Sharon1964

Well I work for a pain management doctor, and we've used most of those drugs in our practice when we do procedures, so I'm familiar with them.

If I were in your shoes, I would ask my primary care physician what they think of your situation. However, having said that, I fail to see how a shooting nerve pain from your buttock down the back of your leg would prevent you from having WLS. Not a doctor, yada yada yada.

We do pre-ops at my office (not a WLS office) and we have a form we fill out for the surgery center. The doctor does a physical exam to complete the form, covering heart, lungs, etc. If the patient is of a certain age or has a cardiac history, the surgery center requires an EKG or clearance from a cardiologist, so those tests are ordered at the pre-op visit. I would imagine a pre-op for WLS would be similar to pre-ops for other types of surgery.

Gut reaction: "Yeah, I'm a beginner all right - I've only been walking for 38 years now. But hey, I'm proud of my amateur status, it means I can still compete in the Olympics." But then again, I'm a smartass.

Sounds like the virus that has been going around. I felt that way for a week before it hit me full on.

That "not a guarantee of payment" thing is standard. Some people cancel their insurance but figure since they have an approval, they can go ahead and have the procedure and it will be covered. Ummm, no. Regarding authorizations, the law is on your side.

Also, just in case you get a newbie when you call the insurance company, make sure you use the terms they use. Claim: Request for payment for services already performed. Authorization or Pre-authorization Paperwork: Documents asking for authorization to perform a procedure. If you call and ask if they have received your "claim" for WLS, they may think you are asking about the surgeon's bill, instead of asking about authorization. I've worked in medical administration for about 20 years, and occasionally I get a newbie when I call an insurance company and have to educate them about what I'm asking.

Just in case anyone else is in this same boat, once you receive an approval for a procedure in writing from your insurance company, if they do NOT rescind the approval before the procedure and you still have coverage, they are required by law to cover the procedure. You do NOT have to pay for the insurance company's mistakes. When a doctor receives a denial from the insurance company for a procedure (surgery) as "not a covered benefit", the paperwork always says "if you have an authorization for these services, please send a copy to (wherever) for reprocessing of the claim."

My surgeon plans to do a VSG, and told me if needed, it can be converted to a DS (several years down the road). He explained to me why he chose the VSG (I have bone spurs and other orthopedic problems, and he said anti-inflammatories are easier with the VSG than any of the other choices). I had gone into his office expecting him to recommend the RNY, but after he explained his reasoning, I was satisfied with his knowledge and experience.

Actually, I wasn't referring to the changes that come with pregnancy and childbirth. I was referring to the ability we have as women to grow a human. Guys lose weight more easily (in general, not trying to offend anyone); women can grow humans. I'll take "grow humans" any day.

[edited cuz my internet fail was a... fail]

"Thank you" is a complete sentence. Just say it with a smile.

Every time I think that it's pretty unfair that men have an easier time with weight loss (in general), I remind myself that as a woman, I grew two human beings in my body.

I'm not sure if you're quoting new research, but traditional science says that while serotonin is found in the stomach, platelets and brain, it is produced in the brain.

If you're familiar with the Minnesota experiments, you'll know that the purpose was to learn more about famine and how to help people in danger of starvation at the end of World War II. You'll also know that the volunteers never went below 1500 calories in a day, and that they also experienced severe depression, emotional distress, hypochondria and hysteria. Further, the physical effects of the experiment on the participants closely resembled the physical effects that happen to people with anorexia or bulimia. And all that with four to five times the calories that you are suggesting. I can't even imagine what will happen to a person who drops to the level you are suggesting. No thanks.

When I called my insurance company to ask about requirements for WLS, they said "no alcohol or substance abuse for 18 months" and "no smoking for last six months." Ask your surgeon what his/her requirements are. It could be anywhere from 30 days to 180 days or more. I tried to give you some links to data regarding smoking and surgery, but those sites were not allowed to be posted here.

Can you be a bit more specific as to what you are having a hard time with? How much to eat? What foods to eat? How often? Are you having a hard time getting food down? If you tell us you're vomiting every time you try to eat, that's a different problem than being uncertain of what to eat.

I know I'm late to the party, but my first reaction was, "I'm about to lose 185 pounds (or whatever your husband weighs) if you don't stop talking about my weight." I always try to channel Miss Manners (Judith Martin), where I first learned that "thank you" is a complete sentence, as is "no", and "thank you but that won't work for me."

I'm not sure how helpful this is... we have a zero tolerance policy for gossip where I work.

I've been working in medical administration for over 15 years. I have NEVER had a secondary insurance that will "just pay" if you bill them (not saying they don't exist, just that I've never seen it)... although I've never worked with Horizon NJ Health. Generally, the secondary follows the decisions of the primary unless you get something different in writing. So if your primary insurance does not cover a procedure, your secondary has two options: follow along with the denial or cover as if they were primary. I would never counsel anyone on my team to perform a procedure without a written authorization/approval from the secondary in your situation. The likelihood that we would get paid for it would be slim.

Wow I'm so jealous! I'm sitting at the hospital right now waiting on my upper gi. Next month is psych eval and colonoscopy. Just starting the six months of medical visits.

I spent some time and read all 107 pages (!!!) of this thread. You all are so inspiring! It is so wonderful to read of all of your victories. Thank you for sharing your stories.

It's not done at the same time. My colonoscopy is scheduled for January; I have four months after that of monthly visits (supervised weight loss) before I can have my vsg.

I have to go back and check my notes, but I'm pretty sure my surgeon's plan says no bread or crackers for six months, as it forms a gummy paste in your stomach, which is very hard to digest.

I would wait to see if you get a denial for that reason. There is a possibility that the medical assistant entered the wrong weight into your records that one time. That is probably what I would base my appeal on. Oh, and as stated above... if you have a medical procedure based on an approval, they cannot come back later and retro-deny that approval. As long as your insurance is current (paid up) at the time of the procedure, and they have not notified you that they have rescinded the approval BEFORE you have the surgery, you're fine.