Sharon1964

I would call your insurance company again to clarify the max out of pocket. For many plans, the out of pocket works a little differently. One person max out of pocket: $6,600 Any combination of more than one person: $13,200 For example, two family members each spend $5,000 out of pocket. The third family member only has to spend $3,200 to reach max out of pocket for the family ($5,000 plus $5,000 plus $3,200 = $13,200). No one single person reached the individual out of pocket, but you met the max family out of pocket. My plan is similar to yours. I saved my income tax refund, and I've been putting money aside every month (since I started this in November 2014). I figure if the hospital bills me for $6,000, for example, I'll pay them a big chunk and then the rest in monthly payments. My surgeon's office says the hospital usually gets paid first, so since that will meet my max out of pocket, my insurance will pay the entire surgeon's bill (remember, once max out of pocket is met, they pay 100% of everything else).

It sounds like you haven't had surgery yet (it wasn't clear to me). What kind of help are you looking for? Are you looking for advice? Okay, call your surgeon's office and fess up. Be prepared for the consequences of your actions. Speaking of consequences, here are a couple of statements to examine: "the two week meal replacement diet went horrible I was not able to adhere" "now I'm 3 days out on a clear liquid diet which I am tolerating" It sounds like you have a mindset that needs some adjusting. You are making these choices; they are not things that are happening to you. More: "I haven't done what I was supposed to but I am so ready to get this done and on with living healthier" What makes you think you are going to live any healthier after surgery if you're not doing what you're supposed to do before surgery?

Do you think perhaps they aren't REALLY asking for opinions on how they look, but instead are looking for some positive reinforcement?

Call your Medicaid worker and ask them. Most people with Medicaid do not have a share of cost.

It would be helpful if you could tell us why it was denied. Is it ever covered under your plan?

I just can't get past this sort of thinking. If you're so capable of intelligent decisions about your own diet and your own best interests, how did you get obese in the first place? It wasn't from making intelligent decisions. I guess this is one of those times when I just have to say "well good on ya".

For what specific reason did they uphold the initial denial? Get it in writing, and also get a written copy of their requirements for bariatric surgery. If you meet the requirements, you have a very good case to get it overturned.

Does your surgeon's office even ALLOW protein right now? Mine has patients on clear fluids after surgery, no protein drinks allowed until the "full liquid" stage.

Short version: Your brain sees what it expects to see, not necessarily what is there. The longer version: "The mirror lies. As people tend to see everything in life as they expect it to be, they see, especially, in the mirror, what they expect to see. Elderly people looking in the mirror do not recognize that they have grown older, until, suddenly, they find themselves in front of a different mirror and their face is lit up more brightly, or just differently.... Similarly, I have known individuals who started off in treatment weighing over 400 pounds and saw in the mirror a fat person—but, perhaps, not that fat. After losing one hundred pounds, or more, they look in the mirror and see someone who is just as fat!" More here: https://www.psychologytoday.com/blog/fighting-fear/201212/mirrors-lie-the-fallibility-perception-and-memory

I will keep my fingers crossed for you!

I don't consider it a battle. My insurance company told me what they needed to approve the surgery, and that's what I'm doing. If they came back and changed their requirements, THEN they would have a battle on their hands!

Now you have the key information - your out of pocket max, and your premiums. There is one more thing to check on, and that is, do your copays and deductibles count towards your out of pocket max? If they do, then here's the breakdown: Plan A Premium $6468/year Max Out of Pocket $2500 Total max expenditure per year $8968 Plan B Premium $4056/year Max Out of Pocket $3500 Total max expenditure per year $7556 ***IF*** the deductible does NOT count for the out of pocket max, then your max expenditure will be $8556/year I would not normally recommend this method of figuring out which plan to choose, but things are different when you're planning surgery. You KNOW the total is going to be more than your max out of pocket, while in a "normal" year it might not. Once you've met your max out of pocket, and your plan is covering everything, you can have whatever you need to have done, that you might have put off otherwise (since your plan will pay 100%). Before taking anything I say as advice, please, PLEASE always check with your plan documents and/or HR and/or insurance professional.

No, I have Blue Shield of California. HOWEVER, I still think you're going to be joining me in the July group! Generally, the requirements are six months of monthly supervised visits, NOT six consecutive visits. I think they're going to count your two January visits as one visit.

You might want to check and see if you are even eligible to still have your father's plan. GENERALLY, if you can be claimed as a dependent by someone else (your husband), you cannot be claimed as your parent's dependent, which means you cannot be carried on your parent's policy. A lot has changed in the last several years, and what I said may no longer be true. But definitely, check to see if a married child who is no longer her parent's dependent can still be carried on their health insurance.

Yes, that's what it means. One of the things you didn't list was the amount of your maximum out of pocket per year. If a plan has a $5,000 max out of pocket, for example, then you will never pay more than that for the year in expenses (not including premiums). So while you have to pay 1000 for your deductible then 10% after that, if that 10% is more than $4000 (using our example), you won't have to pay anything more than $4000. Also, make sure all of the plans will cover the procedure that you want to have done.

Sigh. Look how optimistic I was there! My insurance doesn't count the first visit with the surgeon as part of the six-month nutrition program. So my last appointment won't be until June. Which means my surgery will likely be July. I was hoping for June for many reasons, one being that the company I work for is moving in July, and I wanted to have it done and take the time off before the move. Blah.

Some people who have never been there just can't understand. "There" can be many things, including: weight problems substance abuse problems mental health problems Can an alcoholic stop drinking just because they know they should? Can someone who is depressed just snap out of it? I think this is one of those things that your husband just can't understand.

Thanks! Oh, and I'm not having the band, I'm having sleeve gastrectomy.

So I posted about my colonoscopy from earlier this week. The day before the colonoscopy, I had my psych eval. These are some of the things that we talked about during my psych eval. Ever since I decided that "enough was enough" and I wanted to have WLS, back in November 2014, my right eyelid has been twitching. Almost constantly. It drives me crazy, but it's what happens to me when I'm stressed. I couldn't figure out what I was stressed about, but I figured it had something to do with my decision to have WLS. I have spent a lot of time since that decision really exploring my past and how I got to where I am. I looked at pictures of my childhood, and saw that during the time my father was telling me I had to diet because I was too big, I was actually normal. I was shocked. I was shocked at how much one person could really screw you up. I thought about all of the things he did over the years, and the things that brought me to cut him off about 10 years ago and stop all contact. He is a mean, toxic person and is no longer in my life. I also thought about the time in high school when I weighed 195 (I'm 5 ft 7 inches tall) and thinking, "well, it's okay, because I'm not 200 pounds." I remembered in my early 20's weighing 281 pounds and thinking, "well, it's okay, because I'll never weigh 300 pounds." Now all through this time period, I was still dieting, losing weight, then regaining weight when I couldn't keep up with the demands of the diet. But hey, it was okay, because I wasn't XXX pounds, right? Then in my early 30's, I got serious (or thought I did), and dieted down to 225. I married someone who liked big women and was not supportive in my efforts to lose weight. Two years later, at 350 pounds, I got pregnant. When our daughter was two years old I left him. I continued to struggle with weight. About 5 years ago, I got on the scale and it read 397. I was shocked. There was no way in hell that I was going to let the scale read 400. I went back to my go-to plan, Atkins. I lost 75 pounds. But I couldn't keep it up, I was still emotionally eating and eating out of boredom. But hey, it was okay, because I have tons of clothes (thank you, internet shopping), boots that fit my fat calves, and even tights that fit. There was nothing wrong with being a BIG BEAUTIFUL WOMAN, because that's what I was hearing all over the place. Accept who you are! Accept your size! That's the message I was hearing. People couldn't believe that I was 50 years old. They would say, "you have no wrinkles" and I would respond, "that's because I'm fat - only skinny people have wrinkles." And they would laugh and I would laugh. Because it was okay to be fat, right? In November 2014 I got on a scale and it said 403. I felt sick to my stomach. I did some soul searching. I decided to stop kidding myself and to stop accept being fat. I told the psychologist that Fat Acceptance did me no favors. It may have done wonders for other people's self esteem, but it just enabled me to be fat. Now most of you are younger than me, and you may not remember what things were like before "FA" became a thing. There was no such thing as "BBW" - the term hadn't been invented. I told the doc that I was afraid of failing. That I had read a post here about someone who was afraid to get rid of her fat clothes, because every other time she had done that, she had to go back and buy that same size again when she failed in her efforts to keep the weight off. I told him that I had a hard time with failure (and had been my whole life, another thing to thank my father for), and I think that was what I was really stressed about. I poured all this stuff out to the psychologist, things I had never, ever admitted, even to myself. And it felt great. And then my eye stopped twitching.

Call the doctor's office and ask them. If the doctor doesn't want children in the consultation room, you wouldn't be able to leave the kids alone in the waiting room without someone else with them.

My surgeon requires a colonoscopy prior to gastric surgery if you're over age 50. I had mine in January. While I was under, they also did an endoscopy and took a biopsy of my stomach. The colonoscopy is covered at zero copay to me, as it is one of the special screening procedures. I expected a small bill for the additional work for the endoscopy. The hospital bill came in the mail. My insurance paid around $1500, and they said my part was around $1600, which was a combination of deductible and copay. I called my insurance company and asked if the colonoscopy was indeed covered at 100%, and they said yes. So I said if I had only had the colonoscopy, my portion would be zero. How is it then, that adding a minor procedure that was performed while I was already in the operating room, already under anesthesia, caused my portion to go from zero to $1600?? The rep said he would attach the surgeon's bill to the hospital bill to show it was mostly a screening procedure, and send it back for review. I got the result today in the mail. My insurance company paid the $1600 they originally said was my portion, bringing my portion to... ZERO!

@@Alex Brecher That's not the problem, this is something new. The first time I reply to a thread, I auto-follow it. The next person who posts, and those thereafter, trigger notification. In the last two days, my FIRST post on a thread generates a notification that someone posted on a thread I'm following. This hasn't happened before.

It sounds like you took an assessment called the Minnesota Multiphasic Personality Inventory, or MMPI. It's about 400 true/false questions. You may have answered some questions showing you subconsciously had some lingering regret about your marriage, your husband, or your divorce. I know there weren't any questions specifically about marriage, but that's the way these things work.

This person is not a psychologist as that requires a doctorate. She is likely a marriage and family therapist (MFT), licensed clinical social worker (LCSW) or the equivalent in your state. Not only would I complain to your surgeon, I would file a complaint with her state licensing board. And by the way, you are being way overcharged. A Master's level therapist makes about $50 to $75 per 50 minute session in a mid-sized city. I would mention that to the surgeon as well. Sharon (before I changed careers to running a pain management office, I ran mental health offices for about 13 years)

I think you're doing everything you should be doing. Did you have any comorbidities? On appeal, I might argue that the treatment was for those diseases, not merely as a tool to lose weight. And I might use some phrases and sentences like, "I find it abhorrent that your customer service agents, for a period of XX months, and on at least XX separate occasions, assured me that this procedure was a covered benefit, when in fact it was not. You allowed me to have hope that I could finally live a normal life. You allowed me to have hope that I could fit into the world. You allowed me to have hope and then, you so callously destroyed that hope with nothing more than "oops, we made a mistake." Imagine having a fatal disease, being told for months that you could be cured, then hearing, "oops, we made a mistake". Your repeated mistakes have devastated me. I know you can make an exception, and I implore you to make an exception for me, as you misled me for so long. Please make this right."