ChristyAZ

I was NOT able to get my procedure covered by my insurance last year even with 2 comorbidities. My policy stated that there was a Bariatric Surgey Exclusion. My medical necessity did not matter. My company did not pay the premium to include bariatric surgery on our group policy, making it an exclusion on our policy. So no, they would not cover it and I had to wait till open enrollment to drop that policy.

Not if its an excluded benefit. Medically nesecary or not, if its excluded from your plan, its excluded. Happened to me last year.

I have a $1000 bariatric surgical fee ...... kinda out of the blue but worth it ........

I contacted an insurance broker in my area that delt with medical policies and he gathered all the information for the top 4 companies in my area. I asked for desriptions of the policies and what was and was not covered. I did have to pick a top tier policy (a Platinum policy) and I pay out of pocket every month but I don't pay for my group policy at work so it did even out for the most part. I chose BCBS and the plan I chose covers the sx if I met the guidlines and I did .... I completed the requirments and now I ma scheduled. I do have a $1000 bariatric surgical fee but I can live with that ...... hope this helps ...

Not sure if this will help anyone however I thought I would share how I got my surgery covered when it was excluded from my group policy through my work..... My group policy was a total wash. They said covergae was excluded and medical necessity or not, no coverage. So, when open enrollment thru my work began, I went through an outside insurance broker (you can't go through the Obamacare exchange if you are eligible for a group policy through an employeer or spouse's employeer but you CAN get your own individual policy) ...... I found a full "Individual Policy" thru another big name insurance provider, made sure that the policy I chose had bariatric surgery coverage and signed up then turned down my companies group policy during open enrollment. I now pay for my coverage out of pocket (I really only pay about $60 more a month then if I had my ins thru work since they are not taking my premiums out of my check), have full benefits from a big name company and I get to have the surgery. I was worried at first but from what my broker told me, bariatric surgery does not have to be included on group policies for companies with numbers over 50 (employees) however "individual policies" HAVE to cover, even if they make you do the 6 month diet/nutrician program. Not sure how accurate that is but hey ..... never hurts to check it out .... I plan on keeping this policy till next open enrollment then going back to my employeer offered group policy because a group policy has no exclusions so any "issues" or needs that crop up following my WLS will be covered ..

Go to YouTube and search Gastric Bypass Diet. There a lots of vids there that show wls patients and their grocery hauls and diets

You can file an appeal if hey still refuse to cover it .... however you may have to go through with the initial appointment and have the authorization denied first .... the only problem there is that if the surgeons office knowingly submits a authorization just to get a denial they may not be able to help you with the appeal .... I would call the authorization specialist at your surgeons office and ask what your next move might be ....

They never said anything to me about side sleeping verse back. They told me to do what I would do at home. I found out after that I was able to bring my own pillows and blanket so that would have been nice information to have BEFORE the test lol. I also brought leggings and a big shirt to sleep in ... they ran the electrodes down under my pant legs and that helped a bit ...

Prayers, positive thought, good juju ...... all coming your way!!!!!

Carrie Leigh .... I am still PRE OP myself so I can't say I know exactly what you are going thru but I know I did not get to the point I have (325lbs and needing WLS) by making wonderful choices in regards to food. This surgery is not a magic fix, that I do know and your choices will always be a "head game". My advise <for what it's worth> is to call your surgeons office/nutrtionist and tell them EVERYTHING. Be honest and admit that your making bad choices. They will be able to help you .... wether thru additional classes, support groups or maybe even therapy or meds if your stress level is off the charts. You have just descibed my fear and a am willing to bet, many others as well ...... and I truly believe you can make this work for you. You can do this ..... you just need a bit of help and that is what the staff at you sureons office is there for. They want you to succeed and I am sure they have been ther/done that with what you are going thru ..... reach out ...... and good luck to you ......

This scares me too ... but I plan to move my a$$ off after the surgery. In the hospital and when I get home. Walk walk walk! I may not feel like it but I will feel like developing a PE even less. I have no idea if I will be given the Lovenox as my pre op appointment is still 6 weeks away but I will ask for it if its not standard. My life is full and I have a wonderful family so I can't say I don't lead a good life even at 325lbs however I NEED to feel better physically and I want to have energy and a desire to get out and do things. I am going to go into this with a positive attitude and do everything the surgeon tells me to and just KNOW that it will all work out .... I hope you manage to have your surgery and feel good about your choice ....... good luck on your "journey" to a healthier fitter you!

Mellie May ... No CPAP machine yet however the durable medical equipment place has called and are trying to make the appointment to come out and set me up. My only issue is this ..... I woke a bajillion times that night during my sleep study for many different reasons ... including loud pillows, strange bed, tempuratue <I was cold as heck>, lack of hubby next to me and every time I moed I felt electrodes pull and come off. Then in comes a tech to fix em .... so really, HOW do they determine it's Sleep Apnea? I asked and the tech said "oh you woke yourself more them 30 times" and I was like "well yeah, this sucks lol". So thats my rant ..... I find it odd that I all of a sudden have "Sleep Apnea" and need this machine .... I am seriously considering waiting a few months after surgery to try that study again ......

That would be great Michelle_Rose ....... someone to literally go thru things at the same basic time ..... priceless

I was just curious if there were others here that have RA and have had or will have a gastric bypass. I was diagnosed with RA in 2010 and so far, the only med that works for me is prednisone which I am currently weening from for my surgery. Just thinking ahead and wondering if the surgery/weight loss made a difference in regards to your RA ..... if the meds worked differently after ...... what you use in place of NSAIDS .....how your rheumatologist felt about the surgery (mine was so against it it was almost comical .... she even refused to write a letter of reccomendation for me lol) ... Any information or thoughts are always appriciated!!!

IamBeautiful ..... A new rheumatologist has been recommended more then once and its something I have been thinking about. Maybe after my WLS. Right now, thats where my focus lies. Thanks to my PCP, I received the needed letter and surgery is a go! As for other meds .... I have tried Embril, Plaquinal and Orencia. All with a combo of methotrexate and w/o ..... even tried the methotrexate solo ..... 6 months for each med and nothing. No improvment. The pred keeps me moving and as much as I hate it, I continue to use it. i was never told by my surgeon that NSAIDS were a negative following my procedure but I read that it is so I am trying to plan ahead. So looking forward to getting some of this weight off my joints .......

Mine was awful! I was sent by my bariatric surgeon as a "just FYI" kind of thing and what do ya know. I have Sleep Apnea. The little sleep center was nice and the techs were so amazing but there is no getting around how UNCOMFORTABLE it was. I don't sleep well at the best of circumstances and to tack a million electrodes to me head, back, chest and legs as well as a microphone taped to my neck and electrodes GLUED IN MY HAIR .... then the cheap and plastic pillows that crinkled all night long .... the room was hotel-ish ... had TV, cable and WiFi ...... it took forever for me to fall asleep and I kept waking up every other minute. No surprise the tech woke me 3 hrs in and said lets put this lovely mask on you lol .... that made it even worse. Sleep study ..... not fun ....... and now I have yet another co-morbidity lol .......

Good luck to you Karl..... I am so happy for you ....... mine is still 2.5 months away <im patient, I can wait lol>..... dont forget your favorite pillow/blankie and some comfy jam jams for your hopital stay and clothes for the ride home ..... your gonna do awesome!

June 17th here ....... and very excited!