windyacres_2000

Hi everybody! My name is Linda and I'm 55. I will be 56 about the time I am sleeved.

Have you been sleeved yet or waiting? I'm hoping to hear from the doctor on Monday with the date of my surgery and find out when I see her and what bloodwork etc I need done prior to surgery.

I am NOT looking forward to the 14 day liquid diet but I can do this!

Intro - My name is Edie and I'm 54. I've been waiting for this surgery since 2008. FINALLY BCBS North Carolina stopped calling it investigational. I've finished all my pre-op testing and the doctor's office submitted it to the insurance company. Now I wait in suspense. I think it could happen pretty quickly once they get approval. I had to have a colonoscopy and upper endoscopy and some samples were sent for biopsy so that could take a couple weeks - I don't know if they will wait for those results before scheduling me. The GI doc said everything looked good and that he was going to clear me for surgery.

After waiting all these years, it doesn't even seem real. My surgeon has done MANY bariatric surgeries, but only about a dozen sleeves. He seems very comfortable with it though and I am comfortable with him and the reputation of the practice. I was tested up one side and down the other!

OMG! This is so exciting! After all this time, BCBSNC has finally decided that VSG surgery is no longer investigational. I was making plans to go to Mexico because I really didn't want RNY or the band. I'm just so happy, I could dance (well if my knees didn't hurt, lol).

How did you find out? My therapist told me to get on the ball and start working on the process. So I checked the website ONE MORE TIME and there was the policy change! The only thing I was unhappy about was that the surgeon's office didn't call and tell me. I had started pre-op stuff last year, planning to buckle down and appeal, but I just didn't have the heart for it.

Now all my pre-op is done and the surgery is submitted for approval. I am holding my breath! I've been waiting for this since 2008!

How did things go with Dr. Pirello? Do you know how many sleeves he's done? Was his office helpful with insurance issues?

Edie - trying to move to NC

Hello Windyacres_2000,

Would you do it again even if you knew you would be going through all those complications? I'm considering having the surgery, but I'm very scared.

I'm a surgery wanna-be, but I have been reading this board for a long time, and while the complications scare me spitless, they are a remote possibility. The comorbidities I have because of my obesity are here and now, and I think they are even scarier. Definitely worth the small risk associated with the surgery in my opinion.

If you have any supply issues, there is a wonder product (liquid) called More Milk Plus. You can buy it at Luckyvitamin.com

I am a midwife - I had a client who had insufficient milk supply with her baby. After that baby she had a mastectomy - so only one breast. When she got pregnant again, she didn't know if she should even try to breastfeed. With More Milk Plus she had enough milk for her baby.

Edie

Thanks Joy.

Edie

Hi, my name is Joy. I am the 1% with major complications. I was found to have a leak 2 weeks out. I will be 6 months out on June 16th and have now lost 52 lbs. Beginning weight 190 now 139. I am only 4 ft 10 in. goal weight 115. Here is my story...

I began having back pain and trouble breathing just before my 2 week check-up. I came in and saw the nurse and she said if I was not feeling better the next day to come back in and I would speak with the surgeon. Sure enough...my 1st real meal (a 2 oz. omlette w/cheese). I felt horrible. I headed in to see the surgeon at 9 am. I had an Upper GI, CAT Scan, and another Upper GI to verify the leak. I was rushed into surgery and then spent 10 days in the ICU. Many complications followed; 2 abcess, infections, lung collapse. 4 days on the ward, 2 weeks of high fevers another admission for 12 days. IV antibotics at home for 2 weeks and I was on the feeding tube for 3 months and 1800 calories a day. So, it took me longer to loose the weight.

Now... I am up going to Curves, walking, and doing Water aerobics. I have lost 10 dress sizes (started size 20 now an 8 -10). 23 lbs from goal weight! Happy and healthier. I have a wound that still has not healed and and a rather large hernia. They want to wait to fix the hernia...so the can fix the tummy at the same time.

If anyone wants to talk about complications...I will be glad to talk.

I want to talk! You can PM me if you don't want to post to the board. I am curious if you had your surgery in the States or in Mexico. If in Mexico, who was your surgeon? If you were self pay, who paid to treat the complications? Having to pay out of pocket for any complications is my big fear.

Edie

I guess I'll be the first to post in the 50+ lbs forum. :001_wub: I have about 65-70 lbs to lose (I've put on about 5 lbs since getting my VSG date! :sad0:) I know that number would only increase without the VSG, so I am happy to know my surgery date is only a week away!

I would like to lose 70 - 75 pounds. How did I ever get this heavy?? I am so jealous of you with surgery dates. I need to sell my house for the $$. I refuse to take out another loan! I plan to try for the end of March.

Edie

I was looking into the band through Humana and when I realized they would not pay for it for me, I looked into the sleeve. I am so thankful that door was closed. You might want to look at what all your out of pocket costs will be using your insurance. If something is not covered, that does not become part of your maximum out of pocket. For me, for example, visits to the dietician (required by the surgeon) would not be covered and I would have had to pay. I think my out of pocket costs would have been pretty high. It just doesn't seem like that much more to go to Mexico. The only problem is that if there are any complications once I'm home, I'm sure Humana won't pay for anything. I sure don't plan to tell them when I have surgery done in Mexico! Has anyone tried to use flex plan money for surgery in Mexico?

Edie

Why Mexico? My surgery will pay for the LapBand if I gain more weight. I want to do the surgery because of co-morbidities, not because of weight, and I REFUSE to gain weight to do this. I am blessed, because being forced into being self-pay made me do more research, and I discovered the sleeve surgery. There is no one in my area doing this surgery, including the large university hospital. I can't even begin to imagine what it would cost to do in the states. I had some diagnostics done in preparation to do the LapBand and the costs were staggering. Mexican surgeons have a ton of experience. I am worried about the possibility of developing complications at some later date and running up a big bill back here in the states, and I KNOW my insurance co. would not pay for complications. I don't plan to tell them anything about it, in fact. Told my PCP NOT to chart anything about going to Mexico! Sorry, I'm rambling...

Edie in Wisconsin

There is at least one, maybe two, US surgeons who do the sleeve on an out-patient basis. You don't even get overnight in the hospital -- you go to a nearby hotel. The price of the hotel is included, but I would want to be in the hospital after having most of my stomach cut off.

I'm with you on that one - 100 percent!

I wouldn't go to Mexico for surgery, mainly because I know there are a number of doctors in the US who do the sleeve for about the same price as if I were to fly to Mexico, including the one I'm going to. So there's really no reason at all for me to leave the country for the sleeve. By the time you add in travel costs, it's not any more inexpensive. Plus there is still that language barrier that is possible with some of the nurses.

I don't think the Mexican surgeons are somehow less qualified though. You'll find good and bad ones all over the world.

Who in the states does the sleeve for the same cost as the Mexican doctors? I can't even imagine this. I had a esophagram in preparation for lap-band surgery at my local hospital, and was billed by three different entities! Are you talking just the surgeon's charges? Or all labs, radiology, anesthesia, nursing etc.??? I just want to know who in the states does all this (VSG) for under $10,000

Hi, I am here in Atlanta Georgia, my Lap-band was just approved today by humana tricare south, we are prime. You need at least 2 co-mordbitites and 100lbs over, mine were HBP and Joint Pain. I am approved. I weigh 260, and I am 5' 9", do not give up. If you are 200% overweight, you need no co-morbs. My referral was put in Thursday approved Monday. I barely made it at 260 to be approved, 249 was my Metropolitan Life chart number. Anymore questions just reply.

Sorry for all the questions - you said you barely made it to be approved at 260 - did you doc say you had a large frame? That chart is so confusing!

Hi, is this Humana Tricare or regular Humana? Humana Tricare does not require a six month physcian diet plan. They quoted you the wrong information. If you are border line and fall below the charts you will not be approved. Tricare goes strictly by the Metropolitan life chart. No supervised diet is needed. I would call them and speak to a supervisor.

I have Humana Preferred.

Regarding the Met Life scale - can you help with this? It shows a range of weight for my height. If I am 100 pounds over the bottom of the range, do I qualify?? Apparently we have a somewhat unique policy, terms set by the employer.

Thanks!

I have Humana, and am having a terrible time finding the information I need online. Any advice?

I have Humana and am working this through. You can go to this .pdf document and it gives the company guidelines. I had a heck of a time finding this information. Calling Humana was worthless, I'd wait on the phone for 45 minutes and get a different answer every time. You have to make sure that your policy allows the surgery, though.

http://apps.humana.com/tad/tad_new/returnContent.asp?mime=application/pdf&id=5425&issue=132

Here is a link to a .pdf of Humana's Bariatric Surgery policy. It will tell you what the doc has to chart at each visit, etc. You do need to see a physician, not use Weight Watcher's or something.

http://apps.humana.com/tad/tad_new/returnContent.asp?mime=application/pdf&id=5425&issue=132

Edie

I have had these questions with Humana. Do they use the number at the bottom of the Met Life scale range? And they have told me I need six months physician supervised diet - if I lose below my current weight, will that disqualify me? I am right on the borderline to qualify.

:biggrin:I am getting so excited. On April 16th I will have completed my 6 months of required doctor supervised visits. I have completed all my dietician visits and my psych evaluation. I don't know if I passed it or not but I guess I will find out the results on the 16th. I also had to lose 13 pounds

I also have Humana, and heard about the six month Dr. Supervised diet. My question is, what if I do the diet and lose enough weight that I don't qualify because after the diet my BMI is too low? Is this is an issue for you? I'm right on the borderline with my BMI.

Edie