2goldengirl

I'm no veteran and not one of the folks whose voice you miss, but I have to say I absolutely LOVE your post. Thank you for taking the time to share it. It's lessons like yours that those of us on the early end of our journey need most.

I wasn't sure whether health plans did this - I'm in CA and most health plans delegate case management to medical groups. In the group I work for, anyone with a referral from their PCP for bariatric-related services gets a case manager. The truly fortunate get...me! We contact those members as soon as they get involved in the process, go through health plan requirements, answer any questions, and make follow up calls after surgery. We do have some comprehensive programs in the area that duplicate a lot of this, and we leave it to the member whether they'd still like a case manager.

In the short time I've been on these boards, the most common insurance question is "will XYZ Health Plan approve me?" Here is how to find out BEFORE you move forward. Find your insurance card. Call the toll-free number on it (member or subscriber services) and ask specifically whether your plan has any exclusion for bariatric surgery. It's rare, but it does happen. If you have your "Evidence of Coverage" or "plan documents" booklet shoved in a drawer somewhere, any exclusions will also be in that booklet. Sometimes the person on the phone needs to look up the surgery by Procedure code, or CPT code. The code for a gastric sleeve is 43775. If you don't already know that your deductible or copay is for a hospital stay, the time to ask is now. While you're on the phone ask them to send you a copy of their criteria for bariatric surgery. Most plans will do this; in California, the law says they have to do this. If you have trouble getting them to send it to you, or you simply don't want to wait for the mail, go to your good pal Google. Google "nameofinsurancecompany plantype medical policy bariatric surgery" for example, "BCBSNJ PPO medical policy bariatric surgery" . I did that, and got this link: https://www.horizonblue.com/providers/policies-procedures/utilization-management/prior-authorization-lists/ppo The criteria themselves aren't on this page; but it does tell me that prior auth is required for bariatric surgery. OK, where to go from here? Over on the left, I see a link for "policies". I click that, and there it is: "Medical Policy Manual". There is a disclaimer page there, and then three other tabs. I click the "alphabetical" tab, and looky there, a link to the bariatric surgery policy. Here is that link: https://services3.horizon-bcbsnj.com/hcm/MedPol2.nsf this particular example is one that takes more steps, a lot of plans have a direct link and whammo, you can just pull up the policy. Have a look at the top of the policy and you will see the "last reviewed" date. This can be important if your plan has a recently reviewed policy and your PCP and/or surgeon's office isn't aware of any changes. it can make you crazy if someone you're dealing with insists that the policy is different than what you see in front of you. I am having this problem right now, myhealth plan has recently dramatically changed their policy and made the whole process much more simple - but even after sending a copy to my surgeon's office, they are having trouble wrapping their heads around the change. I get it, it's a big change, and it's a patient who is better informed than they are. Be aware that your surgeon or bariatric clinic may have requirements for all their patients in addition to those set by the insurer. These are done in order to assure you have the most successful surgery possible. Your surgeon has the right (and responsibility) to require that you adhere to a pre/postop diet, get certain preop testing done, etc. I hope this is helpful, I happen to have been in the business of getting services of all types approved for twenty years. It's SO much easier to get your hands on this information than it once was!

EXACTLY. Always, always, find out your insurance requirements BEFORE moving forward. They are often available by simply googling "nameof nsurance company medical policy bariatric surgery" insurance company name medical policy weight loss surgery or surgery for morbid obesity. It's so much better to know rather than feeling you have no control and fretting over it!

This is a link to Anthem's medical policy for bariatric surgery. I know I've posted this link before somewhere. https://www.anthem.com/ca/medicalpolicies/policies/mp_pw_a053317.htm It says 40, or one > 35 with comorbidities AND that you do have to follow a six continuous month program in the two years prior to surgery. Thsi policy is available online to anyone. Be familiar with it, and you wont' have to wonder "will I get approved?" You'll know. Good luck!

Stop. All of you. Just stop doing this do yourselves. This is not a race, and your goal the first few weeks is NOT to lose weight, it is to heal from your surgery. Will you lose weight? Undoubtedly. Your bodies, all of you, have been through a lot.The first order of business for your body is to heal. For that, all you need to do is follow directions - get your Protein, get your fluids, do your walking. Trust the process. Yes, I'm being very blunt about this. I'm serious. I have coached people into and out of surgery and postop phases for more than 30 years. Take your scale and give it to your best friend or your next door neighbor if you have to, but get off the damned thing for the first few weeks.

Of course you're scared; hearing statistics will do that to you, especially when you've just had laid out for you every worst-case scenario in the book. Here are a couple things to remember. First, Any surgery of any kind has a risk - your band had risk. And you did that successfully and are healthy enough to consider revision. Second, most people don't get leaks. and of those who do, only some of those end up in the worst-case scenario your surgeon described to you. Third, the studies that result in those complication statistics are done with pretty small sample sizes. here is a link to some of them (scroll down on the page) http://www.bariatric-surgery-source.com/lap-band-revision-surgery.html It may make you feel a bit better to actually read the studies. I know I like facts. Good luck, whatever you decide.

Here is a link to UHC's policy for coverage of bariatric surgery. I hope it's helpful. https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/UnitedHealthcare%20Medicare%20Coverage/Hidden/Obesity_Bariatric_Surgery.pdf

You realize you don't have to skip stuffing and gravy? Take smaller portions than you may otherwise have done. We co-host with another couple and have between 25 and 30 people. I'm always so busy that I don't eat much, though I do enjoy sipping on wine from midafternoon into the evening. I'm pre-pre-op, and I don't have a 6-month requirement, but I have a longstanding set of habits for the holidays. I know which foods are my favorites, and I focus on those. I don't feel the need or desire to eat everything. I skip the appetizers, except one stuffed mushroom (one of my faves). I love the taste of ham and turkey together, so I have a little of each. I may have a bite of pie after dinner, but I'm just as likely to take a piece home and have it for Breakfast on Friday. A year from now, I expect to be 9-10 months postop. This kind of approach is likely to work as well for me then as it does now. And for that, I'm thankful!

The six month requirement for UHC is to show that you have adhered to a program and been unsuccessful. Is your WW online or have you been going to meetings? I don't think the online qualifies as you don't get the components in online that you do in meetings. I don't know anything ideal Protein, so I can't help you there, except to say that what UHC is looking for in a program is structure, behavior modification, nutrition information, etc. 35.1 IS low BMI to qualify for insurance pay. I wouldn't want to go below that during your six months. As for the vaping, nicotine really gets in the way of healing. If you are nicotine-free, that will help you. Good luck! Good luck!

Thank you for all these posts, it's a real treat to see start to now. You are absolutely stunning all dolled up for the wedding! Your husband's eyes must've popped clean out of his head when he saw you. I hope you feel as wonderful on the inside to match.

California.

Look up the Krebs cycle - if you don't like the term "burn", you can use the term "metabolize". Fat is metabolized on a cellular level by the process of oxidation via the Krebs cycle, the end products of which are CO2 and H20 - Carbon dioxide (which you exhale) and water (which is excreted via sweat and urine).

Um, no. That's not how it works. It's true, however, that the byproduct of burning calories is carbon dioxide and Water. Fat doesn't get "released", it gets burned for fuel when you burn off more calores than you take in. Stalls happen. Change something. You actually might try eating a bit more, changing what you eat, change your workout. You do need to get your Fluid in, especially if you are getting your Protein in, in part to keep the kidneys in shape so they can process the extra water and metabolites that are the byproduct of burning fat. You don't have to drink plain water, herbal tea, broth (watch the sodium here), flavored waters (without added sugar), it all counts.

I am hoping for January. Realistically, I could do it sooner than that, but scheduling the time off work will be an issue until folks are back from the holidays. What state are you in?

The only time a new calendar year might trip you up is if the renewal date for your insurance happens on Jan. 1 AND there is a significant change in your coverage, OR if you have a deductible that rolls to zero every Jan. 1. For example, a lot of people have coverage that changes on Jan. 1 - I've had folks whose employer were changing health plans. In those cases, weveryone knew about the change ahead of time and we made sure everything got wrapped up before the change. Other folks are madly trying to get things done and scheduled before the end of the year because their annual deductible starts on Jan. 1. Hope this helps!

So much good counsel and support you've been given here! I haven't much to add, except to say that my husband's former wife took 20+ years and a long affair to unravel her own sexuality. You are blessed indeed that your wife talked with your about it first, before acting on it. I can tell you from the experience of our family that the alternative has even more hurt within it. My husband was far more hurt over the betrayal of the affair (and its length) than his former wife's orientation. She lost many friends over the lies, not her orientation. What I can offer more than ten years down the road is that not only does healing happen - but change does, too. As you heal, the things you hold as absolute today may also change. I completely believe that you and your wife can re-formulate your friendship and partnership into one that makes room for you to both be fully loved as you each deserve, and to be faithful parents to your son. What you can hope for is that you will heal, and grow, and make room in your heart and your life for someone who will be a full partner to you. One blessing of your relative youth is that you won't be parenting teens through this process, because let me tell you, that's no day at the beach . Peace and healing be with you all.

I totally agree - where I'm most inclined to mess myself up is blurring the line between self-compassion and accountability. Still working on that!

Stop. Stop. Stop. It is entirely normal for anyone's weight to fluctuate a couple pounds day to day, repeat, anyone - no matter whether that someone is trying to lose, maintain, or gain. Do not put yourself through this! If you are eating more carbs (from the crackers) than you had been, then yes, you are putting glycogen back into your muscles and your liver. Glycogen is muscle sugar - fuel. For every ounce of glycogen you put back into storage, you also put back four ounces of Water. Glycogen is NOT FAT - and what you are trying to lose is fat, not fuel. Glycogen is not fat. Water is not fat. EVERYONE has a pound or two that goes up and down, depending on various factors that have absolutely no bearing on overall fat loss, OK? Now go follow your program, go take a walk, but stop beating yourself up over this.

Remember this - "average" includes the results of those individuals who, for whatever reason, did NOT follow their program and hence didn't lose much weight - it also includes those individuals who decided to stop when they got "close enough" to their goal. Who the heck wants to be "average" anyhow? The point is - there is NO reason to say to yourself "I had a sleeve, so I can only expect to lose X percent of my excess weight". Horsefeathers. Lots of folks on this board go on to lose MORE than 100% of their excess weight. I think the better self-talk is to say to yourself "there is no reason I can't lose all my excess weight and meet my goal, I just have to take the right steps to get there".

There's not a thing wrong with you, and insurance doesn't work that way. The reason you have the six-month requirement is to make sure you can adhere to a progrm, which you are doing, and to show that those efforts aren't working, which, guess what, they aren't. I'd be VERY surprised if your insurance coverage of your surgery had anything to do with loss or gain over that six month period, though sometimes your surgeon may have rules about it.

There isn't much lactose left in cheese, so I'm guessing it's the beans.

You lost 17 lbs in four weeks. That's awesome! Now, keep following your program, and put the scale back in the closet. Honest. It is totally and completely normal for anyone's weight to fluctuate a couple pounds. Do not trip yourself out over this!

I love the way you tell your story so far. Well done!

Welcome aboard! Congratulations on taking positive steps to recover from obesity. You've had a LOT of losses. And it sounds as though you've lost confidence in yourself along the way. If you are not currently getting counseling, I'd really recommend it. The people who are the most successful with WLS are those who really commit to themselves - they believe they deserve success and health and work hard every day to make it happen. You deserve the same thing. Learning to deal with your feelings without turning to food is another tool to use, just as the sleeve is. My PCP told me the other day that she believes that WLS is "the definitive treatment for obesity". I really like that term. Good luck to you!