DylanRae

I get my date on this coming Monday

Woohoo!!! I have foun out that My insurance has changed... So it's inly a matter of time before I am approved! Woot! Are you excited,. Or nurvous.. What are you feeling.

Hey shey! How goes it????

I'm curious....

I have not had surgery, not even approved... YET! But I notice you guys talking about how much trouble you have with the Water intake... I was curious what exactly is the Water intake... Because other than an occasional fruit drink once a week at most, I only drink water and lots of it...

Thanks Everyone! At the very least this allows me to take a breath and really have ownership for my choices lately. I have lead a very angry life up until recently and it is hard for me to be ok with letting myself become that angry again. I do understand that anger is often enough momentum for us to push through. I am hesitant to say that it is the route I should take.

Working the system is something I happen to be very good at. Skills you acquire many different ways, I happened to acquire that skill from being in the foster care system most of my teen years. One thing that I have learned when working "the system" is getting angry will only hinder your efforts. If you have ever gone into the DMV and yelled at the state worker for spelling your name wrong, or charging you thousands of dollars for a reprint of your ID, chances are that, you also only experienced a longer more frustrating time there at the DMV. I have come to learn that this is the case in nearly any and ALL large offices of business. Weather it is banks, Post office, Collage or any school administration AND Financial office. This happens even at the customer service desk at your grocery when your check bounces.. ALL of these places and more, getting angry only hurts your chances at getting what you want in a timely manor.

And for me, being angry is just a lot of work that ends up backfiring on me anyway. I love your kind words, and advice. I appreciate where your words are coming from. I am also glad that I am not the only one who has ever felt this way. But I am not satisfied with simply getting angry as a solution to getting better. Mostly because Anger then feeds all sorts of other emotions that are just as negative. And to me, getting angry and using that anger as fuel for my behavior is the same as getting sad allowing those emotions fuel my bad eating habits. Either way it is unhealthy, and going the opposite direction, long term then staying logical, and continuing to jump through the hoops of the system.. :/

I don't know, maybe I am all wrong and twisted up about it. All I know is that, I have been angry before, all it did was give me several medical bills and suicide attempts.. That is not a road I am willing to go down again. :/

I am ashamed to admit it, But I am clearly self sabotaging.

A little back story.

For the last three years I have been educating myself about all the W.L.S. options out there. I have now decided that the sleeve is for me. So in December I contact my doctor. My doctor sends a referral out to the barbaric clinic. I find out that I don't qualify because I do not have some sort of weight dependent disorder/disease/diagnosis. But before I am officially denied, I learn that I am "pre-Diabetes". Along with this, my joint problems have only gotten worse, and there is more and more symptoms leading us to believe that I am on the fast track to sleep apnea. Also, now that I am "Pre-Diabetes" There is this more focused thought about how to keep me from actually getting diabetes. Frankly I am surprised I don't already have it. All the women on my mom's side of the family have it, and have had it since their late teens.

I am 22, almost 23. I am 5'3" at 265 pounds, with a BMI of about 46.... My symptoms are getting worse, and all I want to do is have the surgery so that I can truly do what every doctor I have ever had has told me to do... "lose weight".

Now along with all of this, of course I have unsuccessfully attempted several types of diets. But more so, in the last three years I have completely changed my normal food intake.. I don't like to call it a diet, because it is more then that. I literally changed everything I did about eating.

I have not had a soda, or any kind of carbonated drink in over 2 years. I have only eaten the most expensive, all natural and organic fruits, veggies, AND meats. I have not had bread or any sort of wheat product in over a year. I have forgotten what ice cream and other desert like foods taste like. I rarely have any sort of dairy at all. And when ever I am hungry, I drink a full Water bottle.. (of filtered water), before deciding to have a snack or meal.

I have not only changed my eating habits, but I have changed other intake habits as well. I stopped smoking cigarettes over two years ago, and weed even longer then that. Binge drinking or drinking till I am tipsy is a thing of the past, I have spent the last two new years 100% sober and LOVE IT! If I drink now, it is sharing an Angry Orchard with my dinner mate.

Yes, all of this and I am still not losing any weight. And yet I still get a Kidney stone last winter because I have to much OR not enough Calcium, my doctor does not know which. Yes I needed surgery to get it removed. Need I remind you that I am 22 years old. On top of this, I have a medium case of PCOS. I don't ever have periods, and I need to take tweezers to my chin at least once a week. I completely shave my bellybutton in the shower. My current form of birth control is the Implinon... the little match stick thing that they stick in your arm. I have had this for about three months now. Before that I had an IUD, I had that for a whole two years until it completely disappeared. Yes x-rays, cat scans and all sorts of different ultrasounds where done to confirm that this IUD was for sure MIA. Before that I had the Nuva Ring, which I really liked because I could control when I had a period very precisely. But since I was smoking at the time, they advices me to take something that has less of a risk of blood clots.

So here I am, now waiting for my appeal to my denial, be approved. I got a letter in the mail last week telling me that they needed an additional 30 days to consider my case. After talking with several nurses and doctors, literally the only thing holding back an automatic yes, is the fact that I am not diabetic. Apparently pre-diabetic does not count.

This is where the shame and self sabotage comes in. In the last two weeks, since my appeal was sent in, I have been eating things I know I should not eat, things that I have not eaten in years, and eating LARGE amounts of it. If I am really that close to being diabetic, why not take the next month to tear the shit out of my body, so that I can get this stupid approval and then be on the road to a healthy happy life??

The biggest downside.. is that as I eat the half gallon of ice cream, I remember all the "pleasure" it use to give me. This is bad. As I eat a turkey sandwich on White .99 cent bread, I am anticipating making and eating two more. I am simply just so angry that I am trying to do everything I can to save my own life. To avoid losing my eye sight and 6 toes like my grand mother, and take action now, and the doctors are still fighting me with this! Its another case of, "just loose the weight" If only it where that easy!!!! GRRRRRRR!!

Am I in the wrong for wanting to push my health for the worst just to be approved for surgery? What can I do instead to help my chances of being approved? Have you found yourself in a similar situation???

I am currently working on my undergrad.. Still Undeclared.. And I have yet to be approved for surgery, let alone worry about recovery time. I am on average taking 15 credits every quarter, and have a solid 3.5 GPA.. Staying on track with my grades and my education in general is extremely important to me. But my weight and my potential for W.L.S. is also very important to me.. I did not realize that it took most of you a month and a half to recover... I was only expecting a week or two, simply because its generally a one day sugary appointment. As in you are home the same day of your surgery. If surgery is that "easy", then why would recovery be much different?

Anyway, this gives me a lot to think about. I am definitely curious on seeing if I could wait to do surgery, or time it out perfectly between breaks. (even though I do not have a break that is a month and a half long.)

If I had my way, I would have surgery ASAP, and then continue to attend class as I could, with the negotiation with my teachers. For example, Do all home work, turn it in every week, and show up to classes where tests are being taken, at the very least. If there are days I am feeling particularly better then expected, then go to school. Its really easy for me to commute back and forth. IDK if that would actually work or not.. but it would be cool if it did.

I had group health with a plan that specifically wouldn't cover any bariatric surgeries... not very helpful, sadly. It was a county employee plan. I had to private pay, ultimately. Sounds like you have a better plan - hope you were approved!!

It is covered but under strict rules, most of which I am covered on. It's a close but no cigar sorta situation. The one thing I don't have is the one thing I'm trying to avoid by using the surgery as a tool.

Very annoying. Still waiting to hear back.

Thanks! Yeah I know that it is covered under my plan, but I will still have to pay co-pays and that sort of thing. It comes out to be about 500$. I got a letter the other day saying that the appeal team or who ever they are have requested an extra 30 calendar days on top of their basic 2 weeks. They said in the letter that if they need more time then they can have a total of 15 days with written consent from me.

I'm freaking out a little, is the fact that they need more time to look it over a good thing? Because they are not just shooting me down as quickly. Or am I going to end up just as disappointed at the en of this anyway. I feel like if I could get someone on the phone who had any weight on the decision then I would have a running chance. I don't sound very good on paper.

Anyway, I'm glad I'm not the only GH person. Thanks.

Hello,

Ok, I have a problem. I am fighting tooth and nail with my insurance, like most people I see on here do. I have Group Health insurance.. so I am lucky in the sense that I don't have to worry about my insurance miscommunicating with my doctors.. They all are the same people.. At the same time I am unlucky because this means I am restricted to all of Group Health's rules and whatever else.

Ok here is my story see if you can offer any assistance.

In mid December, I asked my doctor to send in a referral to the bariatric clinic for me to have Weight Loss Surgery. For the following 2 and a half weeks I called in seeing what the process was, and where they where on approving me. I had little doubt that I would not be approved, but was anxious anyway.

According to my insurance, you have to have a BMI higher then 40. I do I have 42, and slowly growing. You have to have tried at least 2 different weight loss programs in the past. I have, Vision Quest 'Biggest loser', and Jenny Craig. Not to mention, I have been on the Beyond Diet, all with very little success. And last, *this is where I get a little lost* I have to have one or more of the following diagnosis.. (off the top of my head) Diabetes, High blood pressure, sleep apnea, Hypertension, arthritis.. and a few others.

The reason I am confused: some nurses have told me that I do not need this qualification if my BMI is higher then 40 which it is. I only need it if I am below 39... and other nurses saying that, I absolutely have to have all the requirements listed above.

I do not have any of the diagnosis they list. But more then half of them are things that are on my doctor's radar. For example, all the woman on my mom's side of the family have diabetes. It is a mixture of type one and two.. (part of that might be misdiagnosis simply because my great grandmother did not have the same doctor resources that I do) I am now diagnosed with what they call PRE-diabetes.. which apparently does not count enough.

Second, I have (in the last year) been under careful watch for sleep apnea. That also runs in my family, and my symptoms are only getting worse.

There are several others. All of them, I am close but not close enough, according to the list of diagnosis I have to have to qualify.

So, back to the waiting.. I finally get a letter saying that I am denied. And spend hours on the phone trying to find out who I can talk to to get this changed. Or at least will tell me what I need to do in order to get this request approved. After several round about conversations, I finally send in a second request, with my appeal.

In my appeal I explain in detail how, my life will benefit from this surgery, and after care. I talk about how the whole reason why I am pushing for it so hard is because I do not want to get the listed diagnosis... when there is proven medical record in the last year alone, that my symptoms are getting worse, and possible causing other issues.

It is now the end of week one, after sending in that letter, and I am feeling less hopeful this time. What sort of things can I use in my advantage to get this approval happening?!?! Please any advice is helpful.

Dylan

Hi, I'm Dylan...

Seattle, Wa.

I am in the waiting for approval phase.

Looking for someone who had struggles with getting their sleeve approved, but finally did get it approved. I have already been denied once, and have sent in an appeal. I am now waiting to hear the verdict on the appeal.

I am noticing some bad habits forming on my end.. and wondering if they are reasonable or not.. :/

I would seek out a therapist for a problem like this.

Agreed. If you don't already, talk to a counselor who is experienced with food disorders. Not saying you have one, but getting another member on board with getting you heathy can only make things better. I would fear that if this feeling of guilt continues after you have lost a good portion of your goal, then this could quickly turn dangerous.

Of course we all are here and can be as supportive as we can be, but again, I think it is a great idea to go and seek out professional council.

Hope you take this as a friendly suggestion.

Dylan

This is amazing!! I'm so glad you got approved! What are the next steps? Are they going to make you jump through more hoops? Or are you guys picking a date and going for it? Keep us updated!

I'm still waiting for my appeal to come back. I have been so distracted with school that I forgot to call them yesterday, so now I will have to wait I till Monday to call an probably still get a no. :/

But you getting approved gives me hope.

Dylan

Thank you so much Hun!

For sure! that's what community is for right?

Bout damn time! They should have done that weeks ago. I'm sorry that this has been such a headache for you! I hope all the best for you, I am checking in on your story the most.

Good luck!

Hi, I'm in west seattle.. Alki area. I have group health. I'm 23 years old. My current bmi is 43 and I am waiting for a yes from my doctors.

Anyone else with group Heath or know any one who is? GH is being quiet difficult.. Not impossible but deffinetly difficult.

I got this message from my doctor yesterday. This might be my ticket into surgery...

Have your doctor call them. Sometimes when the doctor talks to them they are able to get it approved.

Not usually when I don't already qualify for the two basic requirements. But my doctor is in board with me so that makes me feel a little better.

Got my denial today. All because I am not diabetic. I am on my way to the doctors now to see if I can qualify as having "early stages of diabetes" and if I do that might help with my appeal that I send in next week. Guh. Very frustrating!

I have done a lot of research, and what I have found is that it is normal to appear "to skinny" when losing weight. This Is caused by the rapid weight loss and extra skin.. The baggy skin makes you look very unhealthy. But once your skin tightens back up, then people start to notice your face and arms 'fill out', along with this is the fact that you still need to build up muscles that will also help fill you out In a heathy way. Appearing to skinny is part of the process. It goes away after some time. Regardless if you get lower then your goal weight or not this generally happens to people who lose more then 100lb in a year. Which is a lot very quickly. Do more searching on your own, ask your doctor and talk to people who are in the after stages of their WLS.. Yes it can appear to be scary, but keep your doctor informed as it happens and remember to expect it. It's not that you are getting to skinny, it's that this is a big drastic change, and people are going to notice that. Your body just needs time to catch up and do it's thing. acuna matata. No worries.

It seems like whenever you want something bad everything tries to hold you back.

All the more reason I fight for it!

Man, that insurance and hospital dance sounds horrible. Like I said before, I have group health, and the two are the same. I have mixed feelings about the overall care that I receive from GH.. But I suppose I am lucky when it comes to the insurance dance.

I called my doctor on Monday (1week from the sent approval day) and was told that the one and ONLY nurse who could go over my paperwork was out on vacation for the holidays. And it was likely that I would not hear back until sometime next week.. This coming Monday will be the end if week two, (when I was told I would get my approval by at the latest) and now I'm looking into possibly three weeks wait total. Guh!

The part that annoys me is that up until now GH has always been very punctual in their timelines. They always have them selfs extra wiggle room, but alway made it within deadline. I'm going to call again on Friday. See if she is back yet and has done my approval... I want to know!!!

So, those of you who are still waiting, or newly approved. What sorta things are you doing to make sure you don't go crazy during this time of limbo? I want to call the office and see if they approved me.. Much like I would call an office to see if I got the job. :/ I haven't started yet. But I'm one tap away from it. Any advice for the anxious? -Dylan

I am driving myself crazy. I called the insurance company and I was told they have received my authorization request from the hospital. I called the hospital and I was so that they didn't verify my insurance for 2014 so they would resubmit the authorization to the insurance company on tomorrow. This is so frustrating...

Wait I'm confused. Your insurance got the green light from the hospital, but the hospital did not get the green light from the insurance? How does that work. FYI, I have group health... So my hospital I my insurance... I don't understand much about insurance...

So, those of you who are still waiting, or newly approved. What sorta things are you doing to make sure you don't go crazy during this time of limbo? I want to call the office and see if they approved me.. Much like I would call an office to see if I got the job. :/ I haven't started yet. But I'm one tap away from it. Any advice for the anxious? -Dylan

It's been two days for me also. Everyone been telling me I'm not big but maybe I carry it well. I'm 276 and only 5'6, I think that's pretty big knowing in only pounds away from 300. I've been told not to do it by many but this is what I want.

I completely understand that! I am 5'4" at 260-ish pounds. People don't believe me when I tell them I am that close to 300, which I have hit before. People notice I'm "chunky" but not "morbidly obese" sending good thoughts! -Dylan