Nylaj

I am in Durham, NC! I work at UNC Hospitals & that is where I will have my surgery done at.
I am very nervous, but excited!

I am a Patient Financial Services Representative. That title has nothing to do with what I actually do.
I obtain benefits, pre-authorizations, & pre-determinations for same day, next day, & future procedures done at our hospital. I am actually on the inpatient team & my sub-group is Plastics/Bariatric.
I love my job. I work at one of the top 50 hospitals in the USA.

Face & muffin top.

Face & muffin top.

Call BCBS & find out their requirements. You should have done that first. Know your benefits, what will you have to pay, & what they expect out of you.
I have BCBS North Carolina & they don't require anything if you have BMI over 39.
I just submitted it (I do authorizations for a living) & gave BCBS my height, weight, & BMI.
I got an approval in 3 days.
Each BCBS has different requirements.
I am assuming CAL is California? BCBS California is BCBS Anthem.
-----------------------------------------------\\\
ANTHEM BCBS – REQUIREMENTS FOR WEIGHT LOSS SURGERY In Am I Covered by OC StaffOctober 19, 2013
Anthem BCBS does cover weight loss surgery as long as your policy does not specifically exclude coverage. ObesityCoverage strongly feels that morbid obesity is a disease and every insurance company should cover these life saving procedures. So we are happy to report that Anthem BCBS covers weight loss surgery. In fact, most of the Blue cross Blue Shield network has some sort of coverage for weight loss surgery.
It is important to know that your employer can typically opt-out of weight loss surgery insurance coverage for their employees policies. Opting-out typically saves the company money on their premiums. Contact information for your Anthem BCBS is listed below. Even if your policy excludes weight loss surgery, because BCBS has shown that these types of surgeries are medically necessary you might be able to appeal their exclusion. Before calling make sure you see our questions to ask before calling your insurance company section.


Note
Blue Cross of California is the trade name for Anthem BCBS so your criteria for weight loss surgery will be the same as it is here. ANTHEM BCBS PRE-APPROVAL REQUIREMENTS
The items below are the minimum necessary for approval of your weight loss surgery.
Body Mass Index (BMI) of 40 or greater OR… a BMI of 35 or greater with at least 2 comorbidities. Primary Care Physician’s Letter. Active Participation and Documentation of non-surgical methods of weight loss. 18 years of age (special consideration if under 18 with severe morbid obesity and special circumstances). Consult and recommendation from a weight loss surgeon. Psychological evaluation Nutritional evaluation Policies Included in Coverage
Blue cross Kentucky Blue cross Virginia Blue cross Wisconsin Blue cross Ohio Blue cross California Blue cross Georgia Blue cross Missouri Blue cross New York Empire TYPES OF WEIGHT LOSS SURGERIES COVERED BY ANTHEM BCBSRecently gastric sleeves have begun to be covered by some of the large insurance companies as a primary weight loss surgery. Currently, gastric sleeves are considered experimental procedures and are not covered.
Covered Weight Loss Surgery Procedures
Laparoscopic Gastric Bypass Open Gastric Bypass Surgery Gastric Banding – including the Lap Band and Realize Band Duodenal Switch also known as Biliopancreatic Diversion Gastric Sleeves Unsure which surgery is right for you? Take our bariatric surgery test!
Lap Band Fills Covered?
Anthem BCBS considers Lap Band fills a medical necessity when required to meet the proper level of weight loss. This is true only if you’ve had a previous adjustable gastric banding procedure that met all of the criteria laid out for that procedure. Typically, if you paid cash for the procedure ongoing lap band fills will not be covered by insurance.
Procedures Excluded From Coverage
Mini-gastric bypass Banded vertical gastroplasty Any other ‘experimental’ weight loss procedure Is a Second Weight Loss Surgery Covered if Gastric Banding Didn’t Work?
Surgical procedures following a previous weight loss surgery that did not result adequate weight loss, such as a lap band or realize band to a gastric bypass, gastric sleeve or duodenal switch are covered by insurance when the following criteria are met:
The patient continues to meet all the medical necessity criteria for bariatric surgery, and There must be documentation that the patient was compliant with the original post-operative dietary and exercise program, and 2 years after the original weight loss surgery, weight loss is still less than 50% of pre-operative excess body weight and weight remains at least 30% of the patients ideal body weight, per BMI. Revisions
Revisions are covered if there is documentation of a failure secondary to a surgical complication. Complications can include but are not limited to fistula, obstruction or disruption of a suture/staple line. Does Anthem BCBS Require Center Of Excellence?
Yes, weight loss surgery must be done at a Center of Excellence. Do I have to use an in-network weight loss surgeon?
No. However, your deductible and out of pocket costs may be significantly lower if you do. And you will still need to find a surgeon that has privileges to perform the surgery at a accredited Center Of Excellence for Bariatric Surgery. ANTHEM BCBS CONTACT INFORMATIONAnthems can be contacted at 1-866-293-2892. You can also locate a contact number and email address on their website after choosing your state.
ANTHEM BCBS WEIGHT LOSS SURGERY FULL COVERAGE STATEMENTAnthem’s full policy on weight loss surgery insurance coverage from their web site.

I had surgery on Sept 16th at 8:30 am.
So far, I cannot complain one bit.
After surgery, I finally got into a regular room. I was only hooked up to a saline bag.
I walked around, drank my 1oz liquid a hour, & did everything myself.
I came home yesterday around noon & with that, I was drinking 3oz liquids a hour.
These are my only issues so far & I would love ANY guidance into this.
Right now, I am on the Day 3-7 diet, which is 'thick' liquids. My Doctors paper states I can have 4oz up to 5 times a day.
So far, I opened up a can of cream of chicken strained. It is delicious & I am tolerating it well.
Also, I can start Protein shakes, plus I got to make sure to have my 64 ozes of Water.
My Doctor wants me to have 60g of Protein & my 8 cups of Water a day.
If I am only limited to 4oz of 'thick' liquids, then how can I get my protein in?
Does the Protein shake not count towards the thick liquids?
I just had 3oz of sugar free pudding b/c I had to take some medicine & they didn't give me liquid so I had to chop it up & mix it. (Gag).
Any help would be great.
Thank you so much!

@@Nylaj Welcome home and I am so glad you had a great surgery. My surgery is Tuesday and pray it goes just as well. Keep us posted on your successes and I also would be interested in suggestions anyone posts!
PS. I was born a Tarheel and raised in Michigan!!!!!

I am approved.
I go for my pre-op appointment on August 18th.
Then one month later, I will have it. Sept 17th cannot get here fast enough!
And for those wondering, I got approved in North Carolina with the State Hlth Plan at BlueCrossBlueShield.
Btw: I work with insurance companies all the time with getting these types of cases approved.
If anyone ever needs any or guidance, let me know!
I will try to help you all.
Have a great day!

My Doctor recommended them so I would imagine they are okay. But I was told not to rely on them daily. Maybe twice a week, but nothing more than that.

Don't worry about the numbers. You can lose weight or you can not lose weight, but lose inches, Fluid, & etc..
Stop worrying about the numbers or you will drive yourself into a turmoil.

I was told by three of my Doctors that Dumping doesn't happen with the sleeve..

I am approved.
I go for my pre-op appointment on August 18th.
Then one month later, I will have it. Sept 17th cannot get here fast enough!
And for those wondering, I got approved in North Carolina with the State Hlth Plan at BlueCrossBlueShield.
Btw: I work with insurance companies all the time with getting these types of cases approved.
If anyone ever needs any or guidance, let me know!
I will try to help you all.
Have a great day!

Dying & failure. But I know God has me in His hand. I trust Him.

Dying & failure. But I know God has me in His hand. I trust Him.

Drink a lot of Water.
Skip carbs.
Skip snacking.
Skip sugar (as much as you can).
I lost a lot of weight once I quit carbonation beverages.

Why would you be denied? If you are having surgery soon, then they should have already sent that to your insurance company for approval. Once you are approved, the insurance company cannot deny you..
Unless you mean your Doctor? I don't get why 4 pounds would make a difference. What are they saying?

I am Sept 16th!

Having a fever & an infection while under the knife could lead to death.. Be thankful instead of angry. You will get a new day. Just be positive.. Thinking positive makes you positive. Hang in there! You got this!

I am a Patient Financial Services Representative. That title has nothing to do with what I actually do.
I obtain benefits, pre-authorizations, & pre-determinations for same day, next day, & future procedures done at our hospital. I am actually on the inpatient team & my sub-group is Plastics/Bariatric.
I love my job. I work at one of the top 50 hospitals in the USA.

I am under 250 lbs for the first time in over 4 years!!!!!!!!
I love that I am living my life for me now.
Best decision I ever made.

The minute I made the decision to have the surgery, all of my habits went away. It was weird. I am a person that LOVES coke/pepsi & fast food. But now? I still love fast food, but I am 4 weeks out of the carbonation beverages. I been drinking unsweet tea, Water, lemonade, & juice. I find myself looking at the nutrition label & making sure it has Protein & not much sugar or 0 sugar.
I sitll eat too fast, but I decided since I gave up caffeine, now I will give up fast food. Then I will make sure my portions are smaller..
I think something 'clicked' inside of my brain & I am happy that I am making better choices.
I know how you feel though. Every time I made better choices, guess what? I went backwards b/c I wanted coke with the biggest burger at the fast food place. Then I would eat when I got home. My eating was out of control. In a way, it is still out of control. But I find myself telling myself out loud, NO. Whenever I want to cheat or do wrong, I just say outloud, NO. I find that is helping a lot.
I think you should tell your therapist how you feel. Don't keep your feelings inside.
Here if you ever need a ear.
Prayers for you & your struggles.

I been wanting this for years, but at my old job, the insurance we had didn't cover it. Now at my new job, they do cover it. I wanted this last year, but just didn't put much thought into it.
After I stood in my cousins wedding in June 2015 & see how HUGE I actually was in the pictures, I said no more.. I am having surgery in September.
I finally just told myself now or never.. Plus, I am turning 30 in 27 days. I want kids & I can't get pregnant until I lose all this weight. Plus, I want to watch my nieces/nephews grow up & I want to play with them.
Make the decision that feels right for YOU.

I been wanting this for years, but at my old job, the insurance we had didn't cover it. Now at my new job, they do cover it. I wanted this last year, but just didn't put much thought into it.
After I stood in my cousins wedding in June 2015 & see how HUGE I actually was in the pictures, I said no more.. I am having surgery in September.
I finally just told myself now or never.. Plus, I am turning 30 in 27 days. I want kids & I can't get pregnant until I lose all this weight. Plus, I want to watch my nieces/nephews grow up & I want to play with them.
Make the decision that feels right for YOU.

Question - is it safe to take a stool softener daily? I don't go often & I know the Nurse told me I need to take something, but wasn't sure if something daily was okay?

Your first 3 post-op appointments should be included with the surgery. It is called bundling & they should do that. But call other offices in your area. I am sure there is more than 1 that will see a cash patient, even maybe work out a payment plan.
Also, google companies that might give you a grant or a loan to cover it.
Sorry this is happening to you.
Wish the very best to you.