windyacres_2000

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!

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

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

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 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

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

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

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!

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 am being compliant. I went and had an esophogram, and just to top the day off, went and had my first mammogram in a couple of years too. THEN - I had a sleep study. I have been sleeping 11 or so hours a day, and still not having any energy. My FP kept saying that most people don't get enough sleep. He kept asking me all the sleepiness questions. I am not abnormally sleepy during the day (most of the time) but that's because of how much time I give myself to sleep. Anyhow, they wired me up like Frankenstein, and surprisingly, I fell asleep. Had the A/C down to 65 deg. but fell asleep on my side. Eventually, I felt a touch and I startled awake. It was the tech, saying she had called me a couple times, but I didn't wake up. She said I had been sleeping really well on my side, without any real apnea. She wanted me to sleep on my back. I tried, but couldn't get back to sleep. She asked if I wanted a pillow under my knees or a drink of water. I said water would be good (I had been really thirsty). Also, my bladder was bursting, it actually hurt, so I got up and pee'd. Then tried to sleep on my back again. I kept wondering how long it would be before she popped in again and - sure enough - she was back, offering me a sleeping pill, which I took gladly since I was not on call. Then I slept. She took mercy on me and let me sleep until 7AM (I think that meant she worked overtime), then got me up and told me that I had had a LOT of hypopneas (decreased breathing, then decreased O2 sats) and that she wasn't the one to decide, but she thought I would be called back for another study and CPAP titration. A couple days later I got the call, and I am scheduled for another sleep study in June. I can't say I'm looking forward to all the masks and machines, but I am looking forward to being rested during the day. I also hope that the lap-band surgery and weight loss will make it so that I don't need to be on CPAP for a terribly long time. I sucked it up, and called my FP's office for the first "physician supervised weight loss" visit, and made a seperate appt. for a Pap smear. I have to practice what I preach.

I am being compliant. I went and had an esophogram, and just to top the day off, went and had my first mammogram in a couple of years too. THEN - I had a sleep study. I have been sleeping 11 or so hours a day, and still not having any energy. My FP kept saying that most people don't get enough sleep. He kept asking me all the sleepiness questions. I am not abnormally sleepy during the day (most of the time) but that's because of how much time I give myself to sleep. Anyhow, they wired me up like Frankenstein, and surprisingly, I fell asleep. Had the A/C down to 65 deg. but fell asleep on my side. Eventually, I felt a touch and I startled awake. It was the tech, saying she had called me a couple times, but I didn't wake up. She said I had been sleeping really well on my side, without any real apnea. She wanted me to sleep on my back. I tried, but couldn't get back to sleep. She asked if I wanted a pillow under my knees or a drink of water. I said water would be good (I had been really thirsty). Also, my bladder was bursting, it actually hurt, so I got up and pee'd. Then tried to sleep on my back again. I kept wondering how long it would be before she popped in again and - sure enough - she was back, offering me a sleeping pill, which I took gladly since I was not on call. Then I slept. She took mercy on me and let me sleep until 7AM (I think that meant she worked overtime), then got me up and told me that I had had a LOT of hypopneas (decreased breathing, then decreased O2 sats) and that she wasn't the one to decide, but she thought I would be called back for another study and CPAP titration. A couple days later I got the call, and I am scheduled for another sleep study in June. I can't say I'm looking forward to all the masks and machines, but I am looking forward to being rested during the day. I also hope that the lap-band surgery and weight loss will make it so that I don't need to be on CPAP for a terribly long time. I sucked it up, and called my FP's office for the first "physician supervised weight loss" visit, and made a seperate appt. for a Pap smear. I have to practice what I preach.:cursing:

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

Make sure you check your policy, often there is a maximum out of pocket expense for you.

So, I went to a doctor's appointment, and my Hg A1C has gone up to an unacceptable level. My pcp wanted to start me on a diabetes medication that also causes some weight loss. As I did more research into this drug, I saw that it can cause debilitating nausea. It is also pretty short acting, and would not deal with my high fasting blood sugars. As I thought about the prospect in years to come of trying medication after medication to control my diabetes, I went back to the idea of CURING this disease - via the lap-band surgery. I am right at a 35 BMI with comorbidities and I want to do this for my health. I got up my courage and made an appointment to see the surgeon on Friday. I am excited and nervous, and ready to begin the long haul of satisfying the requirements of my health insurance company. My husband is going to the appointment with me, and will learn all about this with me. I have put off a decision about which diabetes medication to use until I talk to the surgeon. In the meantime, I am drinking lots of water, trying to eat low carb, and getting out on my bicycle. I had really let my blood sugar get out of control.

So, I went to a doctor's appointment, and my Hg A1C has gone up to an unacceptable level. My pcp wanted to start me on a diabetes medication that also causes some weight loss. As I did more research into this drug, I saw that it can cause debilitating nausea. It is also pretty short acting, and would not deal with my high fasting blood sugars. As I thought about the prospect in years to come of trying medication after medication to control my diabetes, I went back to the idea of CURING this disease - via the lap-band surgery. I am right at a 35 BMI with comorbidities and I want to do this for my health. I got up my courage and made an appointment to see the surgeon on Friday. I am excited and nervous, and ready to begin the long haul of satisfying the requirements of my health insurance company. My husband is going to the appointment with me, and will learn all about this with me. I have put off a decision about which diabetes medication to use until I talk to the surgeon. In the meantime, I am drinking lots of water, trying to eat low carb, and getting out on my bicycle. I had really let my blood sugar get out of control.

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.