DreamsOfSkinny

I'm in the process now and nothing was mentioned about being over 35..

Well that's great! My doc was supposed to have my peer to peer today but when I called his office they dont even know if he did it but said he wants me to come in tomorrow to talk. :-/ Hoping this means a Good thing..... But think maybe denied again and he's trying to figure out more info to find a way to get it approved

Hi everyone' date=' I'm currently in school for my BSN and I need everyone's help with answering questions.

What is ur biggest fear? What made u decide to get the GS? How did u pick ur Dr? What are the risks, health benefits?

What r some of the health issues ur experiencing?

Thank u all!

rosRosa

[/quote']

Here goes.

What is ur biggest fear? That I die on the table or have a leak that causes me more health issues than actually being my lifesaver. And not losing the weight or able to keep it off.

What made u decide to get the GS? I have tried everything else it seems, and it literally cuts out some of your stomach and craving hormone. I never seem to feel full.

How did u pick ur Dr? Research and more research. Talked to patients, used Yelp, looked up top Drs. In US for GS. Lucky to find one of the pioneers where I live.

What are the risks, health benefits? Risks- your life. Benefits- becoming healthy.

What r some of the health issues ur experiencing? Getting rid of my pseduotumor cerebri, high cholestoral, weight, arthritis in knees, asthma possibly, and being able to breathe easily just doing any physical activity.

Pseudotumor cerebri. My body acts like I have a brain tumor when actually I don't. Look it up--could be cool for you to use as there are case studies saying WLS cures 80-90% of cases bc it is weight related.

I dont know but I hope we can it works better than some prescribed meds for my migraines

My doc told me losing all the weight should help with headaches in general.

Well first because they said I had no Co morbids. So my doctor had to write basically why I needed it. Example ... if she doesn't have this she is at risk for diebeties' date=' HBO, cholesterol, ect.) And my insurance coordinator wrote that my insurance covers it with no comorbids as long as my bmi is over 40. Then I got another denial saying I needed my regular pyscologist to give me a clearance even though I already got a clearance from the psychologist THEY wanted me to see. Then I got denied saying I needed a Pulmonary clearance. That took a little more time cuz I had to use a cpap for two weeks cuz they saw I had sleep apnea(minor case) then finally was approved.[/quote']

Congrats on getting approved!! You are inspiration for me to not give up just yet.

And yea it was long but. Less than a year of work and now I get the surgery completely free to me. I could never afford this on my own.

Well if you get it 100% free that's great. I have $2k more for my OOP max but that includes any medical treatments me and my family have so the surgery may cost me like $1500 after any other tests I need.

Well in order for my insurance to pay I had to do a nine month supervised diet. Then I got a few denials for little stuff.

Wow! 9 months is a long time.

You look great!! Just wondering since you say you lost slower and you look young, are you having any loose skin issues?

I hope to join all of you soon! I've been denied and am having a peer to peer review on Thursday. Crossing fingers!!!

My insurance coordinator said the same thing. That they are trying to find any excuse not to approve me. I finally got approved. It was an 11 month process but I've heard people going through it for 3 years before being approved. So don't give up!

Omg!! 11 months! I think I'd pay OOP lol not patient at all

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

And she said the insurance is just trying to find anything to not approve me. The Med. Dir. Called their office for a peer to peer at lunch time and left a message with the answering service. When my ins. Coordinator called back the ins. Said the peer to peer was already done. She was livid when i talked to her today. Coordinator said she scheduled it for Thursday an gave the Dr's cell phone to make sure they are reached this time. I am really not hopeful at this point and it'll probably go to an appeal but the coordinator said theres no reason they shouldn't approve me by their criteria bc I meet it all. So I'm just praying! I do have a a follow up appt with my surgeon this Friday which we were hoping to use as pre op so I guess if it gets approved I'll be ecstatic as I'll have pre op appt done and can schedule!!! Prayersssssss

So I called again and got ref. number for call stating that I only need 1 co-morbidity and bmi of 35+ for past 5 yrs although the medical Dir. Of Ins. Said I was denied bc I didnt have bmi of 40+. Second issue the insurance chose 2 of my lowest weights for 2 yrs and didnt even mark down for a whole year EVEN THOUGH my dr. Submitted all health documents! I talked to my ins. Coordinator at Dr office today

My Dr just told me to loose 10 lbs. I'm trying to appeal my ins. Denial but still want to lose the weight so if it is approved I'm ready to go!

Are you on Protein Shakes? How many calories a day? Are you only Clear Liquids for 2 days prior to surgery?

8500 upfront and looks like maybe another 300 ish for some labs etc.. I had mine done in Laredo Tx' date=' Live in austin. It was about 6000 cheaper there than here. My Dr and the experience was excellent.[/quote']

What dr. Did you use?

http://theworldaccordingtoeggface.blogspot.com/2010/03/plan-for-success.html?m=1

Just found this blog that has a lot of quick and easy -portion controlled- meals and ideas on how to get your Protein in. She makes tons of things from the powders.< /p>

I have same requirements. I have been at or above 35 for 7 years. I have sleep apnea. I also have MS' date=' fibromyalgea, had reconstructive knee surgery, arthritis.

I did peer to peer for the first level of appeal, and told no. Sent in written appeal for medical necessity. Told no. Sent final appeal for external review. If that is a no, last option will be to beg my employer for an exception.

My fingers are crossed the peer to peer gets you approval.[/quote']

Oh WOW! Well mine says 35 + 2 comorbities... So you could qualify it sounds like. I have carpel tunnel and arthritis in knee which both are weight related.

I believe the comorbidities have to be directly weight-related.

I were told these were as well as another issue I was dx'ed with---intercranial hypertension

Just curious if anyone has gotten this type of denial overturned. What did you do? My ins states I need 35 bmi + 2 comorbities for last 5 yrs. 3 or 4 out of the five I'm over 35 and more like 38-41 (current 40.6). My ins. States the next step is having my dr. Do a peer review by having a call w/the medical director that denied it.....any ideas?

im sorry! i hope that they fix the numbers so you can be approved!

I hope so too and that my surgeon can make whatever case he needs to for that phone call.

Mentioning the best rate' date=' My doctor only charged me around 9,500, because he knew I was self pay [/quote']

Where did you go?

Anyone go through the external appeal process? Just wondering what this may be like. They say no because 5 years of BMI over 40 isn't recorded. We are trying to appeal under medical necessity because of apnea' date=' fibro, and ms. Just wondering if the external board looks at more then just the policy....[/quote']

I'm going to have to do a Dr review where my Dr will call the medical director of my insurance within the next week to appeal. I have UHC and the medical director said bc of not having bMI of 40+ for past 5 yrs. although when I call about my benefits (which I've done 3 times) it states either bmi of 40+ OR 35+ w/2 comorbities. I also found that my Drs office didnt submit the highest weights I was for 2 yrs and didnt submit any weight for the 5th yr needed so I'm pretty mad with them and have to get the info corrected tomorrow so at least when the Dr talk to the ins. Director he has the right info. I'm scared though bc for 1 yr I was pregnant... So not sure they'll accept my weight.

I have to now call my Dr office tomorrow to make sure they get all the highest weight I was for each year right! Bc I know I should be 35+ and have 2 issues. Asthma and high cholesterol.

Ins. Director said my BMI had to be over 40 for last 5 yrs. This aggravates me as my benefits state 35+ w/2 comorbities OR 40+. I also am annoyed bc my Dr. Office submitted the wrong weights for each year! Now the dr. Office has to wait to get the denial letter and schedule a peer to ppeer reviews to have the Dr. Talk to the medical Dir. That made the decision

I have not been approved by my insurance yet' date=' still waiting. The submission was only made last week, but the insurance coordinator did accept my on-line dieting records.I know some insurance companies have approved patients with 6 mos weight watchers documentation. The cases I am aware of we're with stamped logs from meetings, but apparently the insurance coordinator at my surgeons office think the on-line records will suffice.[/quote']

So did you get approved?

OMG! Can we trade bodies?? I want to look like that at 200-215 lbs! You look GREAT! I would have guessed you were much lighter. You wear it so well.

You can't delete your acct.

Really?? That kind of sucks. Guess I shouldn't ever mention my real name lol!