FinallyLosingIt20

I have discovered that I really like the Fairlife Nutrition Plan Protein Shake. This is the 30g Protein shake that is not in the refrigerator section of the grocery store. - it is with the other Protein Drinks on the shelf at Sam's Club. It tastes like chocolate milk. I am lactose intolerant, but I can drink these. There are 4 carbs in one shake,

Document all conversations, who you talked to, their title, ask for the denial letter, etc. The person may have put down incorrect information about diagnosis, or incorrect coding on the submission.
First on your policy do you meet that criteria? Do you have documented failed attempts at weight loss - like Weight Watchers weigh-in logs, or your doctor visits whete you weighed in and talked about weight loss?
Can you take your policy with you to the surgeon's office and call your insurance from there? Keep pushing.
You either have coverage or not, but it sounds like you have coverage. Is it through work or ACA? What state are you in?
Hang in there?

I called my insurance company IBC PPO back in August, they sent me a copy of the bariatric policy. BMI over 40, weight loss attemps, etc. This is for it to be covered under medically necessary. Is the what everyone else used or does everyone else have a bariatric rider?
The surgeons office said I was denied because I do not have coverage. I had to call the insurance company 4 times before I found someone who referred me back to the policy I was sent in August. I am so confused. I have been on the phone all day!
Curious if anyone else got the same run around. Fingers crossed I hear good news soon. Hoping I don't have to pay out of pocket.

I’m not planning on telling anyone aside from 4 family members that I’m having surgery. Did anyone else keep their surgery a secret? How did that work for you?

I’m asking because I work at a place that has extreme fat shaming practices and has terribly discriminatory practices as well. Unfortunately discrimination against overweight employees in my state isn’t illegal. I’m using some of my PTO time and having a hernia repair too.

For those of you who traveled for your surgery, I would love to know how bad the flight home is? I’m having surgery June 22nd in Vegas and flying home two days later. It’s about a 4 hour flight. I’m nervous about flying so soon, but I have no choice. I appreciate the info! TIA.

I’m not planning on telling anyone aside from 4 family members that I’m having surgery. Did anyone else keep their surgery a secret? How did that work for you?

I’m asking because I work at a place that has extreme fat shaming practices and has terribly discriminatory practices as well. Unfortunately discrimination against overweight employees in my state isn’t illegal. I’m using some of my PTO time and having a hernia repair too.

I'm going to have to do this. I love the support, input, and ideas that I find when I go to those groups, but knowing that a coworker could find me there causes anxiety.

I’m not planning on telling anyone aside from 4 family members that I’m having surgery. Did anyone else keep their surgery a secret? How did that work for you?

I’m asking because I work at a place that has extreme fat shaming practices and has terribly discriminatory practices as well. Unfortunately discrimination against overweight employees in my state isn’t illegal. I’m using some of my PTO time and having a hernia repair too.

Hi Everyone! I'm from NW Indiana, and I started my journey nearly 18 months ago! After pills, diets, exercise, etc. I finally got a referral from my family doctor to see a bariatric surgeon last July. I called my insurance company and they said my insurance was covered if I met their prerequisites. I let the surgeon know and they of course called after my first appointment and they got the list of prerequisites. Although I had spent 6 months on a supervised diet with weigh ins twice a month, I had to do 6 months with the doctor and nutritionist, maintain my weight, have a 5 year history, show previous attempts to lose weight, etc. So I did all the standard things, and it was time to submit to insurance in February of 2020. I got a call from the nurse at UHC to check on me after my procedure, but I had not yet had any procedure. Nothing was approved yet! So the nurse checked and the procedure was denied - it was excluded by my policy! I was upset and appealed. My surgeon appealed, because they had a preapproval number from September. Still, UHC refused to cover anything. I was upset, and researched it. I found a website for my state that had information about Healthcare complaints, so I filed a complaint and included information about their calls with me and the doctor's office. I suggested that they review the calls and retrain their employees to properly look at a caller's insurance, because they always say to "Call the number on the back of your card to verify benefits." Then COVID 19 closes everything. The doctor's office closed my case, and I started researching self-pay. I found Blossom Bariatrics in Las Vegas, and I paid my deposit and scheduled surgery for June. Yesterday I received a letter from UHC. They are paying for my surgery with my original surgeon. I thought it was an error, a joke, a dream?!?! I called my surgeon's office and sent them a copy of the letter. They called me in shock and asked what I am doing in July. Well, I think I'm having my Gastric Bypass and hernia repair in July now - close to home and without traveling. I'm worried something will happen to change that. I am out $550 because I paid a deposit to Blossom and for an appointment. I called today to reschedule for now - I don't want to cancel and have my other surgery fall through and be left with nothing. My surgeon's office said I am only the second person to successfully battle UHC over their error and actually win. I am worried the bill will exceed the $40,000 limit that was not a condition of the original guidelines, and I am scared they will find a reason to refuse payment. I am anxiously awaiting surgery in 6 weeks and 4 days.

Sometimes we have to jump through hoops to get the things that we want, but I'm glad that it seems to be working out for you! I know how difficult it is when insurance denies something you NEED! My own experience happened three years ago when I had to battle my own insurance to get an MRI so that I could get the visual proof that I have TN so that I could see a neurosurgeon and originally they denied it, but my neurologist at the time fought it for me and sent in four different requests before finally telling them he was checking for a tumor (TN can sometimes be caused by tumors, mine isn't). I was lucky that he was so set on getting approval because I couldn't even get a hold of anyone, but they finally did approve it and I got my proof, had my brain surgery and have been relatively pain free since (a few flairs came back last year, but are soooo much better than they were).
I hope everything continues to work out for you and congratulations on your upcoming surgery!

Hi Everyone! I'm from NW Indiana, and I started my journey nearly 18 months ago! After pills, diets, exercise, etc. I finally got a referral from my family doctor to see a bariatric surgeon last July. I called my insurance company and they said my insurance was covered if I met their prerequisites. I let the surgeon know and they of course called after my first appointment and they got the list of prerequisites. Although I had spent 6 months on a supervised diet with weigh ins twice a month, I had to do 6 months with the doctor and nutritionist, maintain my weight, have a 5 year history, show previous attempts to lose weight, etc. So I did all the standard things, and it was time to submit to insurance in February of 2020. I got a call from the nurse at UHC to check on me after my procedure, but I had not yet had any procedure. Nothing was approved yet! So the nurse checked and the procedure was denied - it was excluded by my policy! I was upset and appealed. My surgeon appealed, because they had a preapproval number from September. Still, UHC refused to cover anything. I was upset, and researched it. I found a website for my state that had information about Healthcare complaints, so I filed a complaint and included information about their calls with me and the doctor's office. I suggested that they review the calls and retrain their employees to properly look at a caller's insurance, because they always say to "Call the number on the back of your card to verify benefits." Then COVID 19 closes everything. The doctor's office closed my case, and I started researching self-pay. I found Blossom Bariatrics in Las Vegas, and I paid my deposit and scheduled surgery for June. Yesterday I received a letter from UHC. They are paying for my surgery with my original surgeon. I thought it was an error, a joke, a dream?!?! I called my surgeon's office and sent them a copy of the letter. They called me in shock and asked what I am doing in July. Well, I think I'm having my Gastric Bypass and hernia repair in July now - close to home and without traveling. I'm worried something will happen to change that. I am out $550 because I paid a deposit to Blossom and for an appointment. I called today to reschedule for now - I don't want to cancel and have my other surgery fall through and be left with nothing. My surgeon's office said I am only the second person to successfully battle UHC over their error and actually win. I am worried the bill will exceed the $40,000 limit that was not a condition of the original guidelines, and I am scared they will find a reason to refuse payment. I am anxiously awaiting surgery in 6 weeks and 4 days.

Wow! You went through a lot and I want to say congratulations on fighting for your health! You didn't give up no matter what. I really, REALLY hope the surgery scheduled in July does not fall through. I think you have made a great plan by keeping the other surgeon an option just in case. I wish you the best with your surgery.

I’m not planning on telling anyone aside from 4 family members that I’m having surgery. Did anyone else keep their surgery a secret? How did that work for you?

I’m asking because I work at a place that has extreme fat shaming practices and has terribly discriminatory practices as well. Unfortunately discrimination against overweight employees in my state isn’t illegal. I’m using some of my PTO time and having a hernia repair too.

Okay, deep breaths! I was indeed sent home from Blossom the first time I was scheduled for surgery because I had high blood pressure that wasn't controlled. I had told them about it during the phone consult but there was a miscommunication and well, when I got there it was scary high, mainly because I had worked myself up so much.

So, they would not proceed. I went home, and worked with my primary care doctor to get it under control and had the surgery a month later. I was only out of pocket for additional travel costs which was not a big deal, i live in the Los Angeles area.

My advice is to be super clear about any health concerns you have. If something turns up during your cardio check or endoscopy, well thats nothing you can control. They were pleased that I'd lost what I had on the pre op diet, but there was never a set amount that I was required to lose. Plus, their diet is not that bad compared to others I've heard about. In the end, I had my surgery and have lost over 100 lbs. It was worth it even with a delay!

Sent from my SM-G975U using BariatricPal mobile app

I should also add - they wanted a clearance from my doctor too. Once they had that, its was all good. Try not to worry, the clearance should make it fine. Good luck! Be sure to join their Facebook group for fast track patients after the surgery - its really a supportive place.

Sent from my SM-G975U using BariatricPal mobile app

You mind is getting to you ............... Chill pour a glass of wine and get on the program, Do what you have to so you are ready, You got this

I know I'm letting my anxiety play too big of a part in this, and I find myself catastrophizing... so my next question is this: Has anyone ever gone to Blossom or to another surgical center and been sent home without their surgery because they failed the stress test or something else? I'm worried because I have a bundle branch block (BBB) - I told them and they have a cardiac clearance from my cardiologist - but they still perform the stress test and EGD, etc prior to surgery there. I exercise regularly, but the BBB can make it appear that things are not right. The BBB is ironically because I am overweight. I'm really anxious, because this is my last chance. My doctor here will not finance and insurance excludes it. I do not smoke and I will follow my 2 week diet when it starts in 2 weeks. Thanks for all input.

I'm having hiatal hernia surgery too! 😀 No one I know needs to know any more than that!

My close family and a few coworkers know. Mostly the coworkers because they've went through it already and are mostly why I even considered really going thru with surgery.
Idk why I haven't told anyone else. I don't feel ashamed of it, but it's still something I feel should be private.

I talked about it with a couple of people when deciding if I would get the surgery. I didn't like the way most responded. So, once I had it, I never spoke of it and avoided the topic since I already knew how they felt about it.

I have told nobody except my husband that I had VSG. I don't intend to either. I told everyone I was having hiatal hernia surgery because they have a similar recovery. I had already started on a good regimen of biking and Peloton and everyone knows I eat pretty healthy, so I actually started losing weight slowly a couple months before my surgery date (5/15/20). And I intend on keeping up those habits post-op. I'm just a very private person, I do not ever put my deeply personal business out there to anyone, people talk, people judge, and I don't need any of that negativity. I know I can't control what people say or think, but I can control what they know about me. Just my personal comfort level and my decision.

Great idea on the fake FB accounts! I will have to do that too! I'm already secretive about WLS, and am looking forward to having plastic surgery after I hit goal, which of course will be another secret surgery!

I post no pictures of my face on any of the groups i belong too. I have gone to WLS site and new people or people of people.... it's just easier to have a separate one.

I'm going to have to do this. I love the support, input, and ideas that I find when I go to those groups, but knowing that a coworker could find me there causes anxiety.