KimB7811

I have BC/BS Fep too. I’m really nervous for submission because of being on the low BMI side. Only 35.5/36. I have 2 co morbidities (Hypertension and Severe Osteoarthritis in my knee). My surgeon said he feels pretty confident I will have no issue with my insurance and those issues for approval but I’m doubtful. He said BC/BS is one of the better ones for approvals too. I’m sorry you got denied GTGirl. But fight the insurance on it. You’ll get it.

Got my psych evaluation done on March 27th! It was definitely a very easy appointment that went well. I had to just answer about 3 questionnaires with about 20 questions on each. They pretty much continually ask over and over if you feel unhappy or about the same as you always do or if you binge eat, etc... then I went in and sat and talked to her face to face for about an hour. She even said the reason they do these is just to make sure the patient can follow directions or be responsible enough since this could be potentially dangerous if they didn’t after the surgery. She asked me a few things starting all the way back from my childhood... and my life story in general. Do I have a support system... how I would handle holidays and such... how I feel this would benefit me and what I feel the risks are. Asked if I’ve ever been depressed or have family history of it. I did tell her I had terrible post partum depression with my second daughter and saw a therapist for a few months, which seemed to not be an issue. Then she basically said she’ll have the report written up in about 2 weeks and faxed over to my surgeons office and will send me a copy as well. That’s when I joked and asked “ so I passed?” She said yes but it’s actually not up to her....?????‍♀️ I was a bit confused by that because I kind of thought it was but she said she sends the report over with the papers and someone else decides. I guess it’s someone at my surgeons office? ? anyhoo.... So, now all my appointments from what I understand for insurance submission are done. I called my doctors office to touch base to let them know and find out what the next step is. She scheduled me for an appointment with my surgeon on April 12th so I guess he’ll go over the next step with me. Meanwhile, I’m going to really try to be good until then and make sure I weigh in around the same if not a pound or two under then the first time I saw him because he did tell me not to gain weight in the meantime. My insurance doesn’t state anything about gaining during pre-op but I’m sure it can hurt submission. I’m really hoping he gives me some good news next week like maybe a tentative surgery date or tells me they are submitting everything to insurance. Tomorrow I have a Bariatric support group meeting that is held at the hospital once a month. My nutritionist told me she likes to see her patients at at least one before surgery and I figured it would be really good to hear from others that have had it as well just like this site. ?

First off, congrats on such an amazing success so far with your weight loss and transformation! I’m not in any way a fitness expert or anything, and I haven’t had Bariatric surgery yet, but I’ve experienced something similar before. When I got down to my lowest weight a year ago and I was at the gym for 2 hours a day doing cardio and lifting, I hit a major wall all of a sudden. I was counting my calories on my fitness pal daily which was only 1200 but was burning more then that a day. Then my weight loss doctor said something to me that made a lot of sense. She said your body gets used to that level of activity and calories you are burning and therefore you will have to do even more for your body to “react”. So she suggested to actually take a step back from the gym for about a week. Giving my body a rest and a chance to recover while watching what I ate. And in that week I dropped 9lbs. It was kind of amazing how my body really did just need some rest. Maybe it’s worth a shot even though I know it’s hard to not work out everyday.

Some can be real winners. I would’ve looked at her and asked wth that had to do with Bariatric surgery! Lol

i actually was thinking it had something to do with the questionnaires as well too and my surgeons office going over them. I was going to wait until I receive a copy of the letter from the psychiatrist, so this way I know she wrote it up and sent it to my surgeons office as before I contact them. This way I’ll ask if everything is ok and also find out when to make my next apt with my surgeon since I don’t have one scheduled right now.

Psych eval went great. It was def more of an eval that I expected it should be and from what I have read from everyone’s experience on here. I just had about 3 papers of 20 questions to fill out and then about an hour of face to face talk. She asked a little of everything all the way back from my childhood through high school and up. And of course why I want this and how I think it will work and the complications I might think could arise or the challenges... stuff like that. I asked at the end jokingly if I passed and she said yes but then she said it’s actually not up to her...?‍♀️ I asked if she meant the insurance but she said she said it ultimately goes to someone else that looks at everything but she really wasn’t sure who that was.... not sure if she was talking just about the psych part??? Does anyone know what she meant??

About to walk into the psych evaluation. This is it as far as my requirements! Hoping this goes well!!!

Wow, you can’t catch a break! But you are tough and I do feel that these Drs like to prove and test for things sometimes that aren’t always necessary. I believe if you look hard enough in all of us you’re going to always find something....lol. Unless it’s causing a problem then let it be! Lol. Just stay positive and I will send positive vibes your way as well!

Fingers crossed that you will hear good news as well Frustr8 on your next endoscopy!

That’s awesome that you no longer have it! It’s crazy I didn’t know I had it. I’m more concerned about the ulcer I guess. Did you have that as well?

Endoscopy is done! It went really well aside from finding out I have GERD and I had no clue. Apparently I have a small ulcer that’s causing some reflux that I seem to never feel so he prescribed me Omeprozol to take every morning and said he took a biopsy of some bacteria. He said I can still have the surgery though and to just follow up with him in 2 weeks. ?

Endoscopy is done! One more thing checked off the list to the road of my surgery. It went really well aside from finding out I have GERD and I had no clue. Apparently I have a small ulcer that’s causing some reflux that I seem to never feel so he prescribed me Omeprozol to take every morning and said he took a biopsy of some bacteria. He said I can still have the surgery though and to just follow up with him in 2 weeks. They took me in a hospital type waiting room with beds and curtains. Told to just take everything off up top and put on a gown with the back open and go to the bathroom to take a pregnancy test. I assured them my baby days are over but did it anyway. Good news! Test was negative ?. Then after hooking me up with an IV and taking all the vitals and stuff.. I get wheeled into the surgical room where the doc and anesthesiologist is. They told me to lay on my left side and take 5 deep breaths and I should be asleep shortly... well I think I took 1 and 1/2 breaths before I was out cold. Next thing I know I was being woken up in the waiting area saying it was over. I swear it must’ve been about 10 mins total! Next week is the psych!

I’m an hour away before my Endoscopy! Praying everything goes good with this and then I just have my Psych eval next week before I should be ready to submit to insurance! Eeeeek!!

That’s amazing! Congratulations on your hard work and success!!

Congrats on that success CyndieRI. That is incredible!

I actually made an apt with a difference psychologist for next week as well and she explained it will be something similar to that as well. Just a few forms and a face to face which seems better to me.

Just got back from my apt with my weight loss dr that I have been going to for about 2 years. It was hard stepping on the scale today though and seeing the number. I’m at 224 point something or other. It’s a number I swore I would never have gotten to again so I’m praying I get approved for this. I feel like crap. I am really starting to “feel” the weight again and it sucks. It was encouraging sitting down with her today though and talking. She read me the letter she is faxing over to my surgeons office for insurance and it seems very good. She definitely is pulling for me! Meanwhile...still has me on the phentermine but I’m hoping to stop that as soon as we hear from insurance. Meanwhile yesterday I got to deal with someone from the Dr’s office for my Endoscopy that obviously doesn’t seem to know her job that well and decided to give me a slight heart attack. She proceeded to tell me on the phone that my out of pocket for the year hasn’t been met yet and that I would be responsible for the entire procedure and facility until out of pocket is met. Well... I knew that didn’t sound right at all considering our only out of pocket expenses are co-pays. Thankfully, after an hour later of verifying what I already knew on the phone with my insurance, I had to call HER back and explain my insurance to her and explain I only will be responsible for a $150 copay on Friday for the Endoscopy... the rest is 100% covered ??‍♀️ Let’s hope the endoscopy goes smoother! ?

Ty!

Reading everyone’s story on here is so inspiring and insightful on this journey of weight loss surgery that I figured I would share and track mine as well. It will be nice to hopefully look back and read this a year from now anyway after being successful with my gastric sleeve surgery...fingers crossed! All up to that dang insurance approval! Backing up a bit... let me explain a little about me and my battle with the “fluff”. I’ve pretty much have always battled weight. I was always chubby as a kid and grew up in a big Italian family where portion sizes weren’t a thing and life revolves around food. For most of high school I was overweight... except junior year when I decided I would go on a major diet and exercise. I lost a lot of weight and looked good but still only got to 175. By senior year I was pretty much fat again. This would continue every 2 years until my first pregnancy. I would drop 40-50lbs and then gain it right back. By my first kid I really gained a lot though and was a little over 300. Only now due to the pregnancy, I got hypertension that never went away. Then I lost 80lbs. but you guessed it! Gained it all back and then some again! This pattern continued more and more. I remarried and got pregnant again and was back up to 275 again. I have always thought about the idea of weight loss surgery in the back of my head but I was going to try 1 more time to lose it myself and try to keep it off. I found a medically supervised weight loss program with “pills” and lost about 90lbs on it. That was almost 2 years ago. But now I have sadly gained at least 40 of it back and It seems to keep pouring back on me. Plus now I am suffering from severe osteoarthritis as well in both knees and I need a total knee replacement in my right. I’m still going to the gym and I’m still on the medicine, but my body isn’t reacting to it really anymore. So enough was enough and on March 1st I went and saw a weight loss surgeon! When he started explaining to me about how my body just starts to resist the weight loss and thinks it’s starving or wants to go back to my reset mode (which is my 300lb weight) it all made sense! I just always called it my inner fat girl wanting to come back out. He explained how cutting out this part of the stomach removed those hormones and will help me fight those genetics. Now I understand I need to keep up my end of the bargain and still exercise and count calories, but it def explained why it’s like all of a sudden my body would just hit a wall and start gaining back the weight even when I was still dieting. So sleeve it is and I couldn’t be more sure of this! So here goes my journey. They set me up that day with referrals for the psychiatrist, the gastroenterologist and the nutritionist. Luckily, since I’ve been in this medically supervised weight loss program for 2 years, I pretty much already have in my nutritionist meetings but he wanted me to meet with a Bariatric one at least once pre-op. I met with her on March 9th for the first visit already and learned a lot about what to expect the first few weeks out of how to eat and the different phases of food. My next apt with the Bariatric nutritionist is April12th. My endoscopy is scheduled this Friday so hopefully that goes well and my psych is scheduled for the following Friday. I have already filled out the package they sent to me for that which was about 500 questions. I do think it’s a little weird they want me to release all my hospital medical records though. I just hope and pray I get approved by insurance. Depending on who measures me, I range between 5-5 or 5-6 it seems. I also weighed in at 228 which left me with a BMI of 36. My insurance requires a BMI of 35 with comorbitities which I obviously have of hypertension and osteoarthritis. So the low end of BMI has me concerned with approval. Now the other thing is this, and please don’t judge,....My daughter was born in Jan of 2016 and in May of 2016. my husband and I decided to have a “date” night home with a few margaritas for cinco de Mayo. This was my first time drinking anything since she was born so they hit me pretty hard and he and I got into the biggest fight of our lives where he confessed some stuff that I was not expecting...throw in terrible post partum depression that I was suffering from that I wasn’t really aware of at the time and I ended up taking a handful of Tylenol PM’s that night. Well..of course I came to my senses right away and immediately called for help so this landed me stupidly in the ER that night vomiting up the pills and being monitored. I went home the next day after they made sure I wasn’t “suicidal” and of course followed up for a few months with therapy because I was just suffering from out of whack hormones thanks to post partum. my husband and I also worked things out as well. But long story short is....I’m really afraid that might be a clear strike against me for the psych eval. Especially if I release my medical records...... i guess we’ll wait and see. I’ll keep you guys posted on Friday on my Endoscopy. And thanks for reading this whole thing if you made it up to this point! ?

Yea... I’m thinking this seems a bit much? Especially releasing my entire hospital medical history. I think I’m going to find someone else! I mean... I’m not perfect, but I feel like right off the bat, this guy seems to want to really try to dig hard in finding something lol

Did everyone else get papers to sign to release all their medical records in the big questionnaire and packet from the psychiatrist? Just wondering if that’s the norm.

First of all congrats on your success so far! But I’m glad I’m not the only one who obsesses over this. I’m already thonking about that issue and I haven’t even had the sleeve surgery yet!!! I have lost (easily) anywhere between 60-100 pounds a handful of times throughout my life so far and yet here I am!.... getting ready to submit my request to insurance for Bariatric surgery because I gain it back and then some every freakin time! So I’m already terrified that this will ultimately end in the same scenario. I know this is different though. It’s a great tool given for weight loss that I feel this time might be pretty darn hard to ignore.

That would be a huge sigh of relief if that’s the case! It’s just torture just having to wait well over a month before I can even find out if I’ll be approved!

That’s awesome they approved you and it’s ridiculous how much you have to worry to get the approval. I just met with the Bariatric nutritionist this past sat. She made me feel better saying she knows my surgeon and she knows he is good at getting people approved and feels I would have no issues but also not to lose any weight right now or gain.. I need to focus on maintaining this until limbo and if approved see if my surgeon does a pre op diet to shrink liver. ?‍♀️

Thanks Dale! And congrats to your success with WLS as well! I have no problem putting in the hard work and dedication it will take for the rest of my life after surgery... it’s just hoping insurance doesn’t stand in my way!!! Lol