makemyownluck

I don't have a lot of knowledge on the state insurance. i had a girlfriend of mine who had the lap band while on state insurance as well (she was also on SSI), and I know she had to jump a LOT of hoops. A LOT. classes, testing, more testing, she was in the process for over a year. Mind you, this may have nothing to do with her insurance. She also had a long history of drug addiction (tho she had been sober for 10+ years), so I'm pretty sure her providers were also requiring a lot of her as well. And she had ongoing psych treatment that she had to get stable with as well. Also making matters worse, she had significant medical history of osteoporosis (diagnosed in her 30s) and TWO pulmonary embolisms in her life. So she had a lot working against her. I can imagine that Medicaid required a lot simply because it's publicly funded. But her experience may be more of an extreme example, just based on her other history. Unfortunately, 2 months after having her band, she passed away. Not due to the band or surgery complication, though. Her prior drug addiction took hold when she could no longer substitute food for drugs (which she had done because she gained 200 lbs in the 10 years she gave up drugs). She passed away in her sleep of an overdose. It was really a very hard thing for me to deal with (she was really like a sister to me), but it just goes to show that none of these surgeries are "the easy way out". We all still have to deal with our inner selves and keep our heads clear about what our goal is. She had her addiction controlled for many years, and then the stress of post-op life messed with her in a severe way. No one even saw it coming -- she got the drugs from someone in her narcotics support group. We thought she was taking care of herself, but instead she ran into the very thing she was trying to avoid... Very sad story... sorry, got a bit off topic on that one.

also -- I recommend Almond Milk. unsweetened is good, only 30 cals, which is less than even Light soy milk. I think it tastes better than soy, but then again, I never really hated soy milk, either.

haha, not fail - but maybe the NUT doesn't give you all the info you need (per the insurance company), or the psych eval didn't cover enough... I don't mean fail like you'd do something wrong - I mean the insurance company will look for some minor detail to say you didn't meet the requirement is all. Make sure your surgeon has a good support staff. They should already be well aware of what the insurance companies are looking for, so they should be able to guide you through it all. My surgeons staff is really good - but this is my 2nd surgeon. The first office didn't even bother to check my benefits (and I ended up having to switch insurance coverage, otherwise I'd be waiting a whole year or more with my prior plan) - plus the doctor was a total B.I.T.C.H. I'm glad I went for a 2nd opinion because I feel like I'm getting the level of care I should have been getting in the first place. Try not to stress yourself out too much about the insurance part, it will work itself out.

Unjury starter pack for anyone interested: http://www.unjury.com/store/protein/unjury-protein/unjury-starter-pack/unjury-starter-kit.html

I've tried a few... Muscle Milk tastes the best, IMO. but the original is the best tasting, and it's higher in carbs and calories than what I want to be using. Muscle Milk light is OKAY. But it's way lower in protein that what I was looking for. Isopure is nasty. Blech. Cytosport (who also makes MM) has 100% Whey powder that's okay too, and high in protein. But what I've ultimately settled on is Premier shakes. They are available at Costco (and Sam's too, I believe). I like the chocolate by itself and the vanilla mixed with other things. I've make the following different drinks with the vanilla: -sugar free Chai Latte powder mix (found at World Market) -peanut butter and half a banana (a full banana is too "banana-y" for my taste) -1/2 tsp coffee extract -1/2 tsp coffee extract and a small squirt of sugar free chocolate syrup -frozen strawberries The vanilla isn't terrible on its own. Just... IDK... boring. I just ordered the Unjury starter pack. Comes with a variety of flavors, a shaker and a food therm for $22. Just ordered mine today! I know post op, chocolate and vanilla everyday is gonna get tired REALLY quick. I'm hoping the chicken soup is tasty... and unflavored should work nicely in some Jello.

Pre-op here, but I've had my gall bladder out and I remember what I needed help with the most and I'm anticipating the same with this surgery - Bending was very hard for me. For nearly a month post op. I have a cat, so I have a friend of mine willing to come over every few days to clean out the litter box for me. Even if sitting in a chair, leaning forward is painful. Also, you shouldn't lift anything heavier than 10lbs for 2-4 weeks. This means laundry for me, as I have my washer/dryer in the basement, so I have a friend who's agreed to help me with that as well. And with groceries. Basically, I have a very good BFF who's willing to do most of what I need done, and I'm quite grateful to have her. Besides bending and lifting, I also had discomfort when walking for extended times. I would go to the grocery store and walk around leisurely, but after 25-30m (seems all grocery stores around here are H U G E mega-stores), I would ache in my stomach and find myself hunched over the shopping cart to make myself more comfortable. You just have to remember to take it very easy for the first month - go even slower than you think you need to. Oh, and get yourself a good pair of slip-on shoes. I'm getting my surgery in May, so I'm hoping I won't need socks most days and can just slip on some flats for work! I'm also quite independent and don't like asking for help. Figure out who your most supportive friend is and ask them how much they are willing to help you. Remember that it's just for a few weeks. I plan on thanking my friend by taking her to the movies or something when I'm feeling better. A true friend is the one willing to help you when you're down, not just be with you when it's all fun and games. Good luck! You might be pleasantly surprised when you see the genuine kindness of the people you love!

The first rule of Fight Club is 'don't talk about Fight Club' I just reread that book this week, so this seems extra funny to me. Personally, I don't know that I'll E V E R want to show my tummy to anyone, so I don't know that I'll need an excuse.

Well, I'm sure there are people with high BMI that have been denied, but not for their BMI... over 40 BMI means you're a candidate... but an insurance company can deny you for other reasons (like not meeting their criteria for NUT consults, psych eval, etc). Unfortunately, I think many insurance companies like to deny people the first go around. They want to deter people from doing it, if they can. So even if they do deny it, they have to give you the REASON you are denied, so you can work on getting that "reason" cleared up. If you are denied, you can always appeal!

Oh, I certainly won't be wasting my time reading everything you've written -- as I'm sure you wouldn't bother reading everything I've ever posted before dismissing what I had to say. Good luck to you!

I agree with prior posts questioning why you would have this surgery at 30 BMI. Seems quite extreme. But, to each their own. There are people here who have struggled with major weight issues for their whole life, and have lots of medical complications as a result, and are seeking surgery to improve their health and extend their life. In my opinion (which, I realize you didn't ask for it, but oh well), this is strictly about vanity. I just don't understand why you'd do this to yourself considering your current weight. I know this won't deter you, but this is an open forum, and that's my two cents. Luck for you, they'll take anyone's money in Mexico...

CAN you have it? Yes. SHOULD you have it? No. RESIST!

Oh, that's a tricky one... plenty of people have discussed on here how this surgery affects their relationship with their bf/gfs or spouses. I can't imagine it will be easy, especially when you've both gotten comfortable with bad habits. You should start making changes now so it;s not such a shock when surgery comes around... do you have a surgery date yet? I have a girlfriend who has a similar relationship with her bf. They live together and both don't like to cook much. They eat out probably 5 nights a week - and they eat bar food at that. Pizzas, subs, fried foods... she's gained probably 50lbs in the 2 yrs she's been with him... and he stays skinny. It's not my place to tell her to stop eating like that (esp since she's still way thinner than I am - but even at my WORST I didn't eat as poorly as those two do!), but I always have the urge to tell her to slow it down! But I have my own bad habits to work on, so I TRY to keep my opinions to myself!

thank you everyone for your responses... I don't know what to do yet, but it definitely helps to hear how other people deal with it. I'm also a private person. I've already started spilling some Beans because my coworkers have noticed that I'm taking more half days (so I can make my MD appointments), and they're curious. I am not a good liar, and I don't enjoy lying, so my creative responses are vague and so far it's kept people out of my business. I think I'm going to just say "I'm having surgery" and leave it at that. If they ask more questions, I'll just tell them I'm not comfortable discussing my medical issues and leave it at that. It's the truth, and it doesn't force me to talk about things I don't want to discuss. IF ONLY it was as simple as telling people MYOB!!

How much extra are you paying? If you don't mind my asking...

well, I haven't been sleeved yet, so I'm just speaking from my experience from gall bladder surgery, combined with what I've read here. GB surgery isn't that different from what this surgery will be, except for the huge staple line in our stomachs. You can move around, you're just very tender in the abdominal area, and you use your abs for just about every movement you make. I would get this "pulling" pain (no other way to describe it) if I laid down in bed. I had to be nearly sitting all the way up to be comfortable enough to sleep. And walking was okay, but after about 5-10 minutes, I'd get an ache and have to take a break. A simple trip to the grocery store for a few items would wear me completely out. Don't expect to be incapacitated. You can do most stuff, but reaching up for things and bending over will be very painful for a few weeks. Don't push yourself beyond what feels doable. Your body will let you know when it's time to slowww downnn. Having the GB surgery was painful, but it wasn't terrible. After about 5 days, I was fine. I was back to work 9 days after surgery. (office job) Knowing what to expect isn't scaring me off from doing this! The post op pain is temporary, I'm more nervous about all the other changes that will come once the surgery is done... losing weight, having clothes that fit, knowing what/when to eat, staying healthy, getting enough exercise... this is what concerns me. Surgery is only the beginning!

Just to clarify -- I'm not suggesting that a surgeon asking you to lose weight is a bad thing. The surgeon I saw first was just particularly rude, and it seemed that asking me to lose 50lbs was excessive. If you go on a liquid diet, you'll lose weight. Even if you go on a partial liquid diet with shakes as Meal Replacements twice a day, you'll lose weight. As long as your surgeon isn't setting an unrealistic goal (50 lbs was excessive, IMO), then there's no reason you shouldn't try. Besides, the more you lose pre-op, the closer you are to goal!

Good luck to you, Diva1!! Alexian is a great hospital, I'm sure they will take great care of you. I'm hoping for a speedy (and favorable) reply from BCBS - for you and me both!!

Sounds like you'll have challenges no matter where you go! How often would you have to go up and down the stairs? I mean, moving isn't impossible, just uncomfortable. You'll have to walk around anyway post op, but stairs could be a challenge, for sure. It's not like you'll be completely immobile, though. Does your cousin go to school? Would it be terribly inconvenient to go to your aunt's during the day and go home at night? I can totally relate to wanting to be at home, though. My parents house is very comfortable, very quiet, in the country and very big. My dogs are even welcome to come with me. But I know me, and I'll just want to be in my own home!! So I only plan to stay with them for 2-3 days tops after being discharged from the hospital. I'll have to make arrangements for laundry, because my laundry area in the basement has really steep stairs, and I won't be able to lug the baskets up and down... I'll have to make arrangements for someone to come help with groceries and stuff too... but just think, it's only a few weeks, then we'll be back to ourselves!

I had a surgeon tell me she wouldn't even consider operating unless I lost 50 lbs first. I immediately found a new surgeon. And this one sees no reason to make me do that (I told him about the previous surgeon). It never hurts to get a 2nd opinion.

I am going to my 2nd surgeon consult on Friday. I'm supposed to schedule my surgery on that visit, and I haven't yet told more than a handful of people that I'm doing this. I told my BFF and my parents, and I discussed it with my manager at work. Tomorrow, I have a meeting with my supervisor (my manager is no longer in charge of me since I told her about my plans back in July, so my new supervisor doesn't know what's going on with me), and I plan to tell her that I'm going to have surgery. Then I need to talk to HR about using FMLA/taking time off, and I'm just concerned with how much my privacy will be respected. I plan to preface every convo with "This is private info that I don't want disclosed to anyone else without my consent". Is that being overdramatic? I work in a really gossipy office... Frankly, I don't want to tell all my coworkers. But I work on a very small team, and a 2 week absence will be noticed. By everyone. So what do I say? Do I make up some stupid lie? Or do I bite the bullet and tell the truth (considering people will probably start asking questions when the weight comes off anyway)? Also, I've had this news on the tip of my tongue to tell my other friends for the longest time... but it doesn't come up. Now, I already know it's not gonna come up in conversation UNLESS I BRING IT UP, but I just don't want to deal with the judgment that could come with telling this news. Do I really care what anyone says? I mean, not to the point that it's going to change my mind, but I just don't want to see any of the people I care about differently because of how they may react to the news. And I don't know what it means that IN MY HEAD, I'm imaging that the people who love me would be anything but supportive... So, moreso than sharing my plans with friends/family, I wonder how everyone else has dealt with telling the news to others, like coworkers/bosses. Did you come clean beforehand? Or after the fact? Or not at all? What were your reasons for making your choice? Did you tell your whole family? or keep it to yourself? I appreciate anyone who replies, please be honest... no judgment!

I plan to stay with my parents for a few days, then when I'm comfortable, I'll come home. But I live alone, so my reasons aren't the same as yours. I'd advise to stay where you'll be taken care of the best. The last think you'll want is to give yourself a hernia because it "will suck not to be with him at night". I had laparoscopic surgery to have my gall bladder removed a few years ago, and I couldn't even lay down in my bed for about 3 weeks, so most likely, you'll be on the couch or in a chair by yourself anyway. I lived with my bf at that time, too, and lemme tell you, being in pain after surgery made me really cranky, and we argued all the time. That was really the last thing that I needed when I was all hurty from surgery... You are doing this for you - not your bf. I'd hope you could both stand to look at the bigger picture and not worry about sleeping separately for a few days if it means you're being taken care of properly....... can't he come visit you at your aunt's house anyway?

I'm so glad you said this because I was getting myself all worried about this 2 yrs of medical records business!! haha, I had H.M.O last year and found out they required an 18 MONTH supervised diet, so I switched at the beginning of the year when open enrollment came around. The PPO doesn't require any diet, but you had me scared that you knew something I didn't know! Diva1 - In rereading, I'm not sure I answered your question... if you're wondering about approval time-wise, from start to finish, you're looking at a few months - depending on how quickly you can get the psych eval, the NUT visit and surgeon consult scheduled, plus you'll need to see your PCP for a physical. Then once you see the surgeon, they will likely order more pre-op testing which could be lengthy, depending on your medical history. Once you get all that done, tho, BCBS will give a response within 30 days - usually much less - and then you can schedule your surgery. Patience is a virtue I really don't have, so the best advice I can offer is to stay on top of all your providers, call frequently for cancellations if they tell you it's gonna take a while to get an appointment, etc. You can definitely hurry this along by being involved and following up with everything. Diva, where are you located? Do you know where you want to have your surgery? There are only certain providers that BCBS will approve to do bariatric surgery - if you need help with that, let me know!

Well, hopefully you can get the scope ASAP so there's no delay for your surgery - the surgeon needs clear idea of what he'll encounter during surgery, so the testing is more to prepare him, not to decide whether or not you can proceed with surgery. Good luck, I hope you get good news!!

Well, I have completed all my pre-op testing, finally. I didn't have to do a lot of stuff that other people have mentioned they had to do... I'm hoping that doesn't present a problem when I submit to the insurance to approve the surgery. But if the surgeon doesn't think it's necessary, it shouldn't be a problem, right? :\ All I needed was blood work, an EKG and physical with my PCP, and an upper GI. Easy peasy. Anyway, I go back to the surgeon on Friday to go over the test results and I'll get scheduled for surgery as well. They explained that I'll get scheduled for about 3 weeks from then and we'll submit to the insurance to get the approval before surgery (hopefully). I'm hoping this will go smoothly, but if I've learned anything in the last 9 months it's that NOTHING GOES SMOOTHLY where this surgery is concerned!! Wish me luck, hopefully the next time I post, I'll FINALLY have a surgery date!

I have BCBS PPO. Here's a link to the current medical policy: http://medicalpolicy.hcsc.net/medicalpolicy/home?ctype=POLICY&cat=Surgery&path=/templatedata/medpolicies/POLICY/data/SURGERY/SUR716.003_2012-02-01#hlink And here's the criteria, direct from the medical policy: PATIENT SELECTION CRITERIA FOR COVERAGE For a member to be considered eligible for benefit coverage of bariatric surgery to treat morbid obesity, the member must meet the following two criteria: 1. Diagnosis of morbid obesity, defined as a: Body mass index (BMI) equal to or greater than 40 kg/meter² (* see guidelines below for BMI calculation); OR BMI equal to or greater than 35kg/meters² with at least two (2) of the following comorbid conditions related to obesity that have not responded to maximum medical management and that are generally expected to be reversed or improved by bariatric treatment: Hypertension, OR Dyslipidemia, OR Diabetes mellitus, OR Coronary heart disease, OR sleep apnea, OR Osteoarthritis; AND 2. Documentation from the requesting surgical program that: Growth is completed (generally, growth is considered completed by 18 years of age); AND Documentation from the surgeon attesting that the patient has been educated in and understands the post-operative regimen, which should include ALL of the following components: Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program; AND Behavior modification or behavioral health interventions; AND Counseling and instruction on exercise and increased physical activity; AND Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health; AND Patient has completed an evaluation by a licensed professional counselor, psychologist or psychiatrist within the 12 months preceding the request for surgery. This evaluation should document: The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations, AND The absence of any psychological comorbidity that could contribute to weight mismanagement or a diagnosed eating disorder, AND The patient’s willingness to comply with preoperative and postoperative treatment plans. Hope that helps!