JT2002TJ

From a thread someone posted here. I am still pre-op, but I went to https://insurenutrition.com they were able to work with my insurance company and surgical group. They were able to get me 4 boxes (of 18 per box) premier protein shakes, and vitamins my surgical group approved of. I will get this monthly now. All at no cost to me (I have really good insurance). This means, when I start my pre-op diet, I wont have to buy any shakes, just anything else I want during that time.

Although I am not going selfpay, I would imagine it all depends on your surgical groups requirements. Based on those requirements as stated above, it will depend on how quickly you can accomplish everything. I was able to complete all my insurance/surgical groups requirements within one and a half months (excluding the 6 monthly weigh-ins). BUT, I already was diagnosed with sleep apnea. If your surgical group requires a sleep study (visit with the pulmonologist) this itself can take a couple months. Back when I was getting diagnosed, it took me 3 weeks to get an appointment with the pulmonologist, 2 weeks to get a sleep study appointment (I did a take home test, as I would have had to wait another week for an overnight study), then another 2 weeks to go back to the pulmonologist to get the order for a cpap machine. After that another week to actually get the machine. So, IF your surgical group requires a pulmonologist clearance, expect it could be a month and a half or more to actually get that process complete (you can accomplish all the other stuff during this same month). I would start this now, ahead of time. If your insurance will pay for a pulmonologist visit, and a sleep study, it wont hurt to accomplish this even before the surgical consult. since I was already diagnosed, all I had to do was have a quick appointment with my pulmonologist with my surgical order for a consult, he said great, and took the order. The next business day my surgical group had the signed clearance.

That would be hard for me too!!!

I also work in health care, in quality. I do data analytics (basically build systems/reports), with quality and regulatory data. EVERYTHING is about volume and complication rates. I love where I work, but live too far away (38 miles from my house) to get the procedure done at work. So I found a group that has offices <5 miles from my house and <10 miles from my office. I was lucky to find a group with two offices, both close to where I spend most of my time. I'm almost through this, I have my cardiology consult tomorrow, 4th weigh in in two weeks, final weigh in and then the waiting begins.

Oh, yeah, I haven't seen my surgeon since the initial consult. But I have been to the office for each of my weigh ins, so they see me all the time. Whenever I go there I give an updated checklist I created to my coordinator. I created a table in word with: Description, Dr, Phone #, Scheduled Date, Scheduled Time, Location and Complete. In this table I have all 20 items I needed to complete (PCP/Pulmonologist/Psych Consult/Support Group Meetings/Cardiology Consult/Upper Endoscopy/...), I put a check mark in the complete column so she knows where I am, what I have left, and who to contact to follow up of additional information is needed. Because she now expects this from me, I get to have a short conversation with her every month as I give her the updated printout.

Does "they" equal your coordinator? If so, I'm sorry. Mine has been very responsive. I can even email her and she will respond within 24 hours. When was the last time you went into your surgeon's office? Maybe stopping by may help you? Did they give you a pre-surgery/bariatric process checklist? Mine has all the requirements. I am looking at my requirements now. If BMI is over 50 a prescription of Lovenox is required, and if BMI is over 60 there is a requirement of weight loss (20/40/60 they circle what they want). These are surgical group requirements (not NYSHIP). My surgeon's office knows me by name, I have been there 5-6 times in the past 4 months. To me, this is very helpful, and makes me feel very welcome.

I suggest calling your coordinator and asking if the weight loss was an insurance requirement or a surgical group/hospital requirement. I have a feeling it will be the latter. The medical industry is so much tied to patient outcomes. Surgeons really care about their complication rate, as it is what drives patients to them, and what determines future employment. This is why they put restrictions on smoking, it has nothing to do with the insurance companies, just complication rates. If this is the case, it will be up to the surgeon. If they do approve they may warn you that if they even see the slightest issue doing it laparoscopically, they will open you up. The problem with higher BMIs is that the liver is bigger, which makes access to one's stomach more difficult. I am not trying to worry you. Your best bet is to schedule a quick call with your coordinator, and have a list of questions written down and ready (they are busy, and may try to rush you out of workload not that they are dismissing you).

Ah... Here we go. I believe if your BMI is over 50, they add additional restrictions. I believe it is the surgical group and/or the hospital where you will have the surgery. They really want patients under a BMI of 50 for anesthesia purposes. It also is a risk of complications. My group said they do this. I honestly do not believe it is a NYSHIP requirement. So, my opinion is the insurance company will approve it, but it will be up to the surgeon if he/she will. I believe when approved by the insurance company, you have up to 2 years to complete the procedure, so at worst, your surgeon may ask you to continue the diet to lose more, at best, you will be approved and scheduled as is.

No. Not yet. I have my 4th weigh-in this month (2 weeks), so next month they will submit my packet. I do believe my coordinator though, because their entire job is based on getting their patients through the process and approved. The 2 required dr's visits are peanuts (initial consult and pre-surgery visit), and not even worth her time, so their entire motivation is to have you actually go through he surgery. I did do my weigh-ins with them and not my NUT, so they did gain the benefit of 6 additional visits. What was your starting BMI? Mine was 40.3, I am down about 9 lbs since then. I have the full list of comorbidities... I have high BP, Cholesterol, and 2 years of sleep apnea with 94%+ utilization. So, technically I was already above the no need for comorbidities threshold.

Well, hopefully your NUT is correct. My surgical group just said don't gain or lose too much. My coordinator said some insurance companies will deny if you are 1 lb heavier than your initial weight, others require a set amount of weight, but mine had nothing specifically documented. She said she has put many people through with my same insurance (from my same agency) and never had an issue with weight.

My NYSHIP did not require a mandated weight loss amount... Are you sure that wasn't a surgical group mandate?

I have NYSHIP as well, why do you think they wont cover you? The NYSHIP group is very big, which is why the coverage is more than most. As long as you went to a surgical group with experience with NYSHIP, you met the prerequisites, I'm not sure why they would deny you. My surgical group said, they never have problems with NYSHIP, including if patients have slight weight gain or loss during the 6 month monitored diet.

I am still sticking by my thoughts. If you go to bed, consume nothing over night, there is no way you will gain weight by the next morning. You can lose weight (burning energy, sweating), but not gain. It is quite possible that someone gets up in the middle of the night, drinks water/eats without remembering it (sleep walking/eating). Or, more likely, it is an ineffective scale, not on a proper level/solid ground. It is simple science. You can retain more water because of hormonal changes/salt intake, but you have to actually consume the water in order to retain it. It is even in the name, water retention. One could argue that your body extracts water from the air in your lungs, I wouldn't disagree with that. But there simply is no way to gain 5.2 lbs overnight without consuming something. 5 pounds is a LOT of water weight that is 0.599 Gallons (2.4 quarts). It has to be the scale... These are my thoughts, and is not meant to be dismissing anything anyone else has said.

The OP stated they weighed themselves before bed, then first thing in the morning without consuming anything... OP: It has to be you scale, you can't create matter!!! Unless you are sleepwalking and sleepeating! LOL I had a scale that every time I got on it (even right after) I was getting different numbers. I got a good counter balance scale (like a doctors office), and that was the end of the fluctuating weights.

This is it... My dentist told me that she sees bariatric patients come in as a result of GERD causing sensitivity issues. She put me on a medicated toothpaste (for sensitive teeth) because I have a sensitive tooth. I am pre-op and just had my 4/6 weigh-in. She said, if I start it now, if I have GERD issues, it will be unlikely to have any issues with my teeth.

x2.

Have you changed your diet to foods higher in sodium? If by one of your BP med was stopped, you mean the water pill (diuretic), it could be you are retaining more salt causing your BP to go up?

They don't actually cut anything. They stitch the stomach together using 3 stitches in a plane (triangle), then pull it together. So it looks very similar to the vertical sleeve from the inside of the stomach, but you have folded over stomach that is sealed and unusable. This seems like a good video: I think it looks promising, but I wonder if people will get infections or some adverse effect to having the skin folded over, for example, what if food makes it way in there and gets trapped?

Honestly, this should have been part of the application process. Can he get an appointment and do a take home sleep study before the appeal? If he has it, this is probably the biggest thing outside of the BMI.

You said you are pretty sure he has apnea... Did he get tested (sleep study) as part of this process?

I haven't had my surgery yet, but there are a few things I have learned since that I didn't know day one. I suggest to be sure to ask about vertical sleeve and acid reflux, if you have reflux issues. Luckily I have only had a bout with reflux one time, and it was because of taking cod liver oil pills. Never had reflux any other time in my life. Other than that, I would make sure you get a good feel from the surgeon, and they are a well known organization and he/she is experienced.

I had my first appointment with my surgeon on 3/31/2017 (attended a seminar the same week before the initial visit). My last weigh in appointment will be 8/25/2017. I assume approval will be 2 weeks after. Hoping the surgery will be in September. So about 7 months.

Nice. I'm in Long Island. Living in Nassau, and working in Suffolk.

I'm right in the same world as you. I started out at 320 (I'm 6'2") and am 38 years old. I went on a diet and at my first appointment I was 305. I have had 3 weigh ins (3 left, next is in two weeks), and completed everything except the cardiology consult. Good luck with your journey. It is a lot of work (the hoops they make us jump through), but I do see the end, and you will too.

Awesome! Remember, you want 0 mg juice and a regulated 2 battery sub ohm mod. They will ask you if you think you will like custard or fruity flavors. My personal 2 favorites are fruity pebbles and Haulin' Oats (The name just changed to something else because of patent infringement) an oatmeal cookie flavor. The supplies you might want to consider: 2 Battery Regulated Mod, 2 or 4 batteries (18650), 2 or 4 battery charger (much easier to charge outside of the unit, especially if you get 4 batteries so you can swap them), PLASTIC COVER FOR EVERY BATTERY (should come with the batteries, but MAKE SURE as you dont want to short these batteries), Sub ohm tank (Smok Cloud Beast TRV8 or TRV12 are good choices), Spare Atomizers (these are the coils that screw into the tank that vaporizes the juice, they last about a week each during heavy use, they need to match the tank), and a 60 mL bottle of your choice of 0mg (nicotine content) juice. I would print that list out and bring it with you to make it easier. I would expect to pay in the $200 - $300 range for all I listed above (or a little over the average carton of cigarettes, but will last you months). The disposables (atomizer and juice) are in the $15-$30 per month range once you have everything. Another option is to get the mod, tank (comes with at least one atomizer), 2 batteries, and bottle of juice only, then buy the rest online, including extra batteries and charger. I just like to support local businesses when I can. Especially since these vape shops are what keep juice manufactures hard at work developing more flavors. Juices - I suggest giving up on tobacco flavors, they just dont taste the same as smoking. If you get that idea out of your mind from the beginning, you wont be disappointed. Once your house/car/clothes stop smelling like smoke, you will be much happier, and glad you switched. PSA: Batteries... These batteries can burn down a house, it is VERY important to always transport them inside a hard plastic container. Keys, coins and other conductive things in contact with the positive and negative side of the battery WILL either burn you or your house. Get good quality batteries (not knockoffs), and if the battery insulation (wrapping cover that is part of the battery) is even slightly damaged immediately properly dispose of the battery (Home Depot will take batteries). They are $10 each, consider your life, body and understand that they are ONLY $10, replace them as needed.