droose

It appears to be resolved! I fought with appeals for 10 months to get approved for my surgery, the big hurdle was weight loss surgery wasn't included in my coverage. I won my final appeal because the surgery was my only viable option to properly repair my hiatal hernia.

I called insurance, they told me it was automatically rejected based on my coverage, they will process it again and it should be fine.

Had my surgery on 3/10/21, this getting my denial overturned on 3rd appeal.

I am now getting a bill for the full cost of anesthesia that states "we do not offer coverage for this type of sedation" . . .WHAT!?

I don't even know where to go from here, how can this be something new?

Quote

19 minutes ago, jmarie26 said:

I had surgery on March 8th. Thankfully mine was a breeze. I haven't even taken Tylenol since being discharged from the hospital. I had a tonsillectomy in college and I was in absolute agony, so I was nervous. Thankfully this was a much easier experience.

Now if only I could drink a Protein Shake without gagging, life would be great..... (I did not have issues with them pre-op. Post-op, I cannot do it. Switched brands, no better.)

Maybe try a Protein Water?

4 minutes ago, Nanagrrl3 said:

Thank you, I’m getting atleast 30 oz of Water per day, Trying to get more.

I was told we should get 48-64 oz. take care.

2 hours ago, Nanagrrl3 said:

Tommorow will be my third week post op.I start soft foods tomorrow. The problem is I’ve been having trouble eating. Every time I stand up I get so dizzy,and I’m forgetting things a lot.I’ve been taking my vitamins; I don’t know what to eat because I have no appetite ( I know this is normal). Today I tried to heat up some canned chicken noodle Soup ( without the noodles) and I was instantly repulsed by it . Even yogurt I have no interest in eating. I’m just sticking to 2 Protein Shakes a day and sometimes even less. I don’t even know what I’ll eat on soft foods because I don’t eat eggs or tuna. Any advice?

You need to keep your fluids up, dehydration can explain dizzy and forgetfulness, if possible maybe use a Protein Water.< br />
Try canned chicken instead of tuna. I bought those little wieners in a can and some canned tamales. My nutritionist said soft foods is anything you can cut with "this" as he held up a toddler plastic fork. That discussion was as he told me I could eat shrimp as a soft food.....

I really hope things get better for you.

On 3/4/2021 at 12:08 PM, Hopefulin2021 said:

My surgery went really well, how is everyone who had surgery feeling?

Doing well! I haven't posted since well before surgery, just been plugging away at life! 12 days post-op, I'm feeling great. Haven't taken pain meds since day 2, I struggled hard with the anesthesia which kept me nauseous for a solid 48 hours. Once that was out of my system things were looking up.

How are you feeling now?

After fighting insurance for 10 months my surgery is scheduled for March 10th. So excited!

I am doing the bypass for my Hiatal Hernia which caused GERD and Esophageal Spasms. Due to my weight the standard procedure is not an option. As my insurance coverage does not cover "weight loss surgery or medications" it was a 10 month multi appeal process to get my surgery approved.

I do hope your post surgery is going well! Mine is scheduled for March 10th.

On 5/23/2020 at 2:52 PM, Maryeuh said:

Still waiting for the insurance company, they haven't given a decision yet.

On 5/12/2020 at 10:43 AM, danielleleigh90 said:

I feel your pain. I had a doctor that constantly wanted to test me for weed (I VOLUNTARILY told them about this). I smoke or use edibles to sleep, I attempted to get on meds but mirtazapine made me gain about 10lbs so I stopped. Anyway, I've found a couple good doctors i'm inquiring about. The first one is requiring that i do 4 months of dietician visits (my insurance requires ONE), so I'm iffy about them. I've set up appointments with another doctor who luckily will accept my documents so hopefully it goes well & things start rolling sooner. Hopefully we both will have our surgeries soon!

I hope you find the right fit! Keep me posted.

On 5/12/2020 at 6:15 AM, ChubRub said:

I'm sorry, that's annoying! Giving your doc the benefit of the doubt, it could be that with all of the postponed surgeries due to COVID19, he is dealing with patients ahead of you in line so to speak. Hopefully he will get it out this week! HUGS!!

Thanks

He comes highly. Yesterday I received a call that he "wrote a beautiful 4 page letter" and the appeal was submitted. I am relieved that the process has started moving again.

When my surgery was scheduled (would have been Wednesday), we knew it would be denied but my doctor and nutritionist were confident it would go through on appeal with the proper paperwork.
The denial came back, there was some delay getting information and giving the information to my Dr. before COVID put a hold on surgeries.

When I ask about the status I am told "it's on his desk" and "he needs to write up the information for submission" it has been 2 months with no progress.

All I want is for them to finish submitting everything so that when surgeries are allowed again (possibly as early as 2 weeks) I am ready.

23 hours ago, IWantTheDream said:

droose
I am glad you said that because I have been quite with people I know because I felt like it was very disappointing for me but I felt like I would be judged as selfish for feeling disappointed. Normal people that don’t have issues like we do just don’t understand. I work with someone that struggles with about 40 lbs but thinks that this surgery is the easy way out and really believes that theory that I should just try harder n exercise more. So it’s impossible to talk to her. So I just keep quiet and it’s like disappointment is just trying to eat you alive. It’s very frustrating. I really cannot wait for life to go back to the normal.

Always here for you, I do understand. I am blessed enough that most people involved in my day to day life understand how real this is. I did loose 70 pounds once.... found it all and since have been completely unable to loose anything. The surgery was recommended to me as the best option for repairing my hiatal hernia/GERD/esophageal spasms. Once I did my homework I feel that it really is the best option for every aspect of my life.
As for the co worker, they haven't walked in your shoes.

Hang in there, our time will come!

In Washington this is one thing our Governor addressed with an "Emergency Order". All non essential surgeries (that are not emergencies or will not do harm if it were to wait 3 months) have been banned until May 18th unless he extends it later.

Really sucks, my surgery was scheduled for May 13th. We are not selfish to feel disappointed, this is a very emotional topic that will change our lives, we will get through this together.

I'm scheduled for mid May, haven't heard of changes yet. With the current situation they will need to keep all available beds and ventilators open I'm guessing until we see the curve going down.

It is extremely frustrating to be told we have to wait. I do pray you are able to get re scheduled as quickly as is possible.

I pray you and everyone stay healthy and safe from the virus.

I'm so excited for you! I've been waiting forever for my insurance appeal to go through. (ok, only a week but feels like forever).

Keep us posted

My first consult was January 30th and dietitian Feb 6th. I needed an EKG, Labs and medical clearance from my primary. My surgery is May 13th, earliest date I could get because he is booked solid.

I do not have coverage for weight loss surgery BUT it is needed for a hiatal hernia. My doctors are confident what they can get it approved on appeal (we know it will initially be denied).

17 minutes ago, Mark.olypenn said:

I use a Bullet blender for small batches. Works well for 1 or 2 servings and doesn't take a lot of counter space.

Great place to start. 🙂

1 hour ago, VIN_IN_AL said:

Amazon has a huge selection of "Personal Size" blenders including several that are are battery/USB charged and do not require an AC outlet for use. These are not as powerful and will not crush whole ice cubes but can handle partially crushed ice or the small ice cubes from the included ice cube tray.

This is the one I have been using for the last year, works perfect for Meal Replacement drinks.< br /> PopBabies: Portable Blender Glass, PopBabies smoothie Blender to go, Rechargeable USB Blender with travel, Wireless Personal Blender Protein shaker 5200mah 25+ per charge:
https://www.amazon.com/stores/node/17691775011?_encoding=UTF8&field-lbr_brands_browse-bin=PopBabies&ref_=bl_dp_s_web_17691775011

Thanks!

I need to buy a blender for pre/post op meals.

Does anyone have recommendations on products?

On 2/17/2020 at 10:05 AM, BadWolfGirl said:

For the first couple weeks I was told to crush everything. After two weeks they let me take small pills like my birth control. But said I can start swallowing pills at 4 weeks. I think part of the problem is that you want them to absorb properly and if you have RNY you may not have proper absorbtion if you swallow. At least at first. And especially with what I assume are anti rejection meds, you definitely want those to absorb!

I had a couple pills that were so nasty when I crushed them I would gag for like ten minutes after from the bitter taste. I found out what worked best was mixing it with a Gatorade and putting it in a large syringe and putting as far back in my mouth as I could to avoid my tongue. Then I'd have an ice pop on hand to chase it. I'd take a bite of it and let it melt on my tongue and it helped.

Your doctor may have additional information of course.

Good luck, you can do this. We can do anything!

Sent from my Pixel 3 using Tapatalk

I have also been concerned about taking my meds curshed. What an awesome suggestion!

My surgery date is set, for this I am excited!
I already know that insurance will deny the pre approval but my surgeon and dietitian are confident they can get it approved on appeal.
I have a hiatal hernia, due to my weight this is the only surgery recommended due to high rate of failure for the other options. Premera considers this treatment "investigational" which will result in the initial denial I am expecting.

My surgery is scheduled in May (my surgeon is popular ), they are putting in the pre approval now.
Does anyone have an idea as to how long I can expect the denial and appeal to take?

4 hours ago, danielleleigh90 said:

I was happy when I found out, it helped explain (somewhat) why I was so tired all the time! They put me on 100,00mg a week, I've been taking them about a month now. I was just retested and I'm at 20! Hopefully yours changes quickly, I have a couple more doses of the 100,00mg & then I'll be able to take regular supplements. What are you on?

I'm on 2,000 IU (50mcg) a day along with Iron supplements. I agree it explains how tired I get, will re test in 3 months unless my surgeon wants sooner.

So glad you are doing better!

10 hours ago, danielleleigh90 said:

My Vitamin D was super low too.. it was around 8!

I'm at 8 also!

TheAngryMewo

Good luck! and thanks for the input.