FreeTheSkinny66

Congrats!!!

Thanks! I need to put my big girl panties on, I guess!

Thanks. I actually did already express my concern/apprehension, but was told it really is no big deal - will take all of about 5 minutes. I asked about something to "relax" me. lol I'm being a big baby - do whatever to me...as long as it doesn't involve putting anything up my nose! lol

I suppose I should be glad he does it this way - less $$. I have a high deductible plan (it is all my company offers these days), so whatever the cost, it is out of my pocket.

Anyone have a trans-nasal endoscopy? I'm scheduled for mine in a few weeks and I'm a bit freaked about it. No sedation - they just numb up the throat and pass the tube up the nose and down the throat. I am way squeamish about things up my nose - I can't even use saline spray! I'd rather be put out and have it done the normal way, but this is what he is doing so....

Anyone do this?? I need reassurance that it doesn't completely and totally suck.

Ooohhh....good luck!! I wish I were that close!! Keep us posted!

I was told by my surgeon's office that when they submit, they simply say "Obstructive sleep Apnea" ...they do not qualify as mild, moderate or severe. I asked specifically because I have Anthem BCBS (in CT) and for it to qualify as a co-morbidity, sleep apnea must be severe...and mine was mild. Also, the ICD-10 code is the same regardless of if it is mild or severe, so there's that.

Good luck. It is nerve-racking.

When will you be submitted? I am curious to see how you make out!

Woo hoo!

@@silverthreads I was able to get the Plan Document directly from my husband's employer, and it showed that there IS coverage for WLS (the exclusion is for NON-surgical weight loss), yet UHC maintains that there is no coverage. So I asked them the effective date of the plan they were referencing, and it is different that what the company gave me. So I went back and asked for the most current version from my husband's employer, which they assured me they gave me. So.....SOMEONE is providing or looking at the wrong thing!

Since UHC refuses to send me what they are reading from, and my husband's Benefits Coordinator confirmed that I was given the most current version, I think there is coverage, but there is no way to convince UHC of that! UGH. Such a pain in the butt.

I have yet to look at coordination of benefits since I am not sure if I have the "right"document. Sigh.....

@@Jennjjcac Have you been approved yet?

@@VSGAnn2014
This:
"For those of you who haven't lost all your weight yet or who haven't thrown away all your fat clothes, please save one outfit to remind you of how far you have come and of the respect you owe to the person you once were for having the fortitude to survive the burdens of morbid obesity. One day, you will appreciate more than you can imagine right now that fat person's courage.

Wow. Very powerful. For those of us living in this moment of disgust, being able to step outside of ourselves and appreciate that we are summoning up the courage and fortitude to do this...to take drastic action to fix this....that is important to recognize. Thanks for that.

Go to your husband's employer!! Contact the Benefits Coordinator for his employer and request a copy of the Plan Document. As an insured, you are entitled to this document, as it lays out what is covered what is not, etc. I just had a similar situation with United Healthcare - I asked multiple times for thePlan Document and they just kept telling me to go to the employer. I did and got it within 15 minutes.

Good luck. This can all be SO frustrating!

@@jane13 Thank you, thank you, thank you for that. Your post actually made me tear up a little tiny bit - I guess that is a testament to how alone I feel in my misery (I try to hide the real depth of it from my husband and others) and how much I crave support and a sense of not being the only one who feels this way. So...thank you. I will keep coming here.

@@Rainy Days You are getting a C-PAP machine for mild? My surgeon said he doesn't for mild apnea, especially since the surgery will take care of it. Hmmm....

Sadly, I was "happy" when I found out I had mild sleep apnea - it meant possibility a comorbidity to help with insurance approval. Ugh

Totally hits home for me. I have my full length mirrors at home propped up at just the right angle so that I look thinner....or I would probably never leave the house. Talk about gaming and denial! But when I catch a glimpse of myself in a store window reflection, or in the bathroom mirror when I go into the office (I work from my house), or someone takes a photo and I am in it, I am horrified and sink into a deep depression. It's weird. I KNOW I am fat, but I've always thought I was fat - even when I wasn't! So somehow, I keep talking myself into believing I am fat but not THAT fat....that it is worse in my head than in real life. Except that now real life really IS that bad.

Since I decided to pursue WLS and went for my initial consultation, I have been reading so many posts on here, and honestly, I feel worse than ever. It is almost as if I am staring down how far I've let myself go....how bad it really is, and I feel completely disgusted with myself. Like I am repulsive and shouldn't leave the house. I know that is extreme, but it is hitting me hard.

I am still a few month away from being submitted and I am concerned about insurance approval - my BMI is not quite 40 and I don't have the "standard' comorbidities. Honestly, if I don't get approval, I don't know how I will manage. I'm sobered by my reality at this point. Glad I am not alone.

Oh, google and I are WELL acquainted, and I have read multiple comorbidity lists from reputable sources. But in the world of insurance, all bets are off and they can be fickle on what they consider "good enough" to be considered as a comorbidity for THEM. (oy!)

For example, sleep apnea is a comorbidity. But my primary carrier says it must be SEVERE sleep apnea to qualify. There are many more examples. Was just looking for some personal experiences to get a "feel".

I have Anthem BCBS (in CT) , and it is a CDHP. It requires 1 co-morbidity if BMI is under 40 and 6 months continuous active participation in a weight loss plan with serial documentation within the last 2 yrs. I actually did Ideal Protein through a doctor's office Jan 2014 through Aug 2014 (lost 45 lbs and gained all back in 1.5 yrs - ugh). I would say that is within the last 2 years - I was still on the program 2 years ago! But my surgeon's office has me on a 6 month thing with them as they said it was too long ago - I think they are wrong.

This insurance stuff is making me nuts!

@@izzy13 Just curious - who is your insurance through? I'm in a similar situation - < 40 BMI, and my sleep apnea is only mild (severe is required) and I do not have high blood pressure or diabetes....and I am very worried about getting approved (not there yet).

I'll be watching the responses you get. And will keep my fingers crossed for you. I've read sometimes an appeal goes to a "peer to peer" review with your doctor and one from the ins co. That personal "touch" might make a difference.... |??

@@Clementine Sky Thanks for all the info - it is helpful. I am still hoping that I will get approved through my insurance and not have to even consider self-pay, but you never know, so it is good to have info.

I've heard great things about peoples' experiences getting the surgery in Mexico. If I still lived in San Diego, it might seem more doable (as long as the complication coverage thing was sorted out). But I now live in the Northeast, and HATE the cross country plane trip. So the idea of doing that right after surgery is not attractive at all! lol

Good point - that the diagnosis code doesn't differentiate. I thought that when everything is sent in for approval, they will include the results, which will show that my sleep apnea is in the mild range. And my primary carrier required sleep apnea (for it to be considered a comorbidity) to be severe to the point of life-threatening". Yikes!

Apparently, even moderate sleep apnea is improved significantly once weight is lost...at least that is what I have read. Good luck!! Those C-PAP machines look awful! lol

@@Rainy Days Did the one you have automatically shut off (light was off in the a.m.) or did you have to turn it off manually? If it turned off on its own, I think you got what was required!

My results said I have mild sleep apnea - which will be corrected with surgery. The question is....will the insurance company consider "mild" bad enough to have it stand as a comorbidity?! Ugh

@@VSGAnn2014 Thank you - you've given me hope! lol I am 5'6" and around 239-241 so I am just shy of the 40 BMI.

I don't have hypertension, diabetes, etc. BUT....had surgery for a torn meniscus almost a year ago and I am hobbling now, and Ortho told me I had to lose weight to take the stress off it, as arthritis in knees will worsen. My low back hurts but I never connected that to my weight - hmmmmm. And my feet and ankles hurt all the time.

I have Anthem BCBS and they require 1 co-morbidity, but they do not spell out what is considered a comorbidity! What insurance did you have?

Fingers crossed!!!

@@Clementine Sky Hopefully, you have not had any complications at all. But I am curious - if you had, going back to Mexico would not really have been an option so I assume you checked into getting any complications taken care of locally. Did you find out beforehand if your insurance would cover medical expenses from a complication if if you didn't qualify with them for the original surgery?

This is one of the main reasons why I have ruled out Mexico if I get denied, even though it is so much more affordable. Concerned about the potential for complications and the costs. Would love to hear what you know.

Thanks!

Anyone use Dr. Ehrlich (Ehrlich Bariatrics) in CT? Just looking to hear about your experience. Thanks!

Anyone have success with joint pain/arthritis as their comorbitidy for insurance purposes (when BMI is < 40)?

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!