DebDUtah

This sounds all to familiar to me. I ran into the same run around from my surgeons office. Here is what I did. I let the surgeon know. I emailed my surgeon. Chances are he/she is not aware of the fact that things are getting dropped AND I did it all myself. I even faxed directly to my insurance company, speaking to them on several occasions. I was told that it took 10 business days for my insurance to respond, it was 24 hrs. I think the extra days are for the surgeon. I say this because I send documents to my surgeons office to submit to insurance and it took her 5 business days to resend it to my insurance company who responded in less than 24 hrs. Now, when I found this out, I had one last thing to go to insurance I sent it to my drs office, they told me (on a wed) that they would fact it next week! I wasn't going to stand for it I sent it myself and had my approval by the next morning at 906am. I am now scheduled for surgery on Tuesday. Do not stop being your biggest advocate. You will get thru this and know I have experienced exactly what you are going thru and it will pass and once you get the approval you will feel so much better. Good luck if I can do anything let me know.

Well I do......surgery!! I swear I never thought this day would come, how in the world I didn't lose my mind I don't know. But now, how in the world am I going to keep this smile off my face, oh wait I don't have too! For all those people who may read this and think, what I wouldn't give to me her, to have a date to know it is my turn, you will be here. Don't give up no matter what comes your way just do what you have to get to surgery. I already know it is worth it.

Today my life changed, at 09:02 mst my insurance approved my surgery!!! I thought this day would never come, and now that it is here I am even more anxious to keep going. To all of you that are waiting on insurance approval, who think that everyone is out to get you, who think that the requirements that insurance give you are crazy......I was there and still can't have the clock move fast enough. Well I have my approval and I want my surgery date NOW....but of course my surgeon's office moves at a snails pace compared to how I think they should move. My advice to you, don't give up, do what the insurance says, be your own advocate, talk to your insurance company (the utilization review nurse) and find out what is going on if your feel like your surgeon's office is not telling you everything. Ultimately it is the insurance that decides not the surgeon's office. Ok I am so looking forward to my future for the first time in a long long time.

Ok, so it has been awhile since I have been here as I have had a "setback". My insurance advocate (oh and boy do I use that title with lots of anger) finally got my paperwork submitted and we got an answer in less than 36 hrs! They wanted two more things a chest xray/sleep study (opted for chest xray) and a final visit with my PCP. So I did this and sent this to my "advocate" over a week ago. I had not heard so I called and guess what she didn't even know she had the information from me!! WTF, ok I didn't lose my temper as I didn't want her to hate me and never send my paperwork, I just asked when she was going to get the 6 pg fax to my insurance company. She said by the end of next week! REALLY, if I handled my job that way I would be fired. So since I couldn't stand her lack of desire to get my approval, I called my insurance and faxed it myself. Now I will probably have my approval on monday (fingers crossed), and I wonder if she will call me and say yeah we have approval, acting like she did me a favor. Whatever! It then was like someone slapped me upside the head, this is my fight, this is my road to follow, so this is my responsibility to get this done on my time frame. I don't want anyone to tell me I could have done something I didn't do. But now I wait. My best guess is surgery sometime in September. We will see, hopefully it will be earlier rather than later. Keep good thoughts coming my way and I hope this "advocate" wakes up and realize she is dealing with people with feelings and that this isn't easy to do. If I have any advice my advice to you is to take matters into your own hands. This is your decision don't let anyone especially someone who has no interest in your well being determine your outcome. Now I wait..............and i hate waiting I have waited way too long to do this so hurry up already!!

I am experiencing the same yo yo with insurance. I now need to be cleared by a pulmonologist! My surgeon said a sleep study or a chest xray! duh chest xray so much easier and cheaper too. I have to do one more visit with my PCP too that will be the end of August. Everytime I call my surgeon I have different requirements than what my insurance states. So my advise listen to your insurance, do you own leg work then you know it is the correct hoop to jump thru. If I don't get my approval at the end of this month, then I will probably personally go sit down in front of the surgeon with or without an appt and ask WTF am I supposed to do. I feel your frustration.

Well I have done everything that I have been told to do. I have been under the care of my primary care physician for a supervised diet for 6 months, I have completed all my blood work, gotten my referral letter and now.......I wait. Hurry Up....now take your time!!!! WTF I am not controlling and I am far from OCD but turning this over the insurance advocate at my physician's office feels like I am leaving my soul with the devil! I have the utmost repsect for my surgeon, and do not have one doubt in his ability. With that being said, this she-devil is about the nastiest person I have ever met. I am thinking I have this opinion because she told me ..."you will not be approved." I was dumbfounded, who did this women think she was? She said you don't have co-morbidities (OMG do you have any idea how sick I am of hearing that?) and you are healthy. I asked her when she was submitting my paperwork (I was in shock had not idea what to say to her). She said today or tomorrow. So knowing that she will probably wait until tomorrow, I am going to make sure that the insurance company does indeed get it and call them to verify. I was mortified when I left the surgeon's office I wept in my car, I didn't cry I wept....... Who was she to take away my future, I will not let her, I will show her (along with a lot of others). So here I am waiting and waiting and waiting please say a prayer cross your fingers light a candle or put a needle in the voodoo doll in the image of my insurance advocate (aka she-devil)....what every luck you can send my way I will take it..... With this being said, I hope everyone who is waiting on approval gets favorable responses quickly.

Awesome I feel the same way you do listen to YOUR surgeon. I cannot wait to hear about your continued success.

What a great measure of success.....you are doing great have a fantastic time. You will definitely turn heads in such positive ways.

I got it and I am just shy of 50! I am not post yet but I get the training and the acceptance that we will have a new normal. I am more than ok with it my family is behind me I just want to get to surgery!! These new habits will be better for everyone effected.

You may want to look at a whey isolate protein, it is better for us. It sounds like you need more good protein.

I can appreciate how you feel. But aren't you afraid not following the surgeon and nutritionists orders to achieve the best possible outcome from your sleeve, that you could hurt your stomach and its recovery? Don't you think doing whatever it takes to get the maximum weight loss possible is worth following their instructions? I would be afraid to go against what my physician says. I say this because (for a much less invasive outpatient surgery) a co-worker and I had our knees scoped by the same surgeon for the same repair, and both her and I are the same age and did the exact same job (although I was over 150lbs more than her) there was no major difference in us. However, my tear was more severe and my surgery took longer. The surgeon gave me strict instructions to follow, as he did her. The most simple one being non-weight bearing for 3 days, not even weight bearing to the bathroom!! I was mortified, I thought I can't do this but I did, I knew I could walk on it, the knee I felt 100% better. Well I didn't, I kept my knee imoblized. My co-worker didn't she said she was walking on it after 24 hrs "lightly". My knee recovered and it is 100% back to normal. She on the other hand had major inflammation and developed fluid on the knee which had to be drained, more than once. After 6 months of no improvement from her surgery, she had a total knee replacement. The only thing I did differently than her was I followed post-op instructions until I was released by the surgeon. I am only saying this to show that it is so important to follow our physicians instructions and know that this is short lived. Remember the only person we are "cheating/pushing" is yourself. You trusted your surgeon and his team to do the surgery, trust them to know what is best now.

Try Isopure from GNC it is flavored protein but like water not a shake several flavors and you get it by the bottle with 40gms of protein with each bottle! It is the best I have found

How many ups and downs are there on this "ride" put on by our insurance companies? I knew there were going to be hoops to jump thru, but how was I to know the hoops would change along the way!!! Let's see here is how my journey began, almost 6 months ago.... First met with my primary care doc, who once again said I might want to "think" about losing weight. Really, he said this like I have no idea that I am overweight, no wait obese, morbidly obese and he is introducing a new idea to me. I have (like everyone here) attempted, succeeded and regained, failed and basically had no success. But in a way he had, I had been looking into wls for several months and I came to the decision before ever entering his office that day that I was going to have to have wls to stay healthy. This "come to jesus" meeting about my weight was in the beginning of February. My insurance told me that I needed to have three visits no more than 2 months apart for the "supervised" diet to be considered supervised. So I planned my next visit in April, well within 2 months. Then I am told that no I have to see the dr monthly for six months, this came from my surgeon, I called the insurance company and confirmed no not every month only three months. So I continue and now I am told by my insurance that it is 3 visits in 6 months no more than 4 months apart. Oh for the love of it all.....if I didn't have a grasp on the requirements I would go insane and never meet their requirements. But I took a deep breath called again and cleared up the visit requirements a final time, and then started talking money. This opened another can of worms as I have a maximum out of pocket of 1500.00 per year and this surgery will well exceed that (hospital stay alone) so the surgeon, anesthesiologist, etc will be paid 100%. Well my surgeon was wanting $900 before he would do the surgery and the hospital was wanting 1500.00 and the gas man wanted 500.00. What part of MAXIMUM OUT OF POCKET do these people not get. I have the money to pay but I will not be worried about getting refunds on top of my recovery diet and exercise. I found out that if I pay the hospital on the day of admission they will give me a 25% discount on my portion/responsibility!! Well of course, I will pay so this left the surgeon....hmmmm how do I explain this to them. I told them why I was going to pay the hospital instead of him, his office was very understanding, I was surprised it was easy, I mean really easy they agreed that I would not owe them the 900! The first thing that went my way, yeehaw. I actually did the happy dance. So come July 9, my paperwork will be submitted I will be waiting on the utilization review department to give the thumbs up, waiting on the beginning of the rest of my life. Let's hope it is the first week of August

Are you getting any protein with your fluids, that may be the problem.

So here it is only one more visit and my supervised diet will be over, all my lab work and required doctors appointments and tests have been completed. I have to say I have not tried to lose weight during this supervised time (although I have lost a few pounds), but I have not gone wild either with food funerals as I have read others have. I have been swimming, walking and drinking lots of water to get used to it, but I am not dropping weight. I know that it is no surprise to me that I have not lost, but now I am worried that my insurance will deny me. Now I know that they cannot deny me based on my performance during this six month supervised diet, but they could deny me due to medical necessity. Ok this "medical necessity" scares me, as I have no medical condition warranting this surgery, unless obesity is a medical condition. Is obesity a medical condition? I have no co-morbidities, I am one of those lucky (or in this case unlucky) individuals who does not have any co-morbidities or required medication (I don't even take multi-vitamins) that would fast track me to approval. So now, here I sit, so close and scared to death I will not be approved. I guess if I expect the worst and hope for the best that I cannot be disappointed, right? wrong!! I have always be so glad I am "healthy" and now this may be my downfall. My BMI is over 50, yeah I never knew it could go that high either, but it is setting in that I could be denied. I went into this not even thinking that but now basically I have jumped thru every hoop and now my future lies in someone's "opinion and interpretation" of my chart compared to insurance guidelines and coveage. I am so not looking forward to this last leg but am taking it one day at a time.