flmama

I'm the same way...rarely go to the doctor, no comorbids. But I do get my annual well visit each year and the surgeon said those were just fine to use for my weights! Even better because they were at about the same time each year.

Yes! I tried to get an appointment for mid-January, but my surgeon's office checks your insurance requirements first and of course the insurance coordinator was out for the first week of the year, then she had a two week backlog...and then she was just running behind...so I didn't get scheduled until early February. Then my PCP took their sweet time getting info over (fully supportive, just the medical records person said she had 30 days to get the records to them). It's a lot of hurry up and wait while you wait for all the moving parts to do their jobs...someone here told me the most important thing to remember is that this is not important to anyone but you!

Just got scheduled for April 11! I'm flmama80 on MFP if anyone wants to be friends.

Surgery is officially scheduled for 4/11/13! My pre-op diet should be "easy"...I am having oral surgery on 3/22 and won't be able to eat anyway for 7-10 (and won't want to if this one is the same as the last one I had). Hopefully I'll sleep through a good portion of the pre-op diet on pain meds!

Thanks y'all! I'm so excited and can't wait to be on the loser's bench!!!

My coordinator called in my info on Monday 3/4 and was verbally told I would be declined because I didn't have a 6 month physician supervised diet (after being told in January that my only requirement was to have "tried and failed" to lose weight). She raised a fuss and I raised a fuss and we went ahead and submitted everything anyway and I planned on using Lindstrom if I got an actual denial. I called to check on it late last week and the nurses said it had actually been sent for a physician peer to peer review, which surprised me...I thought that was only for appeals, but she said the way THEY work (Aetna Signature Administrators...a self-funded plan being administered by a third party administrator) is that if the nurse can't say "yes", it automatically goes to peer review, because nurses can't determine medical necessity. So, I figured it was just delaying the inevitable "no." I just got a call from the nurse, telling me that the physician director approved my surgery as medically necessary after speaking with my surgeon and PCP! Hooray! I can't wait for the coordinator to call me to schedule now.

Im in FL. I will be sleeved in Gainesville.

Have any of you ever tried acupuncture or tai chi or breathing / relaxation techniques? I hated the hangover from meds, so i looked into other alternatives and they work better for me. If i start getting into a really bad insomnia cycle that i can't break, acu works wonders. Generally 1-2 sessions and i am sleeping like a baby again. Otherwise i can generally do some meditation/visualization while laying in bed to use my mind to physically relax certain parts of my body and focusing on my breathing. Im usually out within 15-20 minutes.

Im not sleeved yet, but i used to be a big fan of juicing. My nutritionist said to throw that machine away. It is basically giving you all of the carbs (sugar) from the fruits and veggies, without any of the beneficial Fiber that normally offsets the carbs and makes them healthy. Yes, you are getting concentrated amounts of Vitamins but if you take a multi, you dont need them. My nut is a huge fan of a real / whole food diet (eg getting off the processed and packaged Protein stuff asap), but not juicing. You would be better off measuring out some power house fruits and veggies and making a green monster smoothie...with or without Protein powder or greek yogurt. You would get the benefit of the fiber, which would offset some carbs. Most people stall when their carb counts are even moderate and fiber intake is low. Combine that with not enough Water and a "maintenance" level calorie count and there you go. I hope you get some answers soon!

They're $18.88 at the Sams in the next town over from me, but only have 12 in a pack.

Yes, sorry! Premier Protein! Sorry...I have a toddler hanging off of me. It's all I can do to put a coherent though together.

How much is a 12 or 24pk (or whatever size you buy) of PP shakes at costco? We don't have a Costco locally. I am trying to compare the cost of buying them a few other places, including an online delivery service. Thank you!

A nurse called me today to update me and let me know that the peer review sshould be completed next week. Apparently if any info is missing or its not a clear "yes " they automatically do a peer to peer review. So it is possible that they could determine its medically necessary without me doing the 6 month diet. So here is hoping.

I'm sorry for all of the questions lately... So, my file was submitted to insurance on Monday. They verbally told my coordinator that I would be denied because I didn't have a 6 month diet (after telling her in January that I only had to have "tried and failed" to diet in the past...nothing about the 6 month diet). I called today to ask a question about the 6 month diet and the nurse told me that my file is in physician peer-to-peer review. I thought peer reviews were just for appeals after you have been denied? Did anyone else have a peer review with their first submission? I'm hoping that this is a good sign and there is a chance they will approve without the 6 month diet, since they gave incorrect information to my coordinator. Trying not to get my hopes up though.

If you have used or are using Lindstrom and don't mind discussing the process and your outcomes, will you please respond here or PM me? I understand most of the responses will likely be PM, and that's okay with me.

Don't I know that! We hoped and prayed for this job for YEARS, because we knew that they covered WLS. Ugh. I just had no idea when we got here there would be hoops and hoops and hoops. Of course, I KNOW that their desire is to avoid paying for the surgery if at all possible. I already cussed at my hubs on the phone...he took the brunt of my frustration. I'm hoping on some hand that his phone call to them accusing them of being intentionally misleading will somehow equal an approval, but I doubt that's going to happen. We are due a really really large tax refund, so I am looking into MX too, just in case. It was supposed to buy us another vehicle, but who needs 2 cars? When does my 3 days start? Tomorrow?

I actually prefer it to the website. Sshhhhh!

Which physician did you choose? How and why did you choose them? I'm not sure if this is an option for me...I worry because my insurance has an exclusion that specifically outlines they will not cover complications or after care from any non-emergent surgery performed outside the US. But I want to do plenty of research into my other options. My insurance is a self-funded "aetna" plan that is run by a third party administrator. That TPA was intentionally misleading about my requirements. And my worry is if I now jump through this set of hoops they are setting out, what happens when there is another set of hoops. And another. And another. Etc etc etc. So please give me the skinny on how you came to your decision...I am sure I'm not the only one out there whose insurance has this type of exclusion. I just know that I need to do something ASAP. There are so many programs and physicians to choose from, I just don't know where to start.

I have it on my Kindle Fire and it works fine.

Yes, it is a long journey. One I've been preparing for for several years. I've been in therapy for my eating disorder for quite some time. It is a major set back to be told you're going to be an "easy" case insurance-wise and you're ready to go when you've been mentally preparing for years.

Yes, they require documentation from the physician and I have to keep a food/exercise journal.

So I had pulled requirements from my insurance companys website and was prepared to do the 3 or 6 month Aetna pre-op stuff. When my surgeon's office called to pre-verify everything before even scheduling my first visit (which took WEEKS, when it should've just taken minutes...first batch of time wasted), they stated that the insurance company said I just had to have "tried and failed" to lose weight in the past. But couldn't say anything about specific diets and there were "no specific requirements." I asked multiple times if they were sure. I called my insurance company and asked and they said to follow my surgeon's instructions. So here I am, on March 4, after wasting yet another month for PCP/surgeon to get all of their paperwork together and get it submitted, and I find out that YES, I have to have a 6 month physician supervised diet. I didn't see my PCP at all in February, because I saw the surgeon and my surgery was supposed to be this month. I'm so freaking frustrated. I was mentally prepared to do the 3/6 month thing, and then they told me I didn't have to. And now here I am again, and I do have to. And I can't even count my January visit, since I didn't see him in February. And I'm not going to count my February visit with the surgeon, because I'm not making a 9 hour roundtrip drive once a month for 6 months. I'm FURIOUS.