ising4godinohio

If you call your insurer, you want to ask if wls is a stated exclusion . If so, you want to ask if their medical guidelines offer any criteria that can override the exclusion. Also, if your employer's plan is self funded you can ask your employer to request an exception on your behalf
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Also, if your employer's plan is self funded, you might want to try to talk the employer into intervening on your behalf. The employer can request the surgery be approved if you meet medical necessity
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I use unjury unflavored instead of GENEPRO. I think it dissolves better and it has significantly more Protein
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If you have strongly documented history of sores, infections, rashes, and methods used to treat them as well as the outcome, you may have a solid foundation to appeal. Also, carefully read the denial letter. It will tell you exactly why it was denied. It should also tell you what your options are to appeal. It may be something as simple as your doctor needing to request a peer-to-peer review.
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Congrats! I'm 51 and finished an Executive MBA last year. I'm now taking a post graduate certificate class. Being an adult student is a challenge but so worth it! Good luck!
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I am using the calendar feature on my phone to remind me when to eat, drink, and take my meds
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It's out of Iowa. I have tried several times to find out what I needed, and the surgeon has also tried to get a straight answer, with no luck.
Go to their website. Look for a link that says providers. Click on that. Depending on the site, you might need to enter the state your policy is out of and click enter. Once you enter the provider portal, look for something that says medical guidelines. Then look for a way to search that part. You might have to click around a little. Once you find the search tool, enter bariatric and click search. That will bring up their specific guidelines for wls. However, please be aware that if wls is a stated exclusion the odds of getting approved are extremely slim. Unless your policy is through a self funded employer. Then you might be able to get the employer to ask for an exception
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I am using the calendar feature on my phone to remind me when to eat, drink, and take my meds
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Here is my bariatric study:
My brother died of a heart attack at age 47, when he weighed 420 pounds.
My mother died at age 67 (just three years older than I am now) of an abdominal aortic aneurysm when she weigh 320 pounds at 5'2" tall. Her mother, who was not overweight died at the age of 98, and she would have lived longer if she had not broken her hip and gotten pneumonia.
Other grandparents, aunts, and uncles who were not overweight lived well into their mid-eighties and early nineties.
Many of my 60 first cousins have already died of overweight-related health issues in their late forties to early sixties.
My older sister weighed about 300 pounds when she graduated high school in 1968 and gained another 100 pounds after that. She got a gastric bypass 15 years ago and is still doing well at age 67 (the age Mother died).
I had the sleeve at age 62 because I just do not want to be done yet. I have grandchildren that I want to see grow up.
One of my younger sisters who weighed close to 400 pounds got a band three years ago. She lost enough weight to get to a size 12, got a Tummy Tuck, breast lift and all that - and looks awesome! She is healthier and happier than she has ever been.
So, my family is my example for life-span. I know I have greatly increased my odds for a longer life with good quality of life.

@@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.... |??

I'd love one for RNY or RNY and sleeve. Be nice to support one another spiritually through prayer and Biblical encouragement.

Would it be wrong of me to ask for before and after pictures and I'll be the judge?

As long as you don't start hacking up hairballs, I'd say you're good!

- I know the first 5 days were the hardest, but in retrospect, not really that terrible.
- Get up and get moving if you want to recover faster!
- Don't buy a lot of anything in advance...your taste buds will not be the same as before surgery.
- the first week is all about trying to actually get some nutrition in your system. It seems like it would be easy to eat 5 bites of something, but it's a challenge!
- Find a Protein shake you can stand. I still drink a Premier shake every morning as its a fast 30 Gms of Protein.
- focus on the protein. Not the fat, not the calories...focus on the protein!
- remember to laugh at yourself the first time you put a heaping scoop of something in your plate only to realize you can eat only 4 bites of it.
- be patient. It works.
- take care of you - mind, body and spirit.
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I've been reading other posters answers ... and thinking about my own ...
I can honestly say I read and re-read all the information I was given by the surgeon ... so I was "prepared" ...
as much as you can be I guess ...
the only thing I wish someone had really stressed to me ...
was the left shoulder gas pain ... whoa ... that made me stop in my tracks ...
the pain from the actual surgery was a piece of cake compared to the shoulder pain ...
So when someone tells you you probably will get the gas pain in your left shoulder ... listen!
It does go away ... thankfully !

For the hospital, definitely bring Chapstick and stock up on it because you will need it all the time. Same with lotion for dry skin.
I also bought way too much canned fruit, Soups, and broth for the early stages. Just loaded up a big tub of it to give away.
Get rid of all junk food before your surgery. If it is not in the house you will not be tempted to eat it. My surgery was right before Halloween and I had to buy candy for the kids. Turned out I didn't have any and that candy kept calling to me until I threw it out.
My recovery was really easy with almost no pain. So I can't think of anything special that you need for that.
Emotionally, you need to prepare that this is not a diet, it is a lifelong journey. You will never be able to eat like you once did, and it can be a struggle every day. Be sure to have hobbies or other things to fill your time. I'm the most hungry when I'm bored. It is head hunger, but is hard to get rid of.
Start exercising NOW! Just walking if you don't currently exercise, but get moving. It will help you recover quicker from surgery and it will be a habit by the time you are pre op.
Good Luck! I'm sure you will do fine.

I wish I took less to the hospital. All I really need was my face wash and lip balm.
I wish I knew I wouldn't be a "freak" forever. At 6 months I felt just like a normal person with a smaller appetite and capacity. I don't feel different or like I had weight loss surgery, at least not how I thought it would be.
I wouldn't have stocked up on anything before surgery like I did. I ended up tossing so much of that stuff recently.
I wavered a little on telling people about my surgery, but now that I am 8 months out I am very happy and secure in my decision not to tell people. It has made my recovery a lot easier and my weight loss easier also.
Things get better at 6 weeks, better again at 3 months and back to normalish at 6 months.

I know it's long, but I posted this reply in regards to someone who had been told that their dark skin was basically"dirt".
"Let me be VERY clear on something. The darkening on the skin we are
experiencing IS NOT dirt. That is either an ignorant comment from an uneducated person, or someone who has been EXTREMELY poorly informed. It has to do with Insulin Resistance and the insulin leaking out of our bodies. Please take a moment to familiarize yourself with the TRUE cause of this very embarrassing, hygiene UNrelated issue. Please read below or take time to do your own research on Acanthosis nigricans. I myself have found very positive information regarding this unsightly issue, with regards to weight loss and overall fading of the problem areas.
Acanthosis nigricans is a brown to black, poorly defined, velvety hyperpigmentation of the skin. It is usually found in body such as the posterior and lateral folds of the neck, the axilla, groin, umbilicus, forehead, and other areas. (In other words..your neck, armpits, groin (inner thighs), near the belly button, and forehead)
It typically occurs in individuals younger than age 40, may be genetically inherited, and is associated with obesity or endocrinopathies, such as hypothyroidism, polycystic ovary disease, insulin-resistance, diabetes, or Cushing's disease.
The most common cause of acanthosis nigricans is insulin resistance, which leads to increased circulating insulin levels. Insulin spillover into the skin results in its abnormal increase in growth (hyperplasia of the skin)."

Yes the others are right.....if WLS is not covered by your plan then they will not pay anything.... there would be no way you could meet your deductible if the surgery is not covered.....non-covered services do not apply to the deductible....I work in the insurance business. Please make sure to get clarification from them....and ask for it in writing. The doctor's office can also check your benefits for you. Good luck.