VIN_IN_AL

I have gone through 3 surgeons over the past 18 months while I was doing my research. All three of them warned me about Caffeine, they provided similar "warning" but none related directly with post surgical issues but more related to the affects of Caffeine on the body. Caffeine causes dehydration and acts as an appetite stimulant. I am not a morning coffee drinker but was told to say goodbye to those "sugar free" Monsters (I like the Orange Can flavor) I used to replace coffee for a morning Caffeine fix.

Don’t you just love insurance companies? The one-page fact sheet is a joke, what you want is the same document, the official policy document they send to providers. What you got is the fluffy not much detail customer document. It may take a few phone calls and some persistence on your part, but it will pay off. If the person you’re talking too at BCBS is not helpful, just hang up and call again until you get someone else. Also make sure your calling the number on the back of the insurance card provided by your employer and if your employer is in one state and you work at another location in a different state, make sure you validate what plan your in since as I have mentioned before the pre-surgery requirements are different from each provider group. Here is an example, my employer’s main offices are in Virginia and Maryland, I am employed at another office in Florida, yet I live in Alabama. Within the last 5 years my member plan has changed three times from BCBS of Florida, to BCBS of Alabama to where it is today as of January 1st 2020. Not one of the pre-surgical policies are the same, some have more restrictions others have less, it VERY frustrating. The one thing that is common to all requirements is that you have to follow it “as written” 100%, any of the slightest deviations and your starting over.

Think of it this way Knowing you "messed up" is one-half of the solution that will help you avoid a repeat event.

I have Blue Cross Blue Shield (BCBS), and the structured diet requirements it varies between the different carriers within the BCBS network. I strongly suggest you get on the phone and call the customer service number listed in the back of your insurance card and request a copy of the "Medical Policy for Obesity and Morbid Obesity Surgery". It took me several calls but I finally received a current copy and I was amazed at the "official" wording, it was much different from what I was told on-line from support forums such as this one and from what the coordinator at the surgeons office was telling me.

I do not think your discouraging anyone, I for one am glad your sharing your story since it is this very same topic (reversal of weight loss) that gave me cold feet last year when I was only 1 week before my schedule surgery. The surgeon I was seeing last year was in fact pushing the procedure as an alternative to watching what I eat since I had failed with everything else. I was told that the sleeve removes the part of the stomach that makes you feel hungry, thus the post-procedure you have a tiny stomach with the removal of the part that makes you feel hungry thus no more overeating. I have now learned this is totally FALSE, I have met several people who are exactly in the same situation, lost all the weight post-surgery then a slow return to pre-surgery weight within a year or less. However, I have also learned the surgical procedure is not a “one and done” fix, and for those who think it is will eventually fail. The surgery is only a tool, and for this tool to work “as advertised” it must be used properly meaning a mandatory lifelong change in how we think about food, our diet and our food consumption habits.

If your going to make the self-investment and go the self-pay rout for bariatric surgery I would not let any geographical restrictions get in my way. The surgeon and facility you feel the most comfortable with may be within driving distance. I am going self-pay myself and currently I am favoring a facility that is about a 5-hour drive away. You would be surprised on how many bariatric offices have resources for out of area patients.

Thank you for the response and I absolutely agree with you 100%! I have absolutely NO intention to do this on my own, I should have mentioned that prior to moving forward with the weight loss boot camp that I had already been working with a surgeon that was recommended to me by my primary care physician. I already completed the psychiatric evaluation, scheduled my pre-op nutrition program and had already finalized my surgical procedure decision for the gastric sleeve. I had all historical weight loss documentation in place and all that was missing was the submission of paperwork to insurance for final approval and the selection a date for the surgery. It was then that I got cold feet and took an unexpected right turn and tried a final non-surgical solution. I am already in the process of selecting a new surgeon, had an appointment with one yesterday 2/13 and have an appointment with another surgeon next week as well as a follow up with my primary care physician. I joined this forum due to a weight loss surgery support recommendation from the office I visited yesterday. 😊

Weight management has always been an issue my entire life, I have gained and lost over 100 pounds THREE times in the last 15 years, hoping the FORTH time post-surgery will be the last. Whatever diet program, book, shot or pill that has come along in the last 15 years, most likely I have already tried it and unfortunately failed. If your “considering” non-surgical alternatives to weight loss surgery feel free to ask me, most likely I have used it at least once and have accurate records of what was used and what were the results and pros / cons of each. The “pill of the month” currently is Contrave Blue which I have been on since December 2019. I have been avoiding weight loss surgery for years. My sister had full bypass surgery 20 years ago and unfortunately, she has suffered complications for many years. At the end of 2018 I had ballooned to the heaviest I have ever been, started January 1, 2019 I was a “Big Mac and Large Fry” away from 400+ pounds. My blood pressure was extremely high, and my new primary care physician was very blunt during my first visit, “lose weight or die” was the basic theme of our health conversations. Even with that much bad news and new physician pushing for weight loss surgery, I still was trying to avoid surgery. I decided to take an alternate route, take some time off from work and attend a Weight Loss Boot Camp for 10 weeks at a cost of over $15,000 self-payed of course since health insurance does not cover this type of activity. Unfortunately, life has ways to make things difficult at the worst time and I only was able to complete 6 weeks For those interested I have a blog that chronicles my weight loss efforts at the weight loss bootcamp last year, good reading for those thinking about that route. https://vin1959.blogspot.com/ For reasons I will expand on in future messages, the weight loss boot camp adventure did not get the job done and weight loss surgery has now become necessary. At this stage I am not going to play the “pre-approve documentation game” and wait for my health insurance company to say I am covered, I am simply going the SELF -PAY route and will plan for the Gastric-Sleeve procedure hopefully in April this year.

I have gone from self-pay, tried to switch to insurance then back to self-pay. For me the attempted switch to insurance was a royal pain. BCBS, or at least my specific carrier provided coverage, but the requirements were to rigid. For example, I had already done 5 months with my current primary care physician in early 2019 for the “doctor supervised” diet. I exceeded all other requirements and already completed the psychiatric evaluation. I got cold feet at the last minute and decided to attend a weight loss boot camp for 10 weeks as an attempt to avoid weight loss surgery. That was a BIG mistake, my doctor warned me I would gain the weight right back and that is exactly what happened by the end of 2019. I decided to I move forward with surgery in 2020, was going to do self-pay at first since the weight loss boot camp was also self-payed. After going through my medical records for the last 3 years I felt I had enough documentation to use my employer provided health insurance so I immediately contacted BCBS for approval. According to BCBS since I did not see my doctor during the time I was attending the weight loss boot camp (which was in another state), I would be required to restart the doctor supervised diet requirement which I was told back in Feb/2019 was three months but now, for whatever reason in 2/2020 it was increased to 6 months? 🤪 If I want BCBS to pick up the tab I must start over, that would be 7 months with the doctor since the first visit does not count, another 30 to 60 days for the approval process and 30 days with the surgeons office or more to get all pre-requisite tests completed and the surgery scheduled. VERY FRUSTRATING! I have appealed but was told it may be 30 to 60 days until I get a decision. When I ask my doctor for advise he simply looked at me and said “I wouldn’t wait…” so I am not, back to self-pay.