Diana_in_Philly

Call your insurance and ask for a letter explaining why you are not covered and sending you copies of the section of the policy they are relying on to make the determination. They must provide that if they deny.

@Apple1 I'm a desk jockey - I'm in the office two days a week and work from home the rest. I had surgery on Tuesday and did a full day on the following Monday. I packed a lunch box with my shakes and had water with me and just sipped all day. I only told work I needed to have a procedure and would miss one of my regularly scheduled office days. (I was able to work at home once I was discharged from the hospital.) My mother and my sister didn't know I had surgery, let alone VSG. My husband, my two teen daughters and one or two very close friends knew. When people ask about my weight loss, I say I'm on a physician prescribed plan, high protein, low carb and I weigh and measure everything along with working out. All of which is true. When I was asked how I could be back to work so soon after my "procedure", I just thanked the person for their concern. If people inquired about what I was (or wasn't) eating, I said I was having some stomach issues and my doctor had recommended what I was eating. Again - all of which was true. Best of luck.

Do call back and ask for a supervisor. Ask them to send you the specific section of the policy that they are relying on to come to that conclusion. Also, ask your doc's team if they will appeal it. When the doc appeals it, he should ask to speak with another bariatric surgeon to do the review. Generally, if they cover RNY they should cover VSG. The only procedure, right now, I'm aware of that policies that cover bariatrics are avoiding are the balloon. Also, ask that they send the denial to you citing the specific language. Best of luck.

Start by walking around the block now. You need to make it part of your life - start scheduling time and find things you like to do. I don't like running, but I'm too stubborn to quit. I work out with a personal trainer every other week. On the week's I'm not with my trainer, I do reformer-based Pilates. I do a combination of aerobics and strength training when I go to the gym. Since we signed up for the 5ks as a family, I've been using 30 minutes of running as my aerobics using the Couch to 5k program. Like I said, I don't like running, but I'm too stubborn to quit before the race. Next week, I have two fencing lessons set up (had a daughter who fences, but can't use her private lessons due to school conflicts before they expire) so I'm going to learn something new. Exercising is a lot easier once you've gotten some weight off. But you have to get your head in the right place and make it a priority - it's got to be like going to the doctor or some other appointment you can't cancel because it will harm your health. You can do this!

@Eva Aycock - I had VSG in August 2016. (I didn't have a band prior.) I was 55 when I had my surgery and staring down dual knee replacement because I'm bone on bone in both knees. I'm down 82 pounds. I'm training to run a 5k in 4 weeks. When I started training 4 weeks ago, I was "running" (that's a charitable description of what I was doing) a 15+ minute mile. Yesterday, I ran a 12:09 first mile. I was scared, too. I had never been through any of this before. I had no complications with the sleeve, so I can't speak to DS, but I can say it was the best decision I have made in my life (after deciding to marry my hubby and have kids). I feel 10-15 years younger. I was in the hospital overnight. I had my surgery on a Tuesday, was home by 3 Wednesday afternoon. I'm a desk jockey who works in the office 2 days a week and from home the rest of the time, but was back at my desk on Monday. I was back at the gym in a week after surgery doing cardio on a recumbent bike. Assuming you have no other health issues which would make you a risk for anesthesia, I would think you'll be ok. I know its scary and its ok to be scary -- but isn't the thought of dying young due to obesity frightening, too. Wishing you all the best on your journey.

Remember that feeling - heavy chest and nasty indigestion. that's your sleeve telling you that you made a mistake. I know how frustrating it is to not eat "real" food. And I know how bad you want to chew, but your stomach is still healing and you can do damage if you do not follow your team's plan to the letter. Pick yourself up, brush yourself off and go back to what ever your plan says to do.

Re: your insurance - depends on the policy - however, most policies consider your weight at first visit before any medically supervised diet as the starting point for weight and BMI. Get yourself scheduled for the seminar and ask some questions - they have probably dealt with your carrier before. As for hiking after surgery, I'm six months out and I'm getting ready to run a 5k in a month. I do all kinds of outside stuff. My pre-surgery BMI was 48.1. Currently, I'm at 34. I'm down 81 pounds. I need to have two knees replaced and with that I'm running 13:39 miles in my 5k training. You may want to make sure you carry a little more water with you, especially in the first few months after surgery, but shouldn't be an issue.

Is your pre-op all liquid or shakes plus one small meal? My pre-op was ultra low fat and under 1000 calories a day. I used My Fitness Pal to track my calories. I would do a shake for breakfast. A shake and a small salad with about 1 tablespoon of balsamic vinaigrette for lunch and dinner would be lean protein and a big salad. And a crap ton of water. For shakes, I would take 1 cup of coffee (cold) and mix it with a caramel Premier Protein shake and ice in the blender with a little sugar-free chocolate syrup. 30G protein Frappucino with about 160 calories. Or I'd take 1/2 cup of fruit, ice and an vanilla premier protein shake into the blender. There are tons of shake recipes out there.

You don't say if you live with your folks. If you don't, limit your contact with him as much as possible. See if you can get mom and sister to flip his opinion. If you think it might help, bring him to a support group meeting - maybe hearing other's stories would be helpful. If you do still live with him, try to avoid the subject with him for now. Or maybe bring him to an appointment with your doctor. He may just be afraid that something bad will happen during surgery - because sh@t happens. My mom would not have been supportive, which I knew, so I didn't tell her. She went to her grave not knowing I had my surgery. I told very few people because I didn't want to deal with negativity.

They are mostly going to ask about any dental issues you might have (partials, implants, caps, crowns) history with anesthesia, medical history, -- mostly its about what they need to know to make your procedure go smoothly. Whether you have drug allergies, have had any negative reactions to anesthesia in the past. I didn't meet my anesthesia team until the morning of surgery, but in the past, I've spoken with them by phone a few days before. They will listen to your lungs and heart, too.

I've had general anesthesia more times than I could count. I also sing at a fairly high level. I had surgery on Tuesday, so I didn't sing the Sunday after (missed Thursday rehearsal). But I sang the following Sunday. Not even hoarse. Really, intubation is the least of your worries unless you have other health conditions that would increase that risk (e.g. serious lung problems, COPD, other serious lung ailments.)

"For surgery my doctor recommended. Did you have sex last night?" Asking you what kind of surgery you had is terribly rude -- most people do it out of concern, but you really can just say, I had to have a procedure and I'm feeling much better now. Thank you so much for asking. Then change the topic. I have come back with the sex query when people who had no right to ask or know butted into a conversation - when they looked shocked I would explain that my health was just as personal to me as their sex life was to them. My work knew I was having surgery. That's all they knew. Whenever anyone asked, I thanked them for their concern and said it was something my doctor recommended and said I was on the mend. They usually got the hint.

Have you been documenting problems (flapping skin, rashes, irritations) with your primary care doc? If you do that, over time, you will have developed medical grounds to have skin removal. Without documentation and "complaining" to your PCP about the skin issues (including how they interfere with activities of daily living - e.g. skin on arms flapping when you try to exercise, you then are setting them up to have to pay for it. If the skin is causing medical issues, it is no longer a cosmetic procedure and, in most cases, falls within coverage. (This is not legal advice, but I have practiced insurance law for the last 25 years. Your mileage may vary depending on your policy terms and conditions - read your documentation - a solution may not be as far away as you think). You may be able to get them to cover the panni (stomach) but you may be able to cut a deal with the surgeon to do the other procedures. In the mean time, the insurance is paying for the hospital and anesthesia so you are, most likely, only paying for the surgeon's fee. BTW - you have done great and you should be proud of what you've done.

I was cleared to do anything that was under 15 pound lift as soon as I felt up to it. My surgery was on a Tuesday. By Saturday, I was sitting on the recumbent bike at the gym and did about 45 minutes of cardio. I was walking hours after surgery. After my 2 week post-op visit, and my incisions were checked, I was cleared to do whatever I felt up to. I got in the pool at that point, because swimming was easier on my knees. At about three weeks out, I started working with my trainer again - cardio, weights, whole nine yards. But your team may have a different opinion.

I'm 6.5 months out from surgery. I am the primary cook for my husband and two teenage daughters. As far as using the not going to the bar and drinking analogy, I don't think that's right. Once I got to the point where I was eating "normal" food (about 6 weeks out) I was able to go out to eat with my family or order from a takeout menu. At the end of January, my husband and I enjoyed an anniversary dinner as part of restaurant week here in Philly. I was able to find many things to order and just brought stuff home. We went out for Cuban Friday with the family. I didn't order an appetizer. I did have a small taste of what everyone else ordered (1 bite) and then I had a chicken dish. I didn't eat the rice or the beans and took half of the portion home because it was too big. They had dessert, and we all chatted. It was fine. The most difficult part is the first few weeks while you are on a limited diet. It was very hard for me, emotionally, to prepare meals for them once I was off full liquids, but had been moved onto soft foods. But you stick with it. Make sure you involve him in the process and during the pre-op program, he can eat just what you eat, but eat more of it for the calories he needs. Have him come to one of the appointments with your team and to a support group meeting. (I'm assuming your program has them -- mine has three different meetings each month and spouses are welcome). Also, my program had a great binder they gave us with all kinds of information and I made sure he had access to it to read, if he wanted. My guy has been wonderfully supportive. If you have questions, feel free to message me. We started in about the same place. I'm shooting to be 150 by my 1 year anniversary but I need to see how I look when I get near that weight. Right now, I'm within 10 pounds of what I weighed when I got married 20 years ago.

I didn't have a six month wait, but 3 months and it was required by my group. The theory is they want to make sure you will stick with the rules you are given over a longer period of time. I think the most difficult part of this process was getting my head in the right place. It has made the last 6 months post-op so great!

@Monikareigh - You are about where I was 13 months ago. At the end of March/beginning of April 2016, I was 271.5 and 5'3". Today, I'm 190 and headed to 150. I feel like a new person. I'm going to offer some tips from my journey: Protein - is what is going to keep you from getting hungry. Try to eat 90-100 grams of protein a day. Carbs - limit your carbs, but don't cut them completely. While you are "waiting" for your appointment, do something like Atkins. I start each day with a protein shake - 1 cup coconut milk, 1 scoop protein powder and about 1 cup of frozen fruit. Throw it in the blender. Its under 200 calories about 25 grams of protein and keeps me full til lunch. Oikos Triple Zero yogurt is a life saver -- about 120 calories in a cup and 15 grams of protein. If you do have pasta - use the Barilla high protein pasta - it's in the yellow box and tastes really good. And start moving -- walk for 1/2 hour a day (around the block, at the mall, at a gym) - and track all your food. I like My Fitness Pal, but there are plenty of other trackers out there. You've got this girl. Best of Luck!

My surgical team required the chest x-ray, cardio and pulmonary before my surgery. Don't sweat it -- it will happen soon enough.

Have you seen a bariatric surgeon yet? (That wasn't clear to me from your post.) If not, do so. If so, when they apply for the insurance, they can appeal. In many cases, insurance companies say no up front assuming you won't appeal. When your doc asks for a review by another physician who is certified in the same field, the determination usually changes. (I used to represent insurance companies - I know.) I wouldn't take a face value what the phone rep says -- I would speak with a surgeon who is covered by your plan and see what kind of success they have had appealing decisions with your carrier in your area. BTW - I had VSG 6.5 months ago. I'm down 80+ pounds and within 40 pounds of goal. I feel like a new person. Best of luck on your journey.

I'm just over 6 months out. It was worst for me between 4-6 months -- handfuls of hair when I shampooed. Keep your protein and water intake up. Take some biotin if you like. There's no avoiding it. Your hair comes back nicely- don't stress. It's just your body reacting to all the changes. You may see changes in your nails as well.

Reach out to someone you can talk to - a clergy member, confide in a friend, talk to your bariatric team. If your husband did not want you to have surgery, that's an issue the two of you are going to have to work through - please consider counseling. At 4 days out, my emotions were all over the place and I was a hot mess. Just remind yourself that you will feel better the further you get from surgery. Those first couple of weeks are rough -physically and emotionally. Be kind to yourself. I don't know how old your kids are but get the ones who can more involved in doing things around the house. Best of luck.

My experience may be different - I am 6 months out. The only people I told were my husband, two teens who live at home with me, a few (3) very good friends who I knew would support my decision. That's it. Didn't tell my mother. Didn't tell my sister. They still don't know. Neither does the rest of my family. Told work I needed to have some surgery and would be out for a few days. (Had surgery on Tuesday and was back to work on Monday - I'm a desk jockey who telecommutes, I'm only in the office Mon. & Wed.). I knew my sister wouldn't understand (she's a great person - I love her, but I knew she wouldn't understand.) My mother has been a judgmental b*tch all my life and I knew she would have plenty negative to say about my decision. (I'm 55). There are a lot of others I wasn't sure how they would react, so I didn't say anything. I have shared my story with two of the nurses at one of my physicians offices as they knew (had to be put in the records) but they are overweight and considering the procedure. I have found that keeping negative people out of my business has been helpful. This is a difficult endeavor - it's hard to stick to the plan, begin to exercise, adjust to your new body, deal with your emotions, etc. When people don't want to support you, you just don't need that negativity in your life. I have told a few people since my surgery, but if they are negative, I shut them down and walk away. I still have 40-50 pounds to go on my journey. I don't need that sh*t in my life.

Almost every employer-based policy is different, particularly if you work for a really big (e.g. Fortune 500) company. They have negotiating power with the health insurers. Never assume that because someone else who was insured by the same company got a certain answer, that answer will apply to you. They may have had a very different policy. It's one thing that 25+ years of practicing law has taught me.

@snakrysheltie Instead of stressing, call your insurance company. Mine was great about answering questions during the process. I was approved 2 days after the materials were sent - in fact - I got notice of my approval from my insurance company before my surgeon's office. What matters is what your carrier does and not what anyone else's has done - and what they do on your policy. You could talk to others who have the same insurance co but have a different policy and the process could be completely different. Good luck!

I didn't even tell my mother or my sister. My husband, two teen daughters and my best friend knew. That was it. I'm 6 months out and 75 pounds down from my high weight in April 2016. When people comment on my weight loss, I thank them. When they ask what I'm doing, I tell the truth, but not the whole truth : I eat a high Protein, low carb diet I exercise 4-5 times a week for at least 1 hour and work with a personal trainer I'm working with a doctor and dietician for guidance It's not easy, but it's been worth it. The only person I told at church was our associate rector, and even then, all I said to her was I was having a procedure and wanted her to hold me in prayer. Same thing at work - I just said I had to have abdominal surgery and would be out for a few days. I just spent the weekend with my husband's family and they don't know and didn't. While you are paying attention to everything on your plate, no one else is. I was able to eat mostly on plan -- I did bring a few Oikos yogurts and some Protein Bars as a just in case. Don't tell anyone you think will be a Negative Nancy.