Mistie

Thank you, LipstickLady. Logically, I know he has my best interest in mind. He wants to ensure a safe procedure. I just quickly got my heart set on it, and it seems so unattainable. In my entire state, there are only three clinics. I'm going to go ahead and do the testing, to see the results. If he does not/will not proceed, I will see another clinic, as my general practitioner is actually three hours away, so therefore was actually more familiar with another clinic (my OB had referred me to this specific clinic, as it is closer to my home - sounds confusing, but I live between two places, as I have a home home, but a secondary home, because I teach at a University). As far as a plan for losing the weight at the moment, they simply printed off the 10 day preop diet they use. That does not really work for me, however, as it incorporates a lot of 'green' foods, which I cannot eat (on blood thinners, so I cannot eat green veggies). I also asked him for suggestions for controlling hunger, as I am on Depo Provera shots, which his nurse practitioner said was more than likely increasing my appetite (I asked her how it influenced weight, as I was told by a doctor it does, and that was the reason I had regained the 74 pounds I lost last year, with friends). He had no recommendations.

I just found out in early April that yes, my insurance does now pay for WLS. I was ecstatic! I immediately did the online educational seminar, went to the support group meeting, and scheduled the doctor's appointment. I began exploring the forums here, as well as other places. I began studying diets, pre-op and post-op. I began testing shakes (I know, I was just getting a head-start, though), trying out how well they worked for curbing hunger, etc. Today, I had my first appointment with the surgeon, and I left in tears. 1) The surgeon requires that I lose 115 pounds (he wants me to have a BMI of 55 or less, so to weight 335). While I logically understand the need for a lower BMI, again, if I could lose that amount of weight on my own so easily, WHY would I need the surgery? I have read many threads in the forums, as I waited to get started, about people who were told they were taking the easy way out. For me, I've never felt that way about others, but I felt that way about MYSELF. It made me feel like a failure that I could not do this on my own, and would need to go have surgery. I've never even let people know in the past if I was trying to lose weight, because I did not want anyone to know if I failed at it. So, I made the appointment and have worked on myself to accept that yes, I failed, but that's ok, I need help. Then, I go into this first appointment, only to be told that what I failed at? Yeah, need to go back and be successful at it to have the surgery... I admit to feeling a bit devastated. My mom, who is SO super supportive, does not understand why this is a problem. She has complete confidence that I can do this, and she does not understand why I am so overwhelmed and upset by this. 2) I was diagnosed with Crohn's Disease when I was 8 years old (up until that point, I was under weight. That's when I began gaining weight). The doctor walked in and almost immediately said he would not do surgery due to the Crohn's. We talked about it awhile, including that a doctor several years ago said he saw no signs of it, and I've had several colonoscopies since with no reports of seeing Crohn's, so he's referring for more testing. So, all of this may be completely in vain. Like I said, I feel completely defeated right now. I thought all of the emotional stuff was suppose to start during pre-op diet when you're not allowed to eat and then after surgery! This first appointment alone has me completely overwhelmed.

Dandylion- what about calling and speaking to the insurance coordinator at the bariatric center? Just explain your situation. You have an appointment, and have been trying to find out insurance requirements but can't get a straight answer. S/he may not be able to give you an exact answer, because each plan is different, but s/he should have an idea.

Heather, The specific info is on pages 20-22, under covered services. On pages 21 and 22 is where it talks about the requirement for a supervised diet. As I said, their bullets are really mixed up! The levels are screwy, so it's hard to tell what's a requirement, and what's an 'option.' I'll post it below for you! Number 1: two programs which have been supervised by other doctors, takes a total of 6 months. Number 3: Supervised by Active Health - takes 6 months - just phone calls. Number 2 can be completed through your bariatric center. Takes 3 months. Includes visits with the physician and a nutritionist. The center said our insurance will NOT cover the nutritionist, however. The exact wording is below! *Member must meet 1 or more of the following criteria (1) physician-supervised nutrition and exercise program; or (2) multidisciplinary surgical preparatory regimen, or (3) Participation in the Weight Management Enhancement Program. (1) Physician-supervised nutrition and exercise program (it's just listed as a sub-bullet, not numbered, so hard to tell the difference) - Member has participated in two (2) or more physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavior modification, Weight Watchers, the Atkins Diet, the South Beach Diet, or Sugar Busters), documented in the medical record at each visit. The physician-supervised nutrition and exercise program must meet ALL of the following criteria: (IE. This is two, three month programs at least - so this requires at least 6 months to complete). (2) Multidisciplinary surgical preparatory regimen: Within 6 months prior to surgery, the participant must participate In organized multidisciplinary surgical preparatory regimen of at least three months (90 days) duration meeting ALL of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the participants ability to comply with post-operative care and dietary restrictions: Behavior modification program supervised by qualified professional Consultation with a dietician or nutritionist Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen). Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to the surgery, supervised by exercise therapist or other qualified professional. Program must have a substantial face-to-face component (and must not be entirely delivered remotely). Reduced-calorie diet program supervised by dietician or nutritionist. (3) Participation in the Weight Management Enhancement Program for 6 months (This is the Active Health program - monthly phone calls). Active Health administers our weight management and smoking cessation programs. The telephone number for more information from them directly is 866-939-4721. They were very helpful when I called!

Greetings! I'm BCBS MS (state employee) and just starting. I found out our insurance now pays (started in fall 2013), completed the online educational seminar the same day (I was going to book the in-person, when I found they added the online portion), and attended the in-person support group the same week. The next week I scheduled the appointment - the earliest they could get me in is May 27th. I called today to see if there had been any cancellations, and I was moved up to May 4th - VERY EXCITED! I have spoken with BCBS, as well as Active Health - who manages that portion of our insurance. I wanted to know specifics of our requirements for approval. According to Active Health we have the three options (and it's in our manual we can find online) - 6 months of a distance supervised program through them, two three-month physician supervised programs, or a three month supervised program through our bariatric center (this is not the wording in the program, rather, layman's terms for it!). They do not have a requirement that we lose weight, rather, that we show we participated in the program. If you go to MyAccessBlue, you can find your 2015 manual under publications - the info on bariatric procedures is on page 20 something. Be forewarned - the formatting is REALLY off, so it took me awhile to make sense of it, that it was ONE of the options, not all! Ha.

If you have any doubt, call your doctor! No one can give you a yay or nay without medical testing. Almost three years ago, I went through a two-month period of having trouble breathing, and it was getting worse and worse. I went to the doctor 5 times, and no one could figure out what was wrong, because the only symptom I actually complained about was my breathing - they said asthma, pneumonia, allergies, bronchitis, and everything in between. Finally, in the ER, someone figured it out. I had blood clots. I was admitted to the hospital and stayed there in ICU and had to go through surgery, etc. I had had so many blood clots, my lungs (both right and left) were collectively over 50% filled with dime and nickel sized blood clots (so of COURSE I could not breathe!), and I still had three in my legs when I was admitted to the hospital. I never had ANY symptoms of swelling or heat in my legs. Perhaps some tenderness, but if so, I would have just thought that was from having to walk and being so heavy. That said - again, if you question it, call your doctor! As others have said - better to be safe than sorry.

Thanks for the info, John! I'm an avid cruiser (28ish), and that's one thing I have worried about. I'm actually trying to figure out how to schedule surgery given my cruising schedule It's nice to know that you were cruising comfortably so soon after surgery, however!

The risk of dvt is high for anyone who is immobile, and according to my hematologist, 1 in 7 women get blood clots when flying overseas-we have a higher chance than men. In other words, do some walking! And when you're in your seat, do some leg lifts every so often-keep your circulation going. Even without a history, lack of movement makes one susceptible.

I just found out my insurance will cover, so I'm steamrolling ahead. I made a comment to my mom over the weekend, after having spent time exploring this site, about how expensive it will be post-op. She put it in perspective. Not only will I not be buying regular food (and I tend to buy pricey organics and fresh food to be healthy), you won't be buying fast food, either. So, I will be SAVING money, now that I think about it!