almosthome

After more than a week of phone trouble with the insurer, I finally reached someone...via Twitter! They will check to see if the pre-cert request arrived.

Will do!

You'd think ACA would include at least the minimum benefits provided under Medicaid. It's weird.

Today I called the hospital again, and the insurance coordinator said she thinks my request has now been submitted. She sounded busy, though, and didn't actually go look. :/

The NJ approval criteria don't specify a supervised diet, so hopefully you're all set. Yayhoo! I contacted the hospital earlier this week, and they said they were still trying to find a way to submit the pre-certification request. Also tried several phone numbers at BCBSIL and was unable to reach a live person. :/ Oh, well.

Heh. You mean people see through the word 'tips'? Darn. Need to be sneakier next time...

1. Read well. Posts don't come with body language, vocal inflection, or a life tour. If the OP didn't write it, don't assume it! 2. Ask lots of questions...carefully. Never reply with "I think/believe/am pretty sure you really want/mean/feel ___." Instead, simply ask if it is possible they really want/mean/feel something different. Give the OP time to reflect without feeling misjudged. 3. Empathize along the way. ＼(~o~)／ (>_<) (T_T) 5. Offer options, advice, and suggestions rather than "you should ____." Explain the costs and benefits to help the OP make an informed decision. If you are responding to a medical question or concern, emphasize professional resources and not your personal experience or hearsay. 6. Does your advice stem from values or opinions the OP doesn't share? If you don't know, find out. Respectfully explain any relevant differences when posting your advice. 7. Avoid over-generalization. There are relatively few things that can be said of all or no people. 'Some' is a safer word. When being more specific, try to use numbers (citing research) in place of words like most, few, many, often, etc. Likewise, 'you might be ____' (stating a possibility) is safer than 'you are ____' (stating your assessment as a fact). 8. If you feel offended by a reply, contact the author and/or moderators privately. Emotional debates and public offense over matters of opinion just detract from the larger conversation, causing stress, anxiety, hurt, and division. Do we want that for each other? ~~~ posted with love ~~~

Thanks for your encouragement, sleeve30. I have met all the requirements and am just waiting on the fix. Congrats on getting coverage for yourself! Don't be afraid to pester the insurance company with calls if you don't hear from them soon!

We all want the absolute best weight loss outcome for each other, but along the way we need to respect individuals' values. Many think of surgery as a turning point for their food choices. They will abstain forever from all junk food because they value physical health above the experience of food. Others simply view surgery as a way to limit the amount of foods they already eat. They will eat fried and other 'junk' foods in moderation, understanding this could result in slower or less overall weight loss, because they value the food experience more than rapid physical improvement. That said, the first few weeks following surgery is not a safe time to test your limits! My surgeon said the main risk of inappropriate foods after sugery is aspiration (resulting in pneumonia).

The insurance company's computer system won't allow an electronic pre-approval request for an inactive member. Faxed/mailed pre-approval requests (for inactive members) are automatically trashed. Since the BCBSIL computer system still thinks I am inactive (not paid up), the hospital cannot successfully submit my pre-approval request because the insurance company blocks or disposes of it. The hospital has been trying since Febraury 25th.

Haven't had surgery yet, but when my mom had her breast reduction she experienced severe itching at the incision sites. Turned out she was allergic to the antibiotic ointment! After switching ointments she healed perfectly well. Minor itching is normal whenever you have a healing cut (especially if the area is dry), but sustained moderate/severe itching accompanied by swelling and increased redness probably deserves medical evaluation.

A clarification: the initial delays were due to the hospital's pre-submission process.

Note: I am extraordinarily grateful to have health insurance and understand there are many whose plans don't cover bariatric surgery. This post is simply a reflection of my current feelings and frustrations regarding unmet expectations -- expectations I thought were completely reasonable. On December 1, 2013, I was finally able to select a Blue Cross Blue Shield plan in Illinois through healthcare.gov. It was such a relief to finally be able to get medical care without sky-high out-of-pocket expenses. But BCBSIL messed up my application processing. First, they cancelled my medical insurance when my dental application came in and had to reinstate the coverage (thankfully, still effective January 1). Second, they invoiced incorrectly, showing I only paid through January, so providers were blocked from the preapproval system. I couldn't even get my prescriptions covered despite having fully paid my premiums. After >20 hours (of my time) on the phone and nearly a month since BCBSIL first fully identified the problems, my providers still can't submit pre-approval requests, and I still have to pay out-of-pocket for prescriptions. I filed a complaint with the state insurance board but don't know how much that will accomplish or how long a resolution will take. Re: Sleeve - BCBS in IL (and other states) does not require a supervised diet, so I expected fast approval for the sleeve. Originally I had hoped for February surgery. Then I hoped for March. Now it's looking like late April, which leaves me in a difficult position. This spring was a convenient time for surgery. I'm just writing my masters thesis and looking for work. If surgery comes too late, though, it could necessitate delaying regular work. It's beyond irritating. Thanks for letting me vent! <3

Congratulations, Lucy! It's encouraging to hear about your success and newfound health! Look how far you've come; you can totally manage those last 10-15 pounds.

They told me to pick a prenatal with any amount of iron and calcium and add that to my current D3 and B12 regimen (have a history of deficiencies in those). I chose BellyBar chewables, which have a mild taste (though who really knows how things will taste after sugery?). Different forms/combinations of vitamins have better absorption rates, but unless my bloodwork shows new deficiencies I'm going to stick with the cheaper stuff.

Welcome, Cathy! You can do this!

Diane - You and I are both just waiting on insurance now! Unless they gave you good news today... readyanxiousscared - I only had two appointments with Dr. Berger. Blue Cross Blue Shield doesn't require a supervised diet so the process was a bit shorter than for most. Here's a breakdown of my appointments: September 25 - Info Meeting January 10 - Psych Eval January 17 - NUT/Brenda and Dr. Elli February 17 - Brenda, Dr. Berger, and bloodwork February 21 - Psych Eval Follow-up Febraury 25 - Dr. Berger, cleared to send everything to insurance

ferfur - Haven't officially started it yet but did try for one day. Yes, there was some fatigue, but I guess that's the price we pay, right? Hope it goes well for you. Keep us updated. marfar7 - You...you...rascal..... (moving on) I'm not really a fan of carbonated drinks (usually wait for them to go half-flat) but figure it will help entertain my mouth and throat in the absence of substantial food.

Any news, Diane? My last visit with Dr. Berger is tomorrow.

kellyann, it's important to remember that although you will almost certainly lose weight on this diet, that's not really its purpose. The pre-op low-carb diet is meant to make surgery safer & easier by shrinking your liver.

Psst...no replies allowed from people who get to eat meat and veggies on their pre-op diet (j/k!).

Last week the nutritionist gave me pre-op instructions. This is the part I always least looked forward to, because taste and texture are such an important part of eating for me. Thankfully, all categories offer tasty and/or textured options: 2 bottled protein shakes --> Slim-Fast 3-2-1! So tasty. 3 servings of dairy --> light yogurt and cottage cheese. special permission --> 2 cups of egg drop soup/eggwhites in broth. (Don't be afraid to ask! I wanted something warm with texture.) unlimited --> flavored water/diet pop/SF jello & popsicles/plain broth I can totally deal with that for two weeks. Easy peasy. Diabetics with low blood sugar get to eat chicken noodle soup on their pre-op diet, but I'm trying not to be too jealous. :^)

None taken! Looking back, my reply reads a little harsh; sorry about that. I know everyone here is just trying to help, and I genuinely appreciate all the wisdom and stories.

For all the "TL;DR" responders, I wrote in the original post that I don't at all mind going through therapy and do see it as valuable. Please don't assume I'm taking this lightly. My issue is the evaluator says all she really wants is proof I've established therapy yet still plans to make me wait 6 weeks. She herself said the 6-week no-naughty assignment can't prove anything, just short-term compliance (something I have already been doing since November). The problem is timing, not recklessness. I talk to the surgeon on Friday and will ask him about it, too. Thank you!

My WLS journey began several years ago, and everything has finally fallen into place for it: easy insurance requirements, a flexible schedule this winter (thesis writing), etc. I've timed my appointments with the hope that I can have surgery in mid/late-February, giving myself two months of recovery time before graduation and travel for job interviews. Last week, though, I had a psych eval and mentioned that about 5 years ago (mid-20's) I had issues with frequent bingeing (2-3 times a week). I explained that since then, high-junk-food-consumption days have been conscious decisions that occur maybe once every two months (like on my birthday), especially since I know there won't be the same opportunities after surgery. The foods I eat regularly are healthy, and I allow myself a small treat daily to stave off cravings. The psych evaluator finds it concerning that I think it's okay to have junk food days and says she won't clear me for surgery until I can prove I've started receiving therapy and abstained from naughty days for the next 6 weeks. She said she is not so much worried about the potential for short-term failings but rather my ability to maintain loss years down the road. I don't mind seeing a therapist and am sure it can help me prepare for future psychological challenges related to WLS. But I have already done a lot of soul-searching, understand my present choices, and am committed to following the pre-/post-op requirements for safety & success. What irritates me is that she won't clear me for 6 weeks even if the surgeon gives a green light. That means my pre-approval can't even be submitted to insurance until late February. The evaluator said she 'knows it must seem inconvenient'. Have any of you had similar experiences with the psych eval? Did it delay your surgery, or were you able to work it out some other way? Any advice? Thanks!