120Cassy

On 1/5/2017 at 3:44 AM, Heath55 said:

On 01/02/13 I had the sleeve done and unfortunately it just didn't really take. Of the 365lbs I started at, my lowest weight was still in the 290's post op. Last June my mother died unexpectedly and young just like her father and brother (all cardiac traumas and it runs significantly on my fathers side too). It scared me into getting myself together and getting back on track, which I've been doing. While I lost only a fraction of weight the first time my quality of life and activities was and has been phenomenal but unfortunately I'm still borderline diabetic, I'm putting stress on my heart, my PCOS is out of wack with multiple cancer biopsies due to this, I started to have high blood pressure and the extra weight caused foot problems. I had two surgeries on my R foot in the last 6mons with little success and he feels my weight is a considerable part of this. I'm doing PT 3x's a week to regain mobility but that's significantly slowed me down.

I work in the healthcare field and know the system pretty decently but today AmeriHealth denied my revision for full bypass. For my first surgery I had Horizon and AmeriHealth told me that as long as it wasn't through them because they're a "one and done" provider and I meet the medical criteria that wouldn't be an issue. I'm currently about 300-307 and my BMI is about 49 and I'm being denied. I'll attach the criteria they sent me again today but any tips on making this happen would be immensely appreciated. Quite frankly I'll die before 60 like my mother with all of my medical issues that could be alleviated and even eradicated with proper weight loss. I'm going to try and attach a screenshot that I was given by my insurance subsidiary in NJ and if someone can tell me how I don't qualify please go for it because I can't fight something I may be too close to see. I'm feeling really frustrated and defeated but I refuse to roll over. After some pushes with calls today I will have a peer review but they don't know when. Thanks for making it through my ramble.

 

Sent from my iPhone using the BariatricPal App

I thought that weight loss surgery revisions are given due to problems with the first surgery, such as severe gerd (which sleeve patients tend to get and that's why they get it revised), slippage (gastric band) and or throat stricture issues (or something like that)? A few insurance companies believe when a procedure doesn't take it's due to the patient and not the procedure itself. That's why when we choose the surgery the first time, your primary physician usually guides you on what they think may be best based on your weight issues (at least that's what my doctor is doing). I hope you get approved. Don't give up. I'm not sure how many times you can appeal...but I'd appeal this as much as I can. Possibly get your doctor to do tests for Gerd issues or issues with the sleeve itself and not the weight issues and health. Those reasons were the reason you got the first surgery. Maybe going about it a different way may help. I know this is coming months after you posted, but I thought I'd reply just in case. :-)

On 7/9/2017 at 9:13 PM, Roux-en-McClanahan said:

I don't really believe the soda thing because there is no conclusive evidence either way that says it causes pouch stretching. Either way, I have maybe one diet soda a week.

My dietician says no Soup because it goes through your pouch too quickly to be satisfying. I've found that to be true for me so I'll do only chili occasionally or something similarly hearty.

I read that the carbonation just pushes the food through the pouch quicker causing you to get hungry again sooner and people tend to overeat and can start gaining the weight back. It doesn't stretch out the pouch. However, everyone is different in regards to what works best for them. Interestingly, I didn't know soup had a similar effect to what I read about the carbonation in soda. Good to know.

5 hours ago, KikiSue🙋🏼 said:

I've recently scheduled a consultation to discuss this procedure and possibly have it done. Basically since it's non-surgical, the Nurse said that there's no pre-op things that need to be done. Basically at my consultation I can schedule surgery right away.

I'm unable to find very much info online regarding this procedure. I've watched YouTube videos and have seen info on the news about it, but want to speak to a live person that has had this done.

Any information will be helpful!

Thanks!

Kiki

What procedure are you referring to?

On 6/26/2017 at 9:06 AM, Jessica2103 said:

Anyone doing this WLS surgery in NYC

Sent from my SM-G930P using BariatricPal mobile app

I'm getting mine done at Mount Sinai Hospital. What about you?

On 6/9/2017 at 5:57 PM, COTutu said:

First time here. Would you please tell me what SW is? I can figure out the rest but am stymied with SW!

SW is Starting Weight

I'm in my 6 month process (2nd month thus far) and I had to get approval from my pcp first. He referred me to a hospital, but when I called to make an appointment for the seminar they told me they didn't accept my metroplus insurance, so I decided (with careful research) to go with Mt Sinai hospital. They have rave reviews. After the seminar with them, I made an appointment to meet my Surgeon, Dr. Eric Edwards (he's nice and very competent) and I was set up with a checklist. Everything goes through your pcp. Some things you can do with Mt. Sinai hospital, but you have to check to see if it's covered by your insurance. Your PCP should be able to coordinate, but you can help them by giving them the checklist (depends on how your hospital works). So far it's going well. Stay dilligent, because if you don't see your pcp every month for the 6 months, it may mess up your process. I never called Metroplus to see if they actually require 6 months so I'm not sure if it is needed, however I'm just following my doctors guidance and the guidance of my nurse practicioner Amy Chen from Mt. Sinai Hospital's bariatric team. I wish you all many blessings in your weight loss endeavors!