Silly Phylly

By the way, mine was diagnosed by ultrasound and was having issues with abdominal swelling.

You would think my bcbs would recognize fatty liver as a comorbidity for surgery, but apparently my doc does not think it is good enough. He says you have to have HTN, diabetes and sleep apnea along with any others. I'm Ms. 39.18 BMI and having to do the 6 month diet as a result. 40 BMI and I would have been good to go! Swift kick to the old gut and spirit!

Called Cigna today. Got the bad news. They say I was denied because my surgeon didn't send in a letter from an additional MD stating that I was evaluated and ok for surgery.

I called and left my surgeon's office a voicemail. I just assume that if the insursance coordinator in the office does this on a regular basis that he/she knows what to send in.

Guess I'll have to micromanage them now.

So sorry to hear your news, but I for one appreciate you posting the issue. It helps others to know what to be aware of. I had a big disappointment as well. Informed by Doc that my BMI was only 39.18, so 6 month diet and frustration here I come! Sooooo upset! Hopefully yours is just some red tape and oversight that will be corrected soon. Continued good luck to you!

I have Blue Cross AL and was approved with BMI 38.7. I do have type 2 diabetes, but that is my only other co-morb. On the sixth month "diet", I went up and down. My pcp warned me not to lose too much if I wanted the surgery. I was approved the same day they submitted it.

Thank you so much for your reply! I am still cautiously hopeful!

Heck I would start eating everything you know you will never eat again!!!!!! so you gain a few pounds, that will prove your DIETING does NOT WORK! keep us posted... we are all ROOTING for you.... you can and will do this!~!!! Ü

I dang sure wished I would have downed a double super sized cheeseburger before I went in! Thanks for the support! This site really is awesome!

Next weigh in. Keep your shoes on and maybe add some ankle weights. However to my understanding if you have 2 comorbid. Conditions your bmi can be as low as 35.

Once it is initially and officially posted on my docs notes, will BCBS even consider it if I go up? I go tomorrow to a sleep clinic to attempt yet another sleep study. The one I had before said that I had apnea, but not enough to justify a c-pap, which I actually wanted! I just wanted to feel better! I know this will all work out, but I need you guys to allow me to vent and give me some encouragement in the mean time. By the way, I am on Metformin for pre-diabetes and according to my Doc that is not good enough for a comorbidity. It has to be full blown diabetes, high blood pressure or sleep apnea! Dang, they need to take my BP right now!!!!!! Looks like I'm gonna have to get sick to get better. You would think they would see this as an opportunity to help me avoid illness and eventually save them money in the long run!

Saw my Doc and got the official BMI of 39.18! Less than a pound away from being approved by BCBS AL! Ughhhh! See my internal med Doc next week to start the 6 months of diet and frustration! I wish I could just go straight to Alvarez, but I know I need to try to get it covered by insurance. The money that I would self pay with needs to be put aside for any cosmetic issues that I may have in the future. Oh well, nothing worthwhile is ever easy! Par for the course for me! God knows best and He will see me through! I just need you all to help keep me sane through all this.

Know of anyone turned down after going on the 6th month diet? Just curious! Went to seminar and asked if that was BCBS way of prooving you can do it on your own to turn you down and Doc answered no. He obviously is as frustrated as we are about it. Chime in if you know of any circumstances.

I am at a BMI of 37 and have the same comorbidities as you! Coverage remains to be seen,but I am hopeful. I am 45 years old and the way I see it this old dog is not capable of learning new tricks, so long as there is a grumbling, growling bear inside of me. I have got to render food powerless over me! With the sleeve binge eating should not be an issue since the sleeve will stop me. Let's start a prayer chain for all the up coming and previously sleeved patients. We need all the help and support we can get with our individual circumstances! Good luck to you and God bless! Keep us posted on your progress and experience!

Danville, Alabama you need to join our Alabama and MS group! Only a few of us, but we need to represent! By the way Roll Tide or War Eagle? LOL! That's important info you know!

Good question! I am a newbie too and just getting started on my journey to being sleeved. We need to learn all we can upfront! I actually was wondering about this earlier. To keep from stretching or prevent sickness from overeating we need to be able to visualize an appropriate amount. Kinda funny that this eating expert is going to have to learn how to eat! Let's see if some of our advanced experts will give us our answer!

Ok Auburn girl you need to join our Alabama and Mississippi group! There is only a few of us, but we need an Auburn fan in the bunch! You know we got to have some fun along with all this! See you are headed to Alvarez! He is my plan B if insurance does not pan out. I am going to B'ham to Dr. Miles right now. Congrats on your August date! I don't expect to know anything for 6 months as I am a BCBS of AL patient. Such a bummer! I will have to do the 6th month diet to satisfy BCBS requirements. Ughhh!

With you sweetie! Sat through my seminar saturday and cried the whole time. I was happy for the opportunity to actually take charge of my health, I pictured myself a year past surgery, I rejoiced with those that had already made their decisions and achieved success! While Doc was giving the pep talk for those that were still unsure, I was mowing over people to be one of the first in line for my initial doc appointment. Because I am BCBS of Alabama I am required to go through 6 months of physician monitored weight loss program. I am going to be fit to be tied before it is over! I can't wait! I know it will be one of the hardest things I have ever done, but oh so worth it! Been planning a trip to Alaska for a couple of years and I am determined that I am gonna hike Denali National Park and be able to keep up with my firefighter husband that is 5 years younger and my preteen daughter! I hope with my surgery's help I can make it happen next summer too! Got to jump these insurance hurdles first! Ughhh! God is good and He will see us through girl!

Anyone been to a weight loss clinic such as Physicians Weight Loss and it was covered by Blue Cross? I know they don't cover Weight Watchers etc... Just trying to decide what program to pursue for this 6 month BCBS hurdle! As you know money is an issue! Got to try to do something covered by insurance if I can!

Just curious if any of you gals know of any cases where someone was actually turned down after completing the 6 month diet? Went to seminar at St Vincents East saturday that was conducted by Dr. Miles. I asked him if they made you do this to proove you can in order to turn you down and he quickly answered a resounding no! He said "don't get me started"! He obviously thinks it is ridiculous that they put us through that.

With you dude! I am just getting everything together myself. Hope to know something before end of year, because I would like to have my surgery during Christmas. Merry Christmas to me! Hopefully I will get approval, otherwise Dr. Alvaraz here I come with another credit card in hand! ( Pray that it does not come to that, but never hurts to have plan B!) I have several comorbidities so I am hopeful!

I am a newbie too! Good questions! Maybe someone will chime in soon!

We are human! We want it and we want it now! Just like I have made up my mind to do this and I am going to be forced to wait on insurance approval and jump through all these hoops first. Having been a nurse, I just imagine that your metabolism is going to have to kick in first. Once you get more energy and start moving more, things should speed up. Best of luck to you!

Good luck sweetie! I don't know if you are a spiritual person or not, but I will say a prayer on your behalf!

Having been a nurse I must admit I am a little concerned. I hope the campground is not too far from home and I sure hope you are not here in the hot balmy south! Sweat and drain tubes not a good thing! I would be a little concerned about infection. Please be careful! Best of luck sweetie!

It is wonderful to see you "taking the bull by the horns" at a younger age. Most of us on here have struggled most of our adult lives with weight and all the issues that go along. I just became a grandmother for the first time and it really put things in prospective for me. I want to be able to run and play, go camping and work around the house and garden with my hubby etc... I am plan on being sleeved during Christmas this year, as I am a teacher. Best wishes sweetie!

Surgery and your health comes first! Thankfully due to your sleeve you are going to have many opportunities to go camping and hiking etc.. in the future! That is one of the things that I am looking forward to the most. I want to be able to go on 5 mile hikes with my hubby and be able to keep up. I have not been sleeved yet, but hope to schedule during Christmas holidays as I am a teacher. By the way, is this camping trip in an RV with a comfy bed? If it is go for it! You can lay around in the RV just as well as you can at home. Good luck!

From a nurses prospective, yes, everything is changing including hormone levels. Every system in our body is dependent on the other systems and their hormones. The sudden weight loss can be percieved by the body as a stress, eventhough we know it is a good thing for us. Stress plays a gigantic role in the proper functioning of our body's hormones, not just sexual hormones either. Find ways to reduce stress and in the meantime try to enjoy the wifely duty anyway. You may find it just takes a little initiative to press the old buttons! Otherwise, you can have your hormones tested. I would suggest finding someone that does saliva testing. It tests the hormones that the body has uptaken from the blood stream. Whereas, most MD's test blood levels, which does not tell you if you are using the hormone on the cellular level. I worked for a practicioner that specialized in the natural hormone replacement therepy and I am a full believer! Been there done that and hubby and I love it! Can't wait till I get my new sexy body to go with it! :wub:

I am a newbie and getting my ducks in a row to try for insurance approval! Any advice from a BCBS of Alabama insured?

I am scheduled to see Dr. Schmitt at St. Vincents East in Birmingham. Anyone out there had Dr. Schmitt? Chime in with advice and recommendations!