Heath55

I'm just heard from my surgeons office and the doctor "surprise" called a day early as she called it and "upheld the denial" so now I need to do a personal appeal called a Level II appeal and I'm going to request a TTY third-party review of the chart. The doctor that reviewed it is a known strict ass and he denied it saying that just because it didn't work the first time doesn't mean I should get a second one. They said that the second they heard his name they knew the answer. I got quiet with her on the phone so after a pause she continued on even though I was silent and as I had to briefly speak and she knew I was crying she said "and that is what you need to show them when you make your appeal". I already had to collect myself and hide my crying before I went back in with one of my patients and I literally want to throw up I'm so upset and afraid. Good luck with yours, it seems like is more about my provider and that specific doctor. Let me know how yours turns out, I'll curious about other providers mentalities.

That's my thoughts and I didn't even come clt she to meeting their 50% loss for the revision criteria. I asked my surgeon for my feet to write a letter of medical necessity from his end so hopefully that'll kick it up. The letter from my PCP was very detailed and supportive so I really don't understand how I got denied based on her recommendation as well. I literally was up all night panicking and went to bed about 11am after talking to a few specialist offices and my Bariatric coordinator. Pathetically I cried for most of the 15min call but she said the review is scheduled for Wednesday. I saw a lot of people say that did it for them so I'm trying to remain hopeful. Thanks for chiming in and the support, I feel like I'm going crazy over here.

On 01/02/13 I had the sleeve done and unfortunately it just didn't really take. Of the 365lbs I started at, my lowest weight was still in the 290's post op. Last June my mother died unexpectedly and young just like her father and brother (all cardiac traumas and it runs significantly on my fathers side too). It scared me into getting myself together and getting back on track, which I've been doing. While I lost only a fraction of weight the first time my quality of life and activities was and has been phenomenal but unfortunately I'm still borderline diabetic, I'm putting stress on my heart, my PCOS is out of wack with multiple cancer biopsies due to this, I started to have high blood pressure and the extra weight caused foot problems. I had two surgeries on my R foot in the last 6mons with little success and he feels my weight is a considerable part of this. I'm doing PT 3x's a week to regain mobility but that's significantly slowed me down. I work in the healthcare field and know the system pretty decently but today AmeriHealth denied my revision for full bypass. For my first surgery I had Horizon and AmeriHealth told me that as long as it wasn't through them because they're a "one and done" provider and I meet the medical criteria that wouldn't be an issue. I'm currently about 300-307 and my BMI is about 49 and I'm being denied. I'll attach the criteria they sent me again today but any tips on making this happen would be immensely appreciated. Quite frankly I'll die before 60 like my mother with all of my medical issues that could be alleviated and even eradicated with proper weight loss. I'm going to try and attach a screenshot that I was given by my insurance subsidiary in NJ and if someone can tell me how I don't qualify please go for it because I can't fight something I may be too close to see. I'm feeling really frustrated and defeated but I refuse to roll over. After some pushes with calls today I will have a peer review but they don't know when. Thanks for making it through my ramble.

What's you're diet look like for the next week? Om god everything worked out :-)

I just had mine done at OLOL in S. Jersey on the 2nd. It really does get better each day but the 1st day or 2 killed me. So far so good and love my doc :-)

Thanks Lorraine! My insurance and doc have me (barring complications) staying the night and leaving around dinner time the next day so it's about a day and a half stay. I heard walking really helps with the pains and since I know with vitals I won't be sleeping much anyway. The leak test both friends said they almost vomited over so that's excitement in the works, lol. I have such issues with permanency so I'm hoping the buyers remorse is minimum. It took me years to be ready despite my doctor begging me so I hope it'll be minimum to none now. I "kinda" have a have a good support network back home waiting. While I love my family, several of which who live with me, they are unhealthy to say the least and after much careful thought I chose not to tell them. I'm a therapist by trade and discussed it with my own therapist and it's just in my best interest. I have a few amazing friends who offered me to recover at their homes but there's something about home that I can't replace and my own space so I'm not sure what I'll do. Plus if I stay elsewhere I'll have more to explain. The syndrome that causes my weight gain causes me to need multiple surgeries too often so I can say it's related to that. I also hate burdening the worriers over the holiday especially when I don't have details to offer. BTW no TMI I need it all and thanks for taking the time!

Ugh you're so lucky. I know people who had it for months, mine was recommended for 2 weeks but I'm just starting it. They said as long as its 4-5 days strong before I'll be fine.

The friend who had hers 3 months ago is coming into town the week of my surgery and said she's bringing me a gift of some awesome caffeine alternative :-) OMG really Mexico??? Where are you from and why Mexico? I'm in South Jersey by Philly. The surgery is actually at the hospital I work in (not intentional last minute change) and I'm trying to figure out how to stay incognito lol.

I started making the jello today lol. There's a decent number of threads that have good ideas. My doc said 2 shakes a day to supplement those meals and one healthy carb free meal a day. I'm trying unsuccessfully to wean myself off coffee too.

How are you doing with your pre-op diet? I'm sure it's the right choice and I'm excited to be healthy and more alive but It's such a huge sudden life change. It's good to know someone though on the same date and timeline as me!

Thanks I just hate the unknowns and not being sure how to prepare for this. I think just saying it out loud is helpful instead of holding it in obsessing :-)

I'm scheduled for 01/02 and while I know I'm ready and this is right I'm starting to think/worry about it constantly. I have a friend who's 3 1/2 months out, doing great and a wealth of information that usually calms me but another friend who just had hers on the 12th is having a whole other experience. They're different types of people and I know your own mindset sets the tone but I'm not sure what to realistically expect immediately after surgery for the first week or two.