above in their policy as it might be intended? If you have any thoughts on this or any more questions, it would be very interesting to hear from anyone. Thank you for taking the time to read this. Also you may get more information on this from doctors who are performing the Sleeve and are able to get it covered by different insurance policies. Have a good day from mountain_lover!! __________________ mountain_lover

Thank you for your prayers!! I am now at 182.6 pounds and have no regrets having the sleeve. I have had acid reflux, but it is mostly due I think to my eating late in the evening.

Hello, I am here to tell my story. I decided to have surgery almost a year ago. I went to one of Dr. Husted's seminars and began the process of my weigh-ins, tests, and learning about the surgery procedure. I have completed all my tests. If the last test results come back "ok" Thursday, then I will be ready to turn them in to the surgeon. I am also waiting for my phyciatric evaluation to be turned in this week or next. Right after they receive this information, they will submit it to my insurance to see if I am approved for the VSG surgery and if I am, I will receive my pre-op packet with my surgery date. I will begin my pre-op diet of milk shakes. Dr. Husted told me that I would be on the pre-op diet for two weeks before the surgery. I started my weigh-ins the month of Feb. 2009 and my weight was at 253. I have lost and gained several times. My weight reached upwards to 266 and I weighed in at 244 this month. I am hoping that I will lose some more with the pre-op diet. I have sleep apnea, high blood pressure, arthritis, fybromyalgia, mixed connective tissue autoimmune disorder and some other health issues related to my obesity. I have had a total knee replacement last year, now I don't have to walk with a cane! I am waiting, hoping and praying that I will be approved for the surgery. I want to have the surgery and lose weight to live a longer healthier life. I am learning many things from all the people who are posting on these forums, and I hope one day soon that I will be able to help others from my experience. Thank you all for being here!!! I will try to keep you updated on my surgery date, and my progress.

Thank you for your prayers. I am now at 182.6. I have been losing very slowly. I have not been doing what I need to be doing. I have been trying to get back into exercising more often to help firm up and to help lose the weight. I need to do better with what I choose to eat. I am very happy that I had the sleeve, because it does restrict how much I can eat. I still have no regrets having the sleeve.

I noticed that I did not have a profile picture so I put one on here of me on New Year's Eve. I weighed 213 pounds and now I weigh 182.6, so I will have to update my profile picture soon.

I noticed after I posted to you, that I did not have a profile picture, so I put one on here that was taken on New Year's Eve. I weighed 213 pounds in this profile picture. I will have to update it later, because now I am at 182.6 pounds. If you go to my profile and click on my photo albums you will see how I looked before surgery. Thank you for sending me the private message about my 9 month post op and Dr. Husted.

I am glad that everything is working out for you. I just sent you a private message right before reading this topic. Sorry that you didn't get to have Dr. Husted, but it seems as though everything is working out for you in the end. I hope you have a speedy recovery and will be on your new journey with the weight loss that you hope for. From Mountain_Lover

I live in the Somerset Ky. area and one day I decided to call a Bariatric Center in Hazard Ky. that I saw advertised on tv. I was informed that there was a Bariatric Center in Somerset with a new doctor, Dr. John Husted and I was told that I should attend a seminar to find out more about bariatric surgery. I called the local Hospital and acquired the information on the seminar and attended. I received a packet with information about the doctor, the Bariatric Center, surgery information, and an application to fill out for Dr. Husted's office. That started me on my journey for Bariatric surgery. I received an appointment with the doctor and I really was very pleased with the visit, and afterwards I did alot of research on Dr. Husted. He has many very nice reviews and recommendations. I know everyone has there own opinions, but so far, mine are only good ones. If you want to find out more about him, he has a web page (which includes my review among many others). I have had to get over a few hurdles along the way, but I am really close. This week all my information should be submitted to the Insurance to see if I will be approved for the procedure. I am looking forward for him to do my surgery and at this point I trust him to perform the surgery. I do have some health related issues due to my obesity and for other reasons, but I have been given the OK for surgery by my Cardiologist, Lung and Sleep Doctor, and Psycologist. I am going into this knowing that there are several risks with having the surgery, but I have the faith that God, Dr. Husted, the Bariatric Center, and all my other doctors have taken my best interests into consideration and that they will ALL help this to be as safe and successful for me as they possibly can. I hope this information helps someone that may be reading this, who may be considering surgery. I know that Dr. Husted does several different procedures and he will help you to decide which is the best one for your situation. Thank you for taking the time to read this!!

Tiffykins, You are such an inspiration. It really helps to read what you have to say. Thanks From Cathy

I am coming back to give everyone an update. I have lost a total of 80 pounds pre-op and post-op. I have 41.8 more pounds to lose to reach my goal weight of 145. I am getting so excited about reaching my goal. It has been a good journey with the vertical sleeve surgery. I have been going through many family related very stressful situations and I had to be hospitalized 2 times in April and May and still dealing with some medicine issues and going to councelling as much as possible to help me get through this. Please pray for me during this time for God to help work everything out. Thank you all for your support. I have not updated my photos, but I will work on trying to get some on as soon as possibe.

hello tiffykins, Thank you for all the information. I didn't know that, I have been using the chocolate chews since surgery. Is there any certain time of the day that I should take the calcium citrate? thank you and I will be back again to see what else you have posted.

I am coming back to update my progress. I have been going through a tough time with family issues and had to go into the Hospital for a week recently to help overcome the obstacles, and was successful. Now I am on my way to losing. On April 15 I weighed 195, but I went back up to 199 while I was in the Hospital. I am happy to say that As of May 4, I now am down to my lowest weight since surgery, I am at 194.8. I hope I can continue to lose more quickly to get to my Goal Weight of 145 pounds. It has been coming off slowly, but I am happy with the results so far. I am sure that This will help me to get back in the groove of things. I tried to post new photos on my album, but was unsuccessful, I will have to have my son to help me, He is really good at uploading photos. I will update when I lose more. Thank you for your prayers and support. I want to come back more often soon, because I need the inspiration. Cathy

Hello Carol, I take Arthritis Strength Tylonol, But I buy the Wal-Mart Equate Brand. A person can take two tablets 3 times in 24 hours and each tablet is 650 mg of actephetaphen (Mispelled). If you have a YMCA close by, check to see if they have an Aquatic (Swimming Pool) exercise program. It is a big help and also the Hot tub or sauna room is helpful for muscle and arthritis pain. I wish you all the best!!