2goldengirl

You won't regret getting your anxiety under control, though. The purpose of the psych eval is to identify whether you have issues that would be barriers to your success. Anxiety would definitely do that. Work hard with our therapist, and keep up with the visitis with your nutritionist as well. Good luck!

33% is a mighty high interest rate. You may be able to do much better with a loan through your bank or credit union - or seek self-pay in Mexico.

I replied to your other post also. The five-day period also applies to Medi-Cal. Blue Shield hasn't any Medi-Cal plans, you would have to be Blue Cross.

I also answered your other post. If you have Medi-Cal in Los Angeles County, it would be from Blue Cross, as Blue Shield doesn't offer Medi-Cal plans. Once your packet is submitted to your health plan, provided all necessary information is included, the plan has five business days to make a decision. In the event more time is necessary in order to obtain additional information, that timeframe can be extended up to 14 days. Here is a link to Blue Shield's policy: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm I hope this helps.

It isn't quite clear from your post which insurance you have. In CA, Blue Cross and Blue Shield are separate health plans. Are you Medi-cal with Blue Cross? HMO with Blue Shield? Once an authorization request is received (provided the required supporting information is all there), in a CA HMO plan, a decision must be made within five business days of receipt. HOWEVER, it can take another few days for your packet to get assembled by your surgeon's office and submitted to the plan. If there is insufficient information submitted for a decision to be made, you will be notified in writing, so don't worry. I hope this helps!

You didn't say what state you're in, nor what kid of health plan you have, but generally speaking, the timeframe a health plan has to process an appeal gives them the time to do a through job of gathering data, including sending records out to a third party MD for review. All this actually works in your favor. In truth, health plans far prefer to resolve appeals in the shortest time possible. Nobody wants a huge queue of work to plow through. Part of the timeframe will be determined by how clear the plan's requirements are for the surgery, and how well the documentation submitted meets those guidelines. This is much simpler for bariatric surgery than many other kinds of procedures with less-specific guidelines. Another factor will be how many appeals your plan is dealing with at the same time. Do what you can to focus on taking care of yourself since the timeframe isn't something you can control. I'm pretty sure you won't be waiting 60 days for an answer. Let us know when you hear back from your health plan, OK?

I wouldn't worry. The policy is that you adhere to the program, not that you lose consistently, or in fact lose at all. I know in five years, I can't remember anyone denied for gaining on a weight loss program. We can't because the policy doesn't stipulate weight loss, only adherence to a program. I hope this makes you feel better.

This is a topic I'm glad to see, because it's something I wonder about. I enjoy a glass of wine (one!) with dinner most nights, if I stay up later, it may be two, maybe three at the outside (I have a non-drinking spouse to drive me home). I have a friend who is 10 months post GBP and she hasn't had any alcohol yet. I have another who is 2.5 years post sleeve and she waited about three months. I don't have a surgery date yet, but I wouldn't plan my first drink for a big holiday dinner or other event - I'd take it slow and see whether the surgery (and also my period of pre and post-op abstinence) had changed my body's response. No sense making a bigger fool of myself in public than I have to

With a BMI of 52, you will qualify in terms of BMI. Call and ask what other requirements need to be met, Your PCP's office will be able to help you with this - that's where you start. The county plan may have other requirements, including assessment by a Registed Dietician and a psychologist. They may require that you follow a plan monitored by either your PCP or the dietician for a period of time. You will need to attend an orientation session and you may have to travel out of county for visits to your surgeon and your surgery. Your PCP will be able to tell you which surgeon(s) are part of your network. The surgeon's office will be able to tell you at which facility they do their surgeries. Yes, some people do get denied, but the most common reason is for low BMI, You won't be. Just follow the requirements and you should be fine. Good luck!

This. Every positive step you take deserves applause. It takes nothing away from your succees today to know that you still have a ways to go. If you were in college and did well on a chemistry exam, would you turn away complements knowing you still had two more semesters to go? A compliment is a sincere effort by someone to acknowledge you. Smile and say thank you. You will be getting lots of practice

The page with the specifics about bariatric surgery won't load, but your member's handbook does say that surgeries (other than emergency) require prior authorization. You don't mention your BMI or any other medical problems you have. What sorts of questions do you have?

Seven days is not very long after major abdominal surgery. I know, it doesn't look like much on the the outside, but inside you've had some serious work. Don't plan on going back to the gym or golf until your sugeon says so. Golf is going to be the hardest because of the range of motion required in a swing. Putting may come first. Be patient with yourself and let your body heal. You don't say how old you are, but also remember that for every decade, you need to allow more time. We don't heal as fast in our 60's as we did in our 30's. Dammit.

What county are you in, and are you part of a County HP, or a Medi-cal managed care plan, for example, Blue Cross Medi-Cal?

My first question is - what state are you in, and what is your health plan? I ask because my California health plan changed their policy July 31 and dropped the 6-month requirement. If you are Blue Shield of CA (HMO plans), you don't have a a 6-month waiting period any longer. And definitely call the surgeon's office and ask why the additional wait. It could simply be a matter of scheduling. The scheduler has to coordinate scheduling for the surgeon, assistant surgeon (if any), and the OR at the hospital. Any one of those could get backed up. At the end of the calendar year, elective surgeries often get backed up, because patients who have an annual deductible or out of pocket to meet want to get elective surgeries done before Jan. 1 when their annual deductible rolls back to zero. And surgeons and hospital staff are as inclined as anyone else to want to take time off during the holidays. I hope this helps!

I'm so sorry this happened to you! But honestly, as a lesson to others, please DO NOT self-treat for this kind of thing. A rash is something that should always be reported to your surgeon the same day you notice it. Drug allergies can be life-threatening and nothing to fool around with.

There is no "BCBS" in California, Blue Cross and Blue Shield are two separate insurance plans. Here is a link to the Anthem Blue Cross medical policy concerning wehght loss surgery: https://www.anthem.com/medicalpolicies/policies/mp_pw_a053317.htm Basically, a BMI of 39 without comorbidities doesn't meet criteria. However (and I'm by NO means recommending this), I have seen several cases where a potential candidate went out and gained until their BMI was 40 or above. As an example, the difference for someone my height between a BMI of 39 and one of 40 is 5 lbs. I hope this helps!

Funny thing about that. I had surgery in my 40's for what turned out to be 3rd degree impingement on the left. I didn't have symptoms from the shoulder, but had trouble on an off in my upper back and neck from accomodating for it. Finally the tendons started shredding and I had actual shoulder pain. I had to have 11mm ground off the end of my clavicle where it was hooked over the top of my humerus. Despite that, I'd been a gymnast and a windsurfer. Yup, picked all the wrong sports! I have gotten advice about the shoulder - I did have a slight tear about seven years ago from overdoing in Water aerobics while I had bad back trouble. The tear is all better, and I no longer live where I can do water aerobics five times a week. The arthritis is, of course, better some days than others.

Fantastic! Will you look at those long legs! I was not blessed in the length of limb department. I seem to have a lot of leggy friends.

I realize the importance of resistance work in a sound fitness program, but since the last time I consistently did a resistance program, I've developed arthritis in my right shoulder, and I have some impingement in it as well. I'm a female in her early 60's. This means working overhead is pretty much out, and depending on the day, push-ups are out, too. Suggestions, anyone? I'm thinking I can handle planking pretty consistently. Extra points for things I can do without driving to the gym. I do have free weights at home. I really want to ditch the excuses and get something started. Thanks!

One more thing I heartily recommend to anyone the day before a planned surgery: Do something nice for yourself. Get a massage, a mani/pedi without polish, go for a walk in the park, put candles on the table and use the good china for dinner - even if dinner is chicken broth. Any of these. Prepping for surgery is stressful, no two ways about it. Taking the time to do things that soothe and relax you pay off big time.

Blue Shield changed their requirements effective July 31. Definitely call your surgeon's office and have them resubmit. I've attached a copy of the policy to this post. Your surgeon's office can always submit the first page of the policy along with your packet. Blue Shield didn't share this change with their participating medical groups. It's actually your medical group who approves or denies your surgery. Blue Shield requires that all of their participating medical groups use Blue Shield policies for bariatric surgery. What the medical group is supposed to do is review the policy each time they approve or deny something. This is the biggest change I can remember in 20 years where we didn't get some kind of notice. Approving these surgeries is part of my job (I can't deny anything, an MD has to do that) Anyone in California who is a member of an *** plan can get their health plan policy for any procedure, usually online. It's the law in CA. I hope this helps, and good luck! Bariatric_SurgeryBlueShieldPolicy2015.pdf

Here is a link to United Healthcare's medical poliicies: https://www.unitedhealthcareonline.com/b2c/CmaAction.do?channelId=016228193392b010VgnVCM100000c520720a____ Hope this helps!

But you ARE overstepping. It's great for you to be concerned over your family member. The Health Department investigates things like whether the office is clean in all the right places not medical records. Please, stay out of this. Support your loved one by NOT second guessing her, or her doctor.

On both of those days you have multiple appts stacked up, do something fun and nice for yourself - get a pedicure, or a massage, or buy yourself flowers. They're all steps you're taking to take care of YOU.

There wasn't a single "aha" moment. I've been working with WLS clients for the past five years, and yo-yo-ing myself for more than forty years. In the past six months or so I've been working on making peace with my body, and realizing that the yo-yoing just wasn't an option any longer. I've ruined my metabolism over the years with going up and down, so my options without surgery are to be hungry, or keep gaining. Neither seemed reasonable to me. I have three friends who have had WLS: one lap-band, one GBP, and one sleeve. All are happy with their decision, as are all of my clients. At first I was certain that I'd be seeing a fair number of clients with complications, but I haven't seen any. Instead, every one of them said they'd do it again. I finally had time to think about WLS seriously this past summer, and discussed it with my husband, who is all for anything I need to do, so long as I'm safe. I changed PCP's from one who did nothing but badger me (move more, eat less, blah-blah-blah - she's been thin all her life) to one who is in favor of me making this change. I'm going back on Thursday and expect my surgeon referral then. Fortunately, my HP has changed their requirements so I don't need to wait for months in the meantime. I do find it interesting that once I decided I was ready, I'm ready NOW.