Sharon1964

Maybe it's a state difference. Here in California, our company has zero liability for medical claims. We pay the premiums only. If I were you, I would speak to another insurance broker to make sure (one that handles more than one insurance company). The only time I am aware of that a company has any liability is when they are "self-insured", which means they basically hire an insurance company who is called a TPA, or Third Party Administrator, to process the claims. Often the big name companies (like the Blues) do handle TPA duties.

It depends. First, the vast majority of psych visits are paid with no notes to the insurance company whatsoever. Kind of like your odds of an IRS audit. Second, should they request the notes, and the notes say, "Pinkbunnies is here today to discuss weight loss surgery" the visit will be denied. If the notes say, "Pinkbunnies is distressed by his health and is considering his options to help resolve those issues", then the visit will be paid. Psych docs don't have to be very specific in their notes. Your psych can discuss all sorts of emotional issues related to weight without actually saying it's related to weight. Further, your doc can keep a separate set of notes called "process notes" (versus "progress notes") which are his/her own private thoughts about you, and in there they can make notes about weight. Those notes are protected by law and do NOT have to be released to the insurance company. The key is that they must be separate from their official progress notes. I'm sure if you tell your psych these things, they will most likely keep your information safe.

You don't need a period to get pregnant, you just need to ovulate. Hormones are stored in fat, so you are releasing enough hormones to have a period. The question is, are you releasing enough hormones to ovulate? I would make an appointment with my doctor.

What's wrong with it? Because your surgeon doesn't allow it, that's what's wrong with it. I'm a "rules" girl. If there's a rule, there's a reason for the rule. Your surgeon said "no solid food", not "so solid food until you lose XX pounds." Give yourself the best chance you can to be successful, by following your surgeon's rules.

I went and answered your original topic.

Your best bet is to call the customer service (or member services) number on your insurance card. Ask them what their requirements are for approval for weight loss surgery. Write down the date, the time, the number you called, and the name of the person you spoke to. Write down your questions and their answers. Some of your questions should be: 1. Does my policy cover weight loss surgery of any kind? 2. Are there certain types of weight loss surgery that are covered and if so what are they? 3. Are there any types of WLS that are specifically excluded? 4. Do I need a psych clearance? 5. Do I need a period of time of medically supervised weight loss appointments, and if so, how long? 6. Do I need any other clearances? 7. What are the BMI requirements? 8. Do I need to have any comorbidities for it to be covered? 9. What is my deductible? (amount you pay before insurance pays a cent) 10. What is my copay? 11. What is my maximum out of pocket? (the total amount you will spend in a year on medical care and then insurance will cover ALL of the rest) 12. Is the psych clearance (if you need one) covered by my insurance? 13. Is my surgeon in my network? And if not, what does that mean to me financially? 14. Is my hospital in my network? And if not, what does that mean to me financially? 15. Is my anesthesiology group in my network? And if not, what does that mean to me financially? Good luck.

Most, but not all, people who have double coverage have zero out of pocket costs. Whatever the primary doesn't pay, the secondary will. Some secondaries only cover deductible, or only cover copays. I always encourage people to become educated on how their insurance plan works. You cannot always trust the person at the doctor's office to know what they are talking about. At my office, my staff is forbidden from discussing costs with patients; only I am allowed to do that. I start the discussion by saying, "this is what your insurance is telling me, I HIGHLY encourage you to call them and ask them the same questions that I'm going to write down for you." I used to be on a panel of experts answering questions on a website about all aspects of the business side of medicine. I would shake my head at the number of people with screennames like "InsuranceExpert" who would ask such basic questions that it would seem that they had no training or experience at all. And I would wonder how on earth they were still employed at a doctors office. /end of rant/hijack Educate thyself!

My psych told me that he had WLS about four years ago, so the dude has some street cred, not just "book learnin". I've never really trusted skinny-minny doctors or nutritionists, because I figured that they learned everything they knew in school and had never really been there. Of course, some of them could have had WLS too and I didn't know it.

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.

OPM - out of pocket max - is exactly that. It's the maximum you will pay out of pocket for your plan year (usually calendar year but not always). Once you've met your max out of pocket everything will be covered at 100% no matter if they're usual coverage is a smaller percentage. I doubt that the term will be defined on the webpage where she is looking up your policy info. You can ask your insurance for a plan coverage booklet if you don't have one; they almost always have definitions. Or you can do a three way call with her and your insurance company. You can also ask to speak to the office manager and discuss this person's need for more training. As someone who works in the business of medicine, including teaching people how to bill and understand insurance, it strongly annoys me when people in these positions (surg coordinator) don't know what they're doing.

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.

My surgeon requires a colonoscopy if you're over 50. Today was mine. I also had an upper endoscopy. Yesterday, I only got 3/4 of the prep material down before I starting vomiting. I had to stop and finish with Water, so I was worried they were going to say that I didn't do enough prep and make me do it again. My plan was to drink only Clear liquids until the next procedure date because there was no way I could do that again! I did tell them that Versed doesn't work on me. Versed is a drug that is supposed to make you forget things, but I always remember. They take me to the procedure room where the nurse said, "I'm going to start giving you medication", she sees my red wristband and asks, "what are you allergic to?" I'm allergic to Demerol, which is what was in her syringe! Close call!! So she just gave me fentanyl and versed, and I drifted off. I came awake very suddenly, halfway through the colonoscopy. There was no pain, and no fear or anything negative like that, but I could definitely feel things happening, so I opened my eyes, looked right at the nurse, and said, "Why am I awake? I don't want to be awake!" and I heard the doctor tell her to give me more fentanyl. Thank goodness I didn't wake up during the endoscopy, when you have a tube down your throat. It was during the colonoscopy portion, when you have a tube up your... wazoo. My next memory is waking up in recovery. When the surgeon came in to give me the results (one polyp), I told him I remembered waking up in the middle of things. He said, "you took ALOT of anesthesia, you'll need propofol next time - make sure you tell your surgeon." Propofol is the sedative that Michael Jackson was so fond of. I came home and had some sprite and slept for most of the afternoon. Phew! Glad that's over!

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.