FreeTheSkinny66

I just did the at home sleep study and I agree that it was hard to sleep wearing that thing. For me, it was just uncomfortable and I woke up often and tossed and turned all night. I was so tired the next day. From what my instructions said, it needs 5 hrs of sleep. Apparently, it shuts off when it has that - and that is what happened to mine. I did it on a Friday night so I would have longer time in bed to sleep and the tiredness the next day wouldn't impact me as it would on a work day. I got my results in a few days after it was returned and it was enough. I also don't think the mouth versus nose breathing matters. Good luck!

Howdy! Been lurking on here for a little while and am posting for the first time. I apologize in advance - this is LONG. I have begun the process with a Bariatric surgeon and am still rather early on in the process. But I am already freaked out and completely terrified of making a misstep, largely because I've read so many things here regarding the different insurance companies and their reasons for approving and denying...and they are ALL DIFFERENT! Unfortunately (?), I am probably not what would be considered a "clear cut case". My BMI is not quite at 40 (but close), and I do not have any of the normal co-morbidities. In fact, all I really have is joint issues - from a torn meniscus that I had surgery on last May that is STILL giving me trouble, and ankles and feet that hurt (from past sprains and other things, but all exacerbated by me carrying too much damn weight.) I do not have high blood pressure, diabetes or pre-diabetes, sleep apnea (that I am aware of...just sent my at home sleep kit back), high cholesterol, etc - none of it. Despite being obese, these problem have so far alluded me. Key words "so far". There is a history of heart disease (my father died at 66 from a heart attach), high BP and diabetes in my family. BUT...I do have some things that to me seem to make a compelling case for Insurance to approve me. I was diagnosed with stress or virus induced cardiomyopathy in 2008. It is largely resolved, and my bariatric surgeon poo-poo'd it because it was so long ago. I have a prolapsed mitral valve (but doesn't really cause problems). And I have a myeloproliferative disease that causes my bone marrow to produce too many platelets, predisposing me to blood clots. I've not had any issues to date, and I only take baby aspirin for that now (no prescription meds yet), so not sure how that will be viewed. But if I were the insurance company, I would see that as a damn good reason to help prevent the onset of arteriosclerosis from obesity! I also have the complexity of having both primary and secondary insurance, so that means I have to meet the requirements of TWO insurance companies if I want both to cover this. (And I do, as my primary insurance is not very good) Primary is Anthem BCBS, and secondary is United Healthcare. Like everyone else, I've done every diet and exercise program known to man...and been successful. In LOSING, but NEVER maintaining. I always gain it all back, and usually more. Most recently, I did Ideal Protein for 7 months (Jan -Jul 2014) - I was referred by my doctor, and the program itself is run by another doctor. I had to meet with a coach weekly and get weighed and have my fat percentage and hydration percentage measured. I have all those records. I lost 45 lbs (but have gained almost all of it back). But my bariatric surgeon's office said it was too long ago (even though Anthem's guidelines say it must be within the last 2 yrs) and I am going through the 6 months doctor supervised diet with them (the surgeon's office) now. Now here is where I am freaked out. I am afraid to lose and I am afraid to not lose during this period. I've read that they want to see that you can follow a plan, and therefore want to see weight loss. I have seen people say they lost and were denied because they showed that they really didn't need it because they can lose on their own and their BMI dropped. I've read of people being denied because they failed to make progress (lose) on the supervised diet, or if they gained, showing that they were not serious about lifestyle change. ARGH!!!! I am paralyzed! I am already concerned that because of my BMI <40 and no "standard" comorbidities that I will be denied. The doctor said I can lose during this time as long as I do not drop below a BMI of 35. And the coordinator who deals with the Insurance said she doesn't think she will have trouble getting me approved. But I am so afraid of making a wrong move. And I do not want to call the insurance company and say something wrong and have them document that soit appears that I am 'gaming' anything, if that makes sense. I am so stressed out about this. Now that I have decided that this is absolutely the right thing to help me, I would be devastated if I were denied. Am I driving myself batty for no reason? Anyone have Anthem BCBS and a similar situation (BMI < 40 and none of the "standard co-morbidities, but other health issues, such as the joint pain/arthritis?) I could sure use some encouragement. Thank you all. And reading these forums has been so helpful.

Exactly! You hit the nail on the head - I can lose, but I can't keep it off. And it is sad that any short term success we have could potentially be our downfall in getting approved. I tend to see the fact that I am able to stick to a program and actually lose (unaided by an awesome tool to make it more manageable to do) as evidence that I am a good candidate! And if I had that extra tool (the sleeve) I might even be able to maintain that loss long term. Unfortunately, I am not sure they see it that way. I am totally stressed, too! Had I had to laugh at your comment about it making you want to eat. I almost wrote that, too. Stress eating! Glad i am not alone.

That is good to know - I had heard stories of some companies excluding coverage for any complications stemming from bariatric surgery! Thanks!

JamieLogical - were you at all concerned about potential complications and insurance not covering that when you decided to do Self Pay? I am still pretty early on in the process and have primary and secondary insurance, neither of which exclude bariatric coverage), but I am still very concerned about getting approved since my BMI in < 40 and I do not have any of the "standard" co-morbidities". So I have started to toy with the self pay option. BUT....the potential for complications and those costs coming out of my pocket have almost scared me out of that idea. Just curious as to whether this was a concern for you.

I thought the same thing! lol But they already have my first "weigh in" documented, so that would put me in the "you gained" bucket...getting back to one of my concerns. I am close. Depending on the day (I fluctuate up and down 3 lbs or so) I am usually between about 38-39 BMI. So close!

That's terrific! I have Anthem BCBS (in CT) and my surgeon's office told me that my almost 8 months of doctor supervised dieting (which required me to meet with a coach and get weighted and have my fat and hydration %s checked weekly) was not good enough for insurance because it was in 2014. Even though Anthem's guidelines state within the last 2 yrs. So I have to go through 6 months at the doctor's office. Doesn't that just sound silly??

I am still hoping that insurance will pay, but because I am a supreme worry-wart and I may not be a clear cut case (BMI < 40 and none of the "standard" co-moridities other than joint issues), I have started looking into self-pay. The thing that scares the beejeezes out of me is the potential for complications. Paying $15,000 or whatever for the surgery is one thing, but what if there are complications.?? Like a leak or something....that's many thousands more. I am not sure those would be covered by insurance. Some surgeons have BLIS coverage, but there are restrictions there, too, no? That is the only thing that would hold me back from self-pay if it comes to that!

Thank you for responding, JamieLogical. And that does, indeed, seem like a logical view of the situation. Whether the insurance companies will apply logical in this all remains to be seen. lol (and Ive worked in insurance for over 25 yrs! ) Fingers crossed.