6kiddos

We have self-pay ins through Aetna. I was approved last week for outpatient VSG. It really depends on your plan.

I just found out today that Aetna approved my surgery for outpatient. Has anyone had this? Did it go ok? I am going to try and have the dr. do the peer to peer to try and get inpatient. I am worried about coming home to 6 kiddos the same day as the surgery. y'know? Thanks for input and experiences!

I was approved (I just found out! I had to call...was approved last thursday!) Anyway, they only approved it for outpatient?? Anyone else? :huh:

I have another email into the patient advocate to see when she submitted it. I am sooo impatient! LOL Mommy2girls - I have done the 6 mo diet/exercise, cardio (with nuclear stress test & echo), pulmonologist (with sleep study), tsh bloodwork, weight history, etc. All the ducks are in a row...now it is up to Aetna. (it is private ins so it really is up to Aetna)

I am not sure about the VSG, but when my cardiologist wanted to do a Nuclear Stress Test (based on TERRIBLE family history with my brother having a MAJOR heart attack at 40) she did a peer to peer review also. It was approved within the day. I would think on the VSG this would be a good thing. =) What is your ins? I am waiting on Aetna. waiting...waiting...ugh.

So, I finally heard back from the patient advocate. After playing phone tag with the patient advocate...I finally got an email back from her. She has sent it into Aetna....waiting for approval! I am sooo nervous! What is they don't approve? I have to do this this year if I do it because I am 100% covered until the end of the year and our ins will be changing (thanks to dh's new job! YEAH!!). AAAHH! Who knows how long I will have to wait to hear. On a good note, dh got the job with Wells Fargo! WOOHOO! He has been a contractor there (computers) and the end date for him was Dec....meaning he would HAVE to leave for 6 mo and then go back if they had room. BUT he got the ONE Full-time Employee job they had open this year in his area. =) So....we will have benefits, PTO, vacation days. We have not had this stuff in 8 yrs! woohoo! We are VERY happy and relieved. Thanks for reading.

Glad to hear someone else is going to him. Also good to hear good recommendations! Thanks! I do have a friend who had a RnY 2 yrs ago by Dr. Juarez who liked him. My paperwork should go in for approval this week! yikes! I am hoping it will go easily and I will be able to do this this year. Good to hear from another Phoenician. =)

I can't tell you from personal experience, but my mother had the same issue when I was a teen. She was better after losing weight (bypass 20 yrs ago) but then her knees were bad enough that she had a knee replacement on the worse of the two. The other one is bad but manageable. (she does have high pain tolerance though...)

Congratulations! I will have all of my stuff in next week to be submitted! I am so nervous!

is Aetna requiring a Pulmonary clearance for you? I am just curious because I have left tons of messages with the ins. lady at the surgeon's office and still no call back. I have my LAST appt with my PCP today! (6-month) woohoo. I am still working on that pulmonary clearance though..sigh.

What do I expect? The Pulmonologist wanted me to do one since the room air night test had a few funny areas....of course I couldn't sleep well that night. (worst night of sleep in a long time). Anyway, I am unsure what to expect. This is my LAST hurdle before submitting to ins! I finish the 6 mo diet today...then I need to get the reports from my PCP with his letter. AND then the Pulmonologist clearance. =)Hopefully I will be submitting in the next few weeks!

I was told I had to have pulmonary clearance and cardiac clearance also. My last appt for the 6 mo program is this Friday! (woohoo!) I have everything in except the last appt from my PCP and his letter. I am also waiting on the pulmonary clearance. (though this is unclear on whether or not I really need this...it might be for the surgeon only because I am close to the 50 bmi. I am at 45.9 after the 6 mo diet/exercise). I am worried about being denied as we cannot afford the surgery otherwise. We hit our family ded. in June ($10k!) and this surgery would be 100% covered. We'll see. =) good luck to you!

interesting... I have high bp ONLY at my TMJ specialist. (155/85 one time...went down to 145/75 about 10 min later). So, I talked to my pcp and he said it was fine...that what he would have me do I am already doing (losing weight, exercise, etc). At his office my bp is 133/72. go figure. It is so confusing. BUT I will pull the TMJ docs notes because she has it documented I have high bp. =) Might help for a documented co-morbidity.

Oh...I am soooo looking forward to NOT sweating so bad in the heat! I live in Phoenix...HOT. It is "only" 105 today. ugh. Thank goodness it is a "dry" heat.

I have to have the option of anti-inflamatories. (ie. ibuprofen, aleve, etc) for my TMJ and if I am like my mother...arthritis when I am older.

This may seem like a wierd question...BUT Is your voice different or hoarse after surgery? Does your throat hurt? I have had 3 c/s but I was never "put under". I am a singer and am curious about this. (not professional...just solos at church, etc. but I do perform a lot). Thanks. Janel

Well, I am hoping mine stays away after I have surgery. =) (almost ready to submit to Aetna). Anyway, I had an ablation done in June. Best thing ever!! No monthly visitor since then. I hope she stays away. =)

So I am working on all the things to get approval. I HAVE to get it THIS year if I want it....we have hit our deductible already so it would be no out of pocket for me. If it is next year it will be 5k. Anywho. I went to the pulmonologist for clearance (trying to make sure everything is ready...and I am borderline needing this clearance). He did some kind of room oxygen sleep test where I slept with the finger thing on all night at home. He now said that he wants a full sleep study! ugh. He said my O2 was low sometimes (not sure if he read that I got up to go pee, switched the finger thing in the night (it hurt!), and kids woke me) and wants to be sure by having a full sleep study. Everything else will be ready to submit to Ins. (Aetna) October 3rd. sigh. Now I get to hurry up and wait again. Frustrating since I feel like I am on a major timeline and I really don't want to be recovering too much around the holidays!

Glad for this question and interested in the answers. =) I have had 3 c-sections so I too was wondering about which was worse. =)

Hey Dave - can't answer your questions...but wanted to say HI to someone in the NW! I LOVE the NW. We spend 1-2 months on Whidbey Island every summer. =)

Suzette - I think I read about your situation. =) It is because of that that I have already gone to my gym. They photocopied the card they kept records on (about 4 weigh ins in 4 months) from last year. It has their letterhead on it and I have the receptionist sign it. Do you think I should do more...like from the manager? According to Aetna we only need 2 yrs history...so I am gathering '10, '09, '08. (I only have 1 appt for '08). Thanks for the encouragement. =)

I also like the Special K Protein Water. It is a powder you add to a water bottle but it has 5 or 6 g of Fiber and protein also. it really helps me when I am hungry. =) Don't feel like a failure. Take it a day at a time. You CAN do this! Hugs!

They would have covered the nutritionist for me IF there was one here on my plan. I am doing the 6 month diet (finish Oct 1!) so I only needed one visit. I hear ya on cost though...we hit our family ded. of $10k in June! The silver lining of that is that everything is 100% now. I am sooo hoping they approve this for me and I can get in before the end of the year! We are doing TONS of medical stuff right now because it is 100%...dermatologist, allergist, etc. fun, fun, fun!

Had mine yesterday. Was pretty painless. =) Basically we talked about finding other outlets instead of food and the need for at least 5 things (hobbies) to help with this. Also having something for the oral motor need (ie, sugar free candy, a straw, etc to chew around when needed). I found it pretty interesting and had a bit of an aha moment. I have spent the last 16+ years working for my children/family and have lost "me". I finally have time now to focus a little on me and I need to figure out what "I" like now. Then there was the MMPI test. Pretty simple. Just answer T/F to a ton of questions. =) good luck!

thanks....I hope they take it. sigh. Btw, it is a personal plan...not through the employer.