stromgardgirl

nerves are starting to kick in. I haven't even started to prepare, and not sure what I need. I never thought I would get approved.

I feel the same way....this waiting game is KILLING ME! In fact, I just emailed my Dr office to push a little more. LOL

I called the insurance company quite regularly.

How long did it take for them to approve you? I'm WAITING....did all my weight loss management....waiting on insurance to say DO IT!! OH and I'm SO HAPPY you are approved!!!

Paperwork was submitted on the 24th and just got approved today. I was totally fretting the entire time.

I finally got my approval this morning. I am so extremely excited, but nerves are slowly starting to kick in.

I've been thinking since about yesterday. What are the complications that can happen after you are completely healed. I know at first you can have leaks and issues with your incisions, but what about later?

If it makes you feel any better, my doc submitted on Wednesday and when I called this morning---Friday---Blue Cross had already approved and mailed out the letters! Much, much faster than I had expected!

That would be nice. I called Friday to see what I needed to do from this point, and it already had a bariatric nurse working on it. Not sure if that is good or not. However she was already gone for the weekend. With it being a holiday week just not sure on turn around time.

As long as you have everything. They approve quickly. My company has a bariatric nurse that I had to talk to throughout the process. She works for Aetna and she called me 2 days after submission to tell me I was approved.

I sure hope I have everything. I followed their checklist and what my dr told me to do. Psych eval done, sleep study done, 4 visits with dietician done, 2 visits with surgeon office done, 2 years weight history done. The weight history I have goes back to 2006 but is missing 2009. I have had over a 40 BMI since middle 2006, but had a 39 the rest of that year. I didn't have insurance for 2009 so didn't go to dr.

Which insurance company?

I have Aetna through my husbands job. I have heard many good things about them. I am also going to call the insurance coordinator I'm working with this afternoon to make sure the paperwork was submitted. Of all the times to submit it right before Thanksgiving holiday festivities.

Well I have jumped through all the insurance hoops. My dr office is suppose to be submitting paperwork either today or tomorrow. Now starts the waiting game. I hope and pray that they have a quick answer. I'm already a mess. I also have a tentative date for my surgery set. it is becoming so real.

Take some Pamprin (the PMS pill) to help with Water weight, I take it the week I ovulate and the 3-4 days before my period is due to start.

I sometimes think nutritionist use little "scare tactics" to try to get us motivated to lose weight. I'm not saying you aren't trying, but when you want something so bad, they tend to think that you'll do anything to get approval. I personally would be popping Pamprin, and doing a modified Atkins diet. Cut all white carbs, no bread at all, and try to stay below 40-50gr of carbs per day. You'll definitely drop some weight, plus it'll be good preparation for life post-op when we have to focus on getting in Protein.

If your file looks awesome, then you should get approval. I'm not sure which insurance carrier you're dealing with, but I've never heard of an insurance company (that is actively approving sleeves) denying someone for a few pounds gained during the pre-op diet and evaluation period.

Hang in there, and just keep logging your food intake, increase your clear fluids, and don't lose hope.

Thanks tiffykins for your words of encouragement. I have my carbs down to about 100-150 most days, and they all come from fruit and veggies. I plan on calling my dr today to get a heavy duty Water pill. I have done everything that was asked of me. If it was just a scare tactic it definitely worked. i am very scared that I won't be approved, and desperately want/need this.

I wish it was my thyroid. I have had all the tests done, and the doctor doesn't know why it's so hard for me to lose weight. I need to ask about a Water pill though. I feel like I have a lot of water retention right now. I guess I just keep praying that everything works out the way it is suppose to.

Hi Everyone

I haven't been on for awhile, but need some strength and guidance. I am in the process of jumping through insurance requirements. Well I went to my 2nd to last dietician appointment when she mentions for the first time my weight. Yes I have gained 8lbs since my first visit with her. I'm still at a loss how this has happened. I have been more active then usual. My monthly cycles have been completely off and have had spotting for about 3 weeks (can we say Water weight). Anways she brought up the fact that if the insurance doesn't see me making the right food choices then I won't get approved. She did say that my file looks awesome and everything I have been asked to do I have done, but this one little thing could end my journey. I do make the right food choices, and have started tracking them on mydailyplate so that I can show her how many calories I eat in a day. the thing is it was never mentioned to me that I needed to stay the same weight or lose weight during this time. My first visit with her I was obsessed about every little thing I put in my mouth and was weighing at least twice a day. If I didn't have a weight issue I wouldn't be there. How do you lose weight when your body refuses to with normal diets?

I have gotten the clear from the psych eval, done my sleep study, and gotten my weight history. I just need this last piece to go smoothly. The other issue is I'm one of the younger patients at 30 and really have no co-morbidities. I only have high cholesterol.

Has this happened to anyone else? I really wish that they would look at my families history. I can't go down that path.

I completely understand your frustration. I went to my second to last dietician meeting this past week, and it was the first time she mentioned that I needed to keep a steady weight or lose weight. I admit I have gained 8 lbs and to this minute I'm still at a loss how. I have been more active then I have been. Anyways she said that as it stands she is unsure if I would get approved for my surgery. That was completely devastating to me. I'm hoping all goes well and I do get approved. I guess I will be starving myself until my next appointment.

Completing by the end of the year will be close. Aetna wants 4 nutrition classes spaced over 90 days. I squeaked thru at 84. Also Dr. Nick will probably taking some vacation time and others will be squeezing in to use FSAs before the end of the year. I certainly think it is doable. They are very efficient.

I started my nut classes the end of Feb. I was scheduled for RNY. The nut classes are pretty basic. You can print the same info off the USDA or FDAs websites. April 12 I heard Aetna was going to approve sleeves so I told Summar to switch me. I was approved about May 3. I finished my psyche eval and last nut class May 22. They wanted to schedule surgery for June 1! I didn't think I was quite ready due to some of lifes little events and Dr. Nick was on vacation the rest of June so July 12th it was. Everything was fast compared to other stories.

My biggest worry now I how much do I really owe??? Dr. Nick's office couldn't say upfront. That kind of worried me. I paid the hospital $1300 when admitted which was the balance of my remaining co-insurance since I had met my deductible for the year. Aetna's website is showing completed bills with coinsurance due of $12,800+! The hospital said once my co-insurance max was reached, the $1300, Aetna picked up the rest 100%. I haven't received any bills so who knows. I will be very upset if I end up getting bills totaling more than the cash price when my insurance has coverage. I'm enjoying the moment and keeping my fingers crossed.

That is one of the main reasons I want it done by end of year. All my deductibles and out of pocket for the year. I thought it was only 3 nut classes? How did you get approval before last nut appt was done?

Hi Stromgardgirl. I used Dr. Nick and Aetna PPO. I also went thru the 3 months nutrition classes. Also had the sleep study, and psyche eval. Feel free to ask me anything. I'm almost 6 weeks out and feeling pretty good. Congrats and good luck!

I'm using Aetna Choice POS II I'm hoping I can get everything done by end of year including surgery. How long of wait for surgery did you have after you completed everything? I just got my sleep study results today which were good no apnea or other sleep issues. I have my first dietician appt on monday then meet with PA at dr nicks office on thursday. still need to schedule psych eval hope not long wait to get in.

I really have no one to watch my children, and my husband isn't home yet to watch them. I have 2 appts scheduled already YAY. I have one this sunday and one on the 25th of this month (hoping they have a cancellation so I can get in sooner). I'm just glad to be moving forward in my journey.

Hi. I'm trying to find someone to mentor me along the process with Dr. Nick. Hopefully someone who also went through the 3month program for insurance. I really think this will help me tremendously./QUOTE]

Hi I just saw your note. I used Dr. Nick, but was self pay. I have no experience going through the insurance merry-go-round. Sorry I can't be of help, but wanted to send a reply! Good luck! I'm very satisfied with my surgery! :confused1:

Thank you for replying....it doesn't seem like it will be that bad of process

Hi. I'm trying to find someone to mentor me along the process with Dr. Nick. Hopefully someone who also went through the 3month program for insurance. I really think this will help me tremendously.

Thank you everyone. I will see how many hoops I have to jump through for the 3month multi. I can stand to wait that much longer. I really don't have the money to do self pay, but that insurance person ticked me off today. I would much rather take a vacation with that money instead of paying off a loan.

I have heard positive things about aetna so hopefully it won't be that bad.

Ok so I have decided on my dr which I feel is a very good decision. He is Dr. Nicholson in Plano. I do have insurance which I'm. Going through. I tried calling my inssurance to find out exactly what I needed and she said she wasn't equipped to tell me what aetna needed specifically and I would need to wait to hear from my dr. I have a feeling the next 3 months are going to be trying.

I would have to agree. There is no reason to not be completely truthful. Luckily my hubby completely supports my decision.

I went to the seminar last night and really happy that I did. I found the person I want to go with for my surgery. Now the long process of getting it approved through insurance.YIKES One step at a time. I am happy with my decision though.

I went to Dr Nicholson's seminar last night and would highly suggest him. He is here in Plano. He is 12,400 I believe for self pay and it covers all aftercare as well.

Ok this sounds silly but here it is. I have an initial appt set up with Dr Barker on Thursday, but am able to attend a seminar for Dr Nicholson tonight. I feel guilty about doing this for some reason. I know I shouldn't be. I deserve to have the best dr my insurance will cover.

Find out how many sleeves he has done and what his complication rate is. He should have done at least 200. My surgeon's complication rate was zero--that's what I would look for. I asked the bariatric coordinator these questions and she had the answers--don't be afraid to ask. The morbidity rate for the sleeve is no different from gall bladder surgery so don't let your aunt's experience scare you. There were definitely problems with early RNYs. But you're not getting an RNY so your surgery risk is the same as for any other abdominal surgery (I looked it up). The biggest problem with the sleeve is post-op dehydration, but you can avoid this by asking for a scopolamine patch to control nausea and religiously getting your fluids in. Find out how many leak tests, and what kind are done before you are discharged. My surgeon does 4--two during surgery and two after. It's very important to have these. Also ask if the staple line is oversewn (making it extra strong).

Thank you so much for the info.. I was at a loss what to exactly ask. I think the nervousness is kicking in evenf or appt which is silly. This did put at ease more which is very nice. I shouldn't worry more about this than my tonsilectomy I had several months back.