Teachingmom

Oh ok.....I didn't even think to ask at the class the other day. Of course I think of all these questions when it's the weekend. So I try to find answers on here! I know I won't be eating any kind of meat or solid food for several weeks post-op. I just wanted to add some variety to the pre-op choices. I guess I can call on Monday & ask. Thanks for your input!

Are there any appetite suppressants to help get through the 2 week pre-op diet? I'm 4 days into it & already tired of the Meal Replacement foods! I'm very impatient to things like this!

I just started my 2 week pre-op diet that allows me 4 Meal Replacements per day (high Protein Drinks, bars, Jello, soups), sugar free drinks, green vegetables, and 1 serving of a lean meat. But why is lean pork not listed? My paperwork only mentions chicken, gr. beef,& turkey. What is the problem with pork? Especially 4 oz.cooked in a smoker with only dry seasonings? Got any suggestions or thoughts?

I just started my 2 week pre-op diet that allows me 4 Meal Replacements per day (high Protein Drinks, bars, Jello, soups), sugar free drinks, green vegetables, and 1 serving of a lean meat. But why is lean pork not listed? My paperwork only mentions chicken, gr. beef,& turkey. What is the problem with pork? Especially 4 oz.cooked in a smoker with only dry seasonings? Got any suggestions or thoughts?

Which surgery was "easier?"

I have BCBS of Al. I got denied one time (office said that was typical). Now we're gonna submit it again. I am trying to get the sleeve. Almost a year ago I had to have lap band removed in emergency surgery due to erosion & a hole in my stomach. My surgeon documented the removal was due to the band failing- not patient non-compliance. I loved the band! I had it for 6 years. I did NOT want to remove it although I know I had to. So I want to know success stories from people who used BCBS of Al.

Has anyone been turned down with that reason? I have BCBS OF AL. I had to have lap band removed due to erosion & making a hole in my stomach. Already even approved by surgeon for sleeve. So I'm gonna have to appeal initial reply of denial due to one WLS per lifetime. This is medically necessary due to BMI, uncontrolled diabetes. I'm anxious to hear any similar stories: success or otherwise.....

I have BCBS of al & I want to know if their guidelines will change for 2014.

Thanks to all of y'all's advice. I'm hoping & praying this works! So glad this forum exists!

Do you mind me asking why you got denied?

Because I had lap band surgery in 2008. I had great success & loved it. But unfortunately. In feb of this year the crazy thing decided to erode into my stomach & make a hole! So I had to have emergency surgery to have it removed. My surgeon suggested the sleeve & I totally agreed. But I had to let my stomach "heal" for about 3 months (minimum). When we tried to submit for approval BCBS denied because of " 1 weight loss surgery per lifetime." But my surgeon is going to try to appeal based on the fact that the band failed me- not vice versa. Very very frustrating & depressing!

Can anyone guide me what to say in my personal appeal letter to BCBS of AL? My surgeon & gen. Practitioner are writing theirs. But my surgeons bariatric coordinator told me to write one too. I just want to know if anyone else has done This and what kind of info did you include? Is there anything I "don't" need to say? Any tricks or hints to help my plea? I appreciate all you fellow WLS friends!

What was their reason for the denial?

Well, to TRY to make a long story short I had the lap band put in with blue cross of al with another company. Now I have blue cross through the school system. They said only 1 WLS per lifetime. But they do have an exclusion for that if the failure was not due to the patient not following the "rules." I loved the band & had total success with it. It was the band that broke down & eroded. I was down to about 150 lbs., no diabetes. Now I'm back up to about 205 with a BMI of 35.2. And I'm back on metformin for high blood sugar again! So my surgeon is totally on board for doing the sleeve as soon as insurance cooperates. But now we have to appeal it. My surgeons coordinator said she'd do whatever they need to on their end.

I got the first initial denial And now we have to submit an appeal letter. I know all the obvious info. To include plus all the doctors notes on his end. But is there anything else I need to include that'll boost my case? It's a cut & dried case to me but apparently BCBS doesn't think so. I am trying to get the sleeve since my band was removed in February in emergency surgery due to erosion and a hole in my stomach. I loved the band- it totally worked for me! But my surgeon doesn't even put them in anymore. So he suggested the sleeve. I'd appreciate any suggestions, comments, secret tricks! Thank you in advance for even reading my posts- I LOVE getting "real people" advice from people who truly understand!

Thanks to all of you who have replied! I am on a constant roller coaster. I get my hopes up then get bad news from insurance then y'all give me hope again! I so wish we didn't have to fight for something that will improve our health! Maybe we are paving the way for bariatrics care down the road! If I had the cash to do it I would not even hesitate. So insurance is my only option. I have 4 kids, with 2 in college & another one going next year. So taking a loan out for my surgery is not an option right now. I am just hoping an appeal or the peer to peer will be my saving grace!

I will definitely try to go that route since apparently that's my only hope. But I'm pretty sure the office coordinator already sent that info in with the request. So what kind of info. Would we submit again? I will do anything necessary! Begging, pleading, crying....

Additional note: my insurance is BCBS of Al. (Peehip- from the school system)

My surgeon just submitted my 1st request & the office called to tell me it said it was denied because of the 1 WLS per lifetime. Am I screwed now? Is there any way to appeal that "clause?" Would the peer to peer help? Or would ANYTHING help? I am sooooo discouraged now- more than ever. My surgery is a revision to the sleeve because of an emergency band removal in feb. of this year. (Erosion & hole in my stomach)

That's great news that you got approved quickly. I have read about so many horror stories of rejection & long wait times! I hope you do great & it's everything I know it can be! I am hoping I'm right behind you!

I use dr. Touliatos at trinity. He's the one who put my lap band in. I really like him. By the way, I loved the band- it totally worked for me. But unfortunately the stupid thing broke down & eroded into my stomach! So I had to get it out. Now dr. Touliatos doesn't even do bands anymore! So he recommended the sleeve. I'm really worried BCBS is gonna reject it - even though its a "revision surgery" due to the band erosion.

Just curious to know what (if any) insurance do you use? Have you been sleeved? What kind of coverage have you experienced? I'm a school teacher with BCBS peehip. Just now submitted my request. Wish me luck - say a big prayer!

Just curious to know what (if any) insurance do you use? Have you been sleeved? What kind of coverage have you experienced? I'm a school teacher with BCBS peehip. Just now submitted my request. Wish me luck - say a big prayer!

Thank you! I have no idea how she submitted it.....she didn't mention the method. Are you blue cross of alabama peehip? I am a school teacher & I'm not aware of any other school employees who've had the sleeve.

Just curious what kind of time frame I'm looking at. My surgeons office submitted it yesterday.

Junior guru- yes they do have that rule but I don't know if I'm wasting time by "fighting it." Plus I want to know if the fact that I had to have the band removed because of erosion plays into it. The band really did work for me- I lost down to 150 lbs (at my lowest). But I followed the rules- IT broke down- not me! The guidelines says something about only revision if its "medically necessary." So I want to talk to my dr. About how to go about getting sleeve surgery approved. I'm just looking for support or words of wisdom. Especially people who've dealt with the same or similar circumstances. I have gained about 30 lbs since feb! My diabetes is now up again & I'm back on medicine for that. So it is medically necessary as far as I'm concerned!

Has anybody else ever fought BCBS about 1 WLS per lifetime? Please tell me your experience- bad or good! I need some help in that area. I had the lap band removed (emergency surgery due to erosion). But I want the sleeve (already approved by my dr.) and BCBS has the 1 surgery rule.