lwmatch

Thanks to the many responses back in January when I first posted this topic. The short version: On day of surgery I was 1 pound 2 oz. below 35 bmi and Hospital Bariatric Director, refused to honor the approved procedures from Aetna. I was in the pre-op room in my surgical gown, being made to pony up $9,000 to still have the surgery that day. So I Did,and had the surgery When I had first complained to Aetna,in January, the person from Aetna said rules are rules and sorry but you no longer met the requirements for Insurance payout. After beating my head on the wall and shedding a few tears in frustration, I called and talked to Aetna Supervisor the next day that told me to submit it.Surgery was December 16th, 2015 and on March 21st Aetna, three months later,said the $9,000 has been paid out to the hospital / Doctor. The hospital has told me that a credit to my card account is pending, yah! But the Dr. office, NO SURPRISE, is saying "We don't know anything, yet" .I know without a doubt, that they are going to be a p.i.a. to get my money back. I will update this topic as it unfolds. I talked to the nicest lady, EVER, at Aetna that called the hospital for me, to first verify the payout this Tuesday, and yes, she called the Dr. office,also, but the billing girl was out of the office . [What a Surprise].The Dr. office, when I called today, said they would call me right back, [they didn't], so next week will try to get the Aetna 'Nice Lady' back on the phone to call the Dr. office for me. Moral of this Topic, Don't give up on what you know is right, get the right people involved and by all means, post your problems and your rewards here to share and to gain input from others that may have gone thru what you have.

I am 58 and yo-yo'ed most of my adult life. Due to health realities, decided to get the sleeve to enjoy my grandkids for a longer time and to reduce the pain on my joints. Almost 3 months since surgery and no regrets. Both of my sons have had sleeves and great results. I feel the risks are worth the rewards. YES, I hate going out to eat because of the small amount I can eat, but a small, small price to pay for the results I get. Good luck to you and only you can decide the path that is right for you.

Being I kept my surgery basically private, I get comments from co-workers and others such as "Are you okay? Everything all right?" So often weight loss to many is a sign of serious health problems and not a sign of taking better care of yourself.

Sorry, not much of a boss not to allow you a little consideration of trying to have a water bottle to sip on or a snack every hour or two. Your body will be changing and you may be getting upset stomach / diarhea, to deal with. I pride you in wanting to go to work and hopefully work will show you the respect you need to have a good working environment. Your Company is lucky to have an employee as you trying to get in better health and coming to work as you are adapting to the changes! Good luck to you and I hope work wakes up and appreciates you!

Double hernia plus sleeve, no drains.

Good luck, Frank, glad you came through ok. Pain is worth the gain or loss in our case. Take care, my friend.

Just my immediate family. At work I left it at double hernia surgery. Losing weight due to liquid diet due to hernia repair. lol.

Frank, relax, you got this. My biggest fear was dying and not being there to raise my grandkids. High blood pressure, heart surgery before, etc., etc. 5 weeks ago had the sleeve and double hernia surgery. For what you can look forward to on losing weight, one of the easiest things you'll ever do. No more yoyo diets, no more drugs to lose weight, only to gain more back. The only thing to p_ss you off is why did you wait to do it! Good luck, my friend, I hope you gain the peace of mind to make the choice that is right for you!

Van Vleck, near Bay City

I felt bloated and more pain right below ribcage I'm assuming was from the hernia repair. On pain scale maybe a 3 1/2 to 4 but medication kept it down to a minimum. Took about 3 weeks to lose the bloated feeling. My biggest discomfort was having to be cath'd the two days I was in the hospital. They tell me a common man thing after this surgery. A great life changer, but still a newbie only 5 weeks post op.

I was like that for nine days. Had to take me off of protein shakes to firm me up.

I didn't have a tough pre-op, just the day before surgery. My last 'bad' meal, 1/2 pound cheeseburger at Fuddruckers with fries and onion rings. Sigh ,,,,lol

I was at the minimum bmi so had to keep my weight within a pound or two, either by drinking alot of fluids prior to Dr. weigh in or carring my phone and spare charger packs etc., etc. Fluid loss or gain is so quick it can get you. I am having a cluster post op cause I weighed in 2 pounds light day of surgery. Had to cash pay and now filing to see if Aetna will approve. Their first reaction is no.So maintain level, if you lose they will say keep losing, if you gain, bad. I had it wrote up that due to actual knee and back issues, unable to do much exercising. [co morbidities, also, blood pressure, etc.] If you have any medical issues, make sure your primary care Dr. sends a letter with you to your Surgeon. Good luck to you!

Had double hernia, so had more pain with that, didn't notice my stomach, lol. On pain meds for two days, in hospital but on pain level, maybe a three to 4 and mostly because of reoccurring back pain unrelated to surgery. Gained 5 pounds right after surgery weigh-- in due to i.v. fluids. I have had open heart and knee surgery, this one in comparison, very easy, and well worth it.

To me no better way than a sleeve. I watched my 2 sons lose well over a hundred pounds each and not following a lot of the rules and are maintaining very well. [They are sleeved]Myself at 58 CANNOT keep the weight off on my own. I am only 4 weeks post-op, but best decision I made for my well -being. THE BEST PART IS THAT MY HUNGER BUTTON IS TURNED OFF! I hope it stays that way. Honestly don't care if I eat or not. I know that hinges also on what I eat, but so far, I love it. 31 pounds in a month and feeling great! GOOD LUCK and I wish you the BEST!

I am 58 and have tried countless ways of losing weight. Cold reality I want to be there for my Grandkids as long as the Lord will allow me. I can/t lose and keep off on my own. Grasp the situation and see if your thoughts are similar. Can I lose weight? Can I comfortable keep it off? Do I want to get around better with less pain? Me, not on my own. The sleeve and double hernia surgeries didn't scare me, I had a great surgeon and am recovering very well. Do your homework on your Dr. I survived open heart surgery, January 2013, where the heart is lifted out, placed in a bowl of ice Water and mitral valve repaired. Why in ice water, after surgery Dr. said so heart wouldn't try to beat. I AM GLAD I DIDN"T KNOW ALL THIS 30 pounds in 30 days, trying to slow it down All surgery has its risks, but I would easily do this again if I woke up a twin and needed a sleeve. lol.With the part of the stomach cut out, your food love will be diminished.

Thanks Sharon, another person on my other thread had made that same comment. Hopefully I will have a compassionate reviewer. Either way I have a life changing procedure I plan on making the most of.

So with all the good advice and comments on my other topic, called Aetna tonight before going to Dr. tomorrow. Aetna flat pulled the rug out from under me. Their corporate policy with co- morbidities is 35 bmi or more. I was 34.8 so don't meet the criteria. Never mind surgery delayed from 7:30 a.m. till 5 p.m., not their fault. Agent with Aetna gave me her Supervisor voice mail, like I will ever get a call back. I guess I am s.o.l. Never mind I was preapproved and every weigh in including 2 week pre-op was fine. Any suggestions on what I can do? Other than accept it for what it is. So as harsh as it all is, the hospital was right and Aetna said if they had submitted that it would of been denied. Going to be a long 1 1/2 hour drive for my check up tomorrow. Thanks so much for listening and responding!

Thanks all for support and good ideas. I went for my 27th day checkup and laugh cause they fussed at me for once again, losing too much weight! I said your fault just going for the ride! Anyway, both the Dr. and the Hospital have or are filing, and hopefully a compassionate examiner with Aetna ill review and approve.

The good news, got sleeved on December 16th, including 2 hernia repairs. Doing good after I got off of protein shakes at two weeks. Had diarrhea for 9 days, developed a lactose intolerance. Now the kicker. Got approval thru Aetna for the hernias and sleeve. The sleeve I felt was needed due to constant back pain and knee pain. And yes, lost 25 pounds already and only needing hydrocodone, once in last ten days, yea! My sleeve was postponed from 7:30 a.m. to 5 p.m. Since the day previous and the day of surgery, had nothing to eat but a little water the previous day, I dropped below the bmi of 35. Hospital WOULD NOT allow sleeve to be done charged to insurance. I am in my gown in pre-op in tears because I felt I really needing this done. 1.2 pounds light, really. Dr. said no more openings the rest of year and would of cost me more if I reset after the first of year, due to deductions starting over. I was able to pay the out of pocket additional amount of $9,000 after two weeks earlier paying $3700 which should have covered my insurance deductible. I contacted Aetna after getting home and lady I talked to said that doesn't sound right. I am trying to get hospital to submit claim to insurance, but I know Dr. will be p.i.a. because he has gotten his cash money. ANY SUGGESTIONS or thoughts, please share! I had read before that once insurance approves that they don't care and hope you lose weight, to make the surgery easier. I know this is all the doing of the hospital and really is upsetting me.

Yea, I understand. When I started this journey, A surgeons office in Houston said no way for insurance. Talked to people in Victoria, Texas and they led me to a direction of hoop jumping and was approved. I had already borrowed the money and had put back for cash pay, so imagine the satisfaction of getting the approval letters. So when in pre-op in my gown when confronted with cash pay or no way, as you did, hell or high Water I needed the sleeve and got it. As Nikkidoc stated, just because a phone person says no, is no reason not to submit the claims.

Thanks for that. The nurse allowed me to redress but Didn't realize my magic go home number was anything less than 258. I weighed 256.8.

It appears the Hospital is smarter than I gave them credit for. When I called Aetna yesterday evening to talk with them, they are like no if ands or buts if bmi goes below 35 even with co morbities. Wasn't their fault or concern my surgery was delayed that day, not their fault I dropped 2 pounds below my 35 bmi. I feel where I am at now, to get Dr. and hospital to file and when I get the Aetna denial letter, to educate myself better on the process of filing an internal and or external appeal. Appears this hospital had dealt with the Hard hearted Aetna people before. And rightfully so, covering their _ss.

Thanks Steph, who is your Insurance. I told Cindy if surgery done at 7:30 a.m. as scheduled would of been fine, no done at 5:30 p.m. No drinking or eating two days, extra pee break got me. Official weight wrote down 256, needed to be 258. She pulls corporate policy out, I guess I need denial letter in hand