Sharon1964

This topic made me chuckle - I just couldn't help it. The invasive (and/or uncomfortable) things that women undergo throughout our entire lives, such as pap smears, vaginal childbirth, C-sections, colposcopy, miscarriages, mammograms... I'm trying hard to be sympathetic at the thought of a man having a tube inserted into his penis. I'm trying. Really I am.

My thoughts are... do what your surgeon says.

She actually misread it and thought it said "bohemian", not "behemoth".

I feel like I just need to whine to people who will understand. I usually do a good job of keeping my "Teflon shields" up, to deflect verbal crap that has no effect on me. If a patient at work is being difficult, I remind myself that they are upset and in pain, and it really has nothing to do with me personally. Until yesterday. I was caught off-guard with my Teflon down. One of my staff pointed out a review on vitals.com of our office. The word that was used to describe me was "behemoth." Behemoth. A large horrendous monster. Ouch.

On another forum I used to hang out on, the peeps were discussing the way girls' genitals look. One particularly charming guy used the phrase "floppy meat flaps". I almost thought it was the same guy for a minute, then realized he said "mud flaps".

Yeah, it's in the guys room. Mud flaps.

I feel like I should get a gold star just for staying out of the "mud flaps" thread. Just sayin'.

That would have earned her the icy stare of death and a very slow, "I'll... let... you... know... when... I... need... your... advice."

Call back and ask for a supervisor. Or go to your surgeon's office and sit with them while they call.

I would suggest counseling. It sounds like you buried some issues that won't stay buried. Time to bring them out into the light of day and examine them.

Don't be afraid to tell your provider something like, "I do so much better with the focus on the positive side of thing instead of the negative. Can you focus on the positives please?" And if/when they don't seem to know what you mean, you can say, "instead of saying, 'it's normal to ONLY lose a few pounds in the first week', can you say, 'awesome! you've lost weight!' ".

I was going to ask... "older than what?"

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.