2goldengirl

As I understand it, you do your appointments via Skype and telephone, so don't let that be a barrier. There is a forum here for folks who are planning to, or have gone, to Mexico.

What you don't know is the rest of the story. Was she off for two weeks for the holidays? Was the office closed during the holidays? Was another key person in the office out sick and everyone doing double duty? Put yourself in this person's shoes. Would you want someone getting angry despite you doing the best you could? Does your surgeon also do other kinds of surgery, some of which may have been urgent? I'd probably call and ask to speak to the office manager and ask why it's taking three weeks for elective surgery requests. You may find out that the person who is doing the submitting is not doing her job as expected - but you may find otherwise.

Just think about this a minute: You have lost 17-20 lbs. in three weeks. Do you not see that this is awesome? Hide the scale or give it to your next door neighbor for a month or two. Keep following your program. You're doing great!

Congratulations on your loss, and remember - nobody can make you feel like a failure unless you allow them to. Success can't be judged two weeks postop. Period.

London. Be still my beating heart. I absolutely adore London. and absolutely more walking everywhere. When I was there, I invariably needed to use a tube station with a nonworking escalator. This was nearly fifteen years ago, and I remember only having the time for two meals a day because I was trying to see a month's worth of London in just over a week. I ate anything I wanted to, enjoyed it immensely, and came home 5 lbs. lighter. If you enjoy architecture, both St. Martin in the Field and St. Paul's church have cafe's in the crypts. I actually had a meal in both, I thought t was a gas to have a meal in a crypt. St. Martin in the Field does a lot of concerts and jazz on Wednesday evenings in the crypt itself.

Paris. Seriously. Paris! Stop worrying, and prepare to enjoy a glorious trip. Stop obsessing about every bite that goes in your mouth, or you will miss out on SO much of this wonderful experience. You will be busy every moment. Enjoy knowing that your pouch limits you to not overindulging, but enjoy every sip and bite you take while you're there. You will probably find that you continue to lose while you're gone - I always have in Europe, partly because of walking absolutely everywhere. Your senses will be completely filled with all that is Paris, and you likely won't even think much about food. You've lost 190 lbs. Think of this trip as a lovely reward for yourself. You will doubtless have the joy of fitting MUCH more comfortably in the airplane seat! Plan to buy yourself something - a scarf, a pair of leather gloves, something that makes you feel special and absolutely Parisian. It can be your anchor for shedding the pounds that remain until maintenance. Bonne chance!

Broadly speaking, insurance doesn't cover drugs or supplements available without a prescription. A lot of deals can be found online. I use the Flintstones Chewables vites and they're very reasonably priced. I found a sublingual B12 at CVS that does the trick, also reasonable. Since I'm preop, I'm taking Calcium from costco, I have to figure out what to do postop. I hate the taste and texture of the chews. I spend less than $20 a month on Vitamins. It's worth it to protect my health.

You wouldn't talk to the pre-auth department at Blue Shield - that department only handles things that Blue Shield directly authorizes (like clinical trials, certain transplants, that kind of thing. Have you called your medical group? Your medical group ought to be able to intervene. Remember in the pst where I told you that if you got any pushback from your surgeon to contact Blue Shield and file a grievance? That's what you need to do. Call Member Services and say "I have a grievance". "Grievance" is a magic word, make sure you use it. And when they ask you what the nature of your grievance is, you tell them that your surgeon's office is not following Blue Shield's medical policy for bariatric surgery. Tell them that you are aware that Blue Shield's policy changed effective 7/31/15, but that because Blue Shield has not effectively educated their medical groups, you are being held hostage to a policy no longer in force. Good luck!

I really appreciate this post. I'm preop, but have several friends who are postop. One of them had a tummy tuck late last year after losing 150 lbs with her sleeve. She was SO unhappy with the extra skin around her abdomen. I rather expect that when the time comes I'll have something done - I've wanted a boob reduction/lift anyhow. I love the comment of wanting not to look like a deflated fat girl. I think there is something about taking the leap to get plastics done that can be the final acceptance that the "fat life" is over, and that the "thin and fit life" is a permanent change. And permanent change is what we all want when we start this journey, isn't it?

@@RileyBear, in CA, Blue Shield delegates review of authorizations to delegated medical groups. Blue Shield's policy is used, but there are more than 200 medical groups in the state. It works differently here than in other states with other insurance products. Letters of medical necessity aren't used in H M O products in CA. The medical groups contract with specific bariatric surgeons who prform surgeries at specific hospitals contracted with each of the health plans. If the surgeon's office can't get the surgery approved, the surgeon can't get paid, so they are very motivated to get surgeries approved the first time their request is submitted. A decision has to be made within five business days in CA so long as the required documentation is provided at the time of the request.

Welcome! Did your surgeon say you would need some time after your baby is born to have your surgery? I'm just curious. Kaiser should have a support group for bariatric patients. I really recommend you start attending, it's a big help.

@@sjrn16, you may have different forms of Aetna. You have H M O, which limits your out of pocket to copays.

Please don't worry about the numer of days. The important thisg is - your insurance approved your surgery. How many days you stay depends on your surgeon. All this means is that the hospital would have to justify for medical reasons a stay longer than the number of days on the letter.

Call the surgeon's office - they are the ones who submit everything to Aetna for approval. They know the process better than anyone.

@@TnT123, you have lost 31 lbs. in four weeks. That's a LOT! Think about it. Your body needs to catch up. Relax. Keep doing what you're doing.

The first culprit I would suspect are those shoes. The midsole in athletic shoes doesn't last forever, and if you've had to glue to soles, chances are the midsoles are shot and aren't absorbing any shock. Back off for a a day or two. Get some new shoes. Then see how you feel. Yes, there definitely could be something else going on, but start with the simple fix first and see how you do.

It's a narrow-network product, and I believe it's only offered in northern CA. here in the bay area, which means your two sites for surgery ought to be either Valleycare or Summit in the east bay, UCSF in SF, or Mercy Methodist in Sacramento. The same criteria apply for approval of surgery; here is a link to the policy: https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/BariatricSurgery.pdf They do NOT require six months waiting period, nor have they since this policy was updated in May 2015, however "Patient has made a reasonable effort to lose weight and there is documentation that these attempts at dietary control have been ineffective in achieving a medically significant long-term weight loss.". A psychological evaluation is required. Their criteria for individuals with a BMI between 35 and 40 are pretty stringent. All of these details are on pages 3 and 4 of the policy. Health Net requires that its delegated medical groups (Brown & Toland, Hill, Mercy, etc.) follow Health Net's criteria. This means that if your medical group says that you need to anything beyond what is mentioned in the criteria, they are incorrect. Your surgeon will have specific requirements for preop diagnostic testing, such as an EGD and/or upper GI X-ray, a sleep study, or an EKG, and that's fine, those are diagnostics your surgeon needs and not subject to the health plan or medical group's policies. I hope this helps!

@@needtorecover, G to H here. I think my shoulders & sleeve length will be just fine in a size 6-8. We'll see!

Yes, they count. I'd done so many over the years that I'd forgotten the names of some of them. I just made a list and gave it to both my PCP and my surgeon. I did it as a table, and I added which year, how much I'd lost, and how long the loss lasted. And don't forget this - completing the form is your surgeon's job; properly documenting how you meet the criteria for surgery is their job as well. They will need information from you, but they've gotten many, many patients authorized for surgery - whereas the only experience you personally have is your own.

I'm actually researching this right now. I have to do something while I get all my preop work done, right? Pinterest has been a great help, along with a book I got recently about style for women > 40. I've realized that my personal style has been a bit unfocused, which has led me to some choices I've been very happy with, and some unfortunate ones. I've realize that simple lines, classic cuts, and timeless fashion are what have always appealed to me. It will be a LOT easier to find things worth investing in when I'm not in that Twilight Zone of "sometimes a plus size, sometimes a standard size". One of my treats to myself at goal will be to sew a tweed Chanel jacket with all the couture details. Did you know you can buy tweeds from the same mill that Chanel buys from? What a want is to buy a shirt or a sweater where the shoulders don't droop down my arms so that it fits over my boobs. Right now I just can't do a classic white button-up shirt. Anything that fits over the front has sleeves that are too long and shoulders too wide. I don't have very narrow shoulders, and once I get to where my circumference is more in keeping with my bone structure, it will be SO much easier to get things that fit. Right now I wear knits almost exclusively, because they have give and drape. I'd love to explore wovens again. I'd love to wear jeans that were both comfortable and flattering, just now they're just not a good look for me, and they're beastly uncomfortable, especially all day at my desk. I have a friend who is an absolute genius at consignment shopping. She's on board to replenish my wardrobe as I shrink. I have things stored in the attic that will do me for the first 20-30 lbs. loss, maybe further with the addition of something like a belt for the cardigan sweaters, that kind of thing. And in the meantime (thanks to a year-end bonus), I bought myself a lovely new handbag and tote for work, and did a bit of shopping on eBay over the weekend; I'm wearing my first-ever statement necklace today, and it's drawn raves. I think it cost about $15 on eBay. I've got unfortunate feet from past injuries, so time will tell if the weight loss will enable me to wear some kind of heels again.

You've gotten a lot of tough love here, and while I may wonder at the manner in which your psychologist delivered the message, there are some hard truths to face before you make your decision. But here's the most telling from my POV. You are 34 years old. You say you have been fighting obesity since you were a teenager. That's roughly half your life. if you decide that WLS surgery is a good option for you, what you then have to look forward to is having a healthier life for many, many decades. I say this because I'm in my 60's. I have been fighting the notion of surgery for more than five years while at the same time working with individuals who are on the surgical journey. I've read countless reports from Registered Dieticians, Psychologists, primary physicians, and surgeons. Only a very few of those clients had any kind of complications after surgery. All would do it again. All had tried over and over again to lose weight without surgery. All failed to maintain their weight loss without having surgery, despite multiple and very sincere efforts on their part. Having made the decision to have surgery myself, I wish so badly that there had been a way to treat my obesity successfully and definitively when I was your age. I don't know necessarily that I would have been happier or had a better life (I'm well and truly blessed), but I'm now staring down the last third of my life knowing the damage that decades of obesity have done to the only body I have. I won't ever get those healthier years back. One final note for you, and that's about your "I'm a rebel" comment. I get it, I'm kind of a rebel myself. Tell me I can't do something, and I tend to see that as a challenge. One thing that is absolute where surgery is concerned: rebellion needs to be able to come off the table in terms of pre and postop directives. I only mention this because it's something that is part of my preop self-reeducation. Good luck with whatever you decide.

The policy change is for H M O, and does not apply to P P O so far as I know.

Sigh. People who answer 800 numbers aren't paid to think. And Bariatric Pal asterisks out "***", which is why I spelled it out in my post. Let me say this again: Blue Shield of CA for Health Maintenance Organization members follows the policy I linked above. period, no matter WHAT anyone answering an 800# says. I don't blame you for being confused, since Blue Shield's member services staff are. Here is how you do this. You make an appointment with your PCP. Take a copy of the Blue Shield policy (not the whole 48 pages, just the first four will do). Talk to your PCP about a referral to a bariatric surgeon. make sure the surgeon gets a copy of the policy (though mine didn't believe me when I sent it to them, hence my Grievance with Blue Shield). You have to get a referral to see the surgeon. Make an appointment with the surgeon. Some surgeon's offices want you to see an RD and a psychologist first before they will see you. this is where you explain again that your health plan criteria don't require these before consulting with a surgeon (surgeon may want you to have them, but you can certainly see the surgeon first) IF surgeon's office won't see you without these two visits despite Blue Shield's policy, call Blue Shield and file a Grievance. Blue Shield will overturn the decision not to see you first, because Blue Shield requires their delegated medical groups to follow Blue Shield's policy. Work with your surgeon's office to complete any required preop testing and diagnostic work. My surgeon wants the RD and Psych visits, a sleep study (which means a referral to a pulmonologist) , an upper GI (for which I just needed an MD order from the surgeon) and an EGD (which means referral to a GI specialist from the surgeon). Expect to wait for all this to be accomplished. I had to wait nearly a month just for an initial appointment with the GI doc, for example. I don't know how long it will take after I see her to get the EGD done. I hope this helps!

Contact your health plan and request a copy of their criteria for revision of bariatric surgery - this is key, because most health plans have different criteria for revision than initial surgery. Hope this helps!

Blue Shield does NOT require six months any longer for their Health Maintenance Organization members. They changed their policy effective 7/31/15. Here is a link to their medical policy index. own to the "B's and you see bariatric surgery. https://www.blueshieldca.com/provider/authorizations/clinical-policies/medical-procedures/policy.sp Link to the policy itself: https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Bariatric_Surgery.pdf And the section concerning patient selection criteria: Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure (e.g., Weight Watchers, Jenny Craig, Optifast, MediFast). The timing, intensity and duration of the preoperative timeframe should be individualized and left to the discretion of the patient and provider. However, given the elective and life changing nature of these procedures, and the necessity of proper education and instruction in the lifestyle changes inherent in both the immediate and long term postoperative management, it is recommended that three months elapse between the initial bariatric consultation and the date of surgery. You need to meet BMI criteria as well, that information is earlier in the policy.