thisislou

I know what you mean.. I started last Wednesday so I'm now starting my 6th day. I hate the 3 different protein shakes EAS Advant Edge French Vanilla chocolate and Atkins Advantage Dark Royale Shake. I switched to GNC's AMP wheyblocic extrem 60 - I put 1 scoop in a cup of cold water 3 times a day - each time is 20 gr. My died also consist of Greek Yogurt with honey, Emerial beef and chicken broth, some sugar free popsicles. I'm averaging ~ 500 calories and 60 grams of protein. I know that is low but seems to be working for me. I refuse to get on the scale until my last doctor's visit before surgery on 7/8. It's been tough since I'm at the end of a 2 day weekend, but I keep thinking it is worth it. I'm also thinking what I can eat when I'm back to real food.... We can do it.... We have all come too far to "cheat" Lou

wow 6 month - The BCBSIL requires a 3 month supervised diet and your BMI number they consider is your initial one: "Documentation of active participation in a comprehensive, non-surgical program of weight reduction for at least three (3) months, occurring within the twenty-four (24) months prior to the proposed surgery. (NOTE: The initial BMI at the beginning of a weight reduction program will be used to meet the BMI criteria for the definition of morbid obesity used in this policy.) " Lou

Great news?. I check BCBSIL procedure web site every few days to see if it has been updated for the sleeve ? and it has been updated today. I could not find the words "investigational" with "sleeve" - If I'm reading it correctly - VSG is now accepted.... I was a few weeks too early - I was denied and approved after I did the appeal...

My appeal letter was about me. Why I think I should be approved. I stated that my diabetes was getting out of control and the next step was a pump (backed up with a letter from by PCP. I am 61 and in the process of raising my 2 grandsons (4 & 6) and would like to be healthy to enjoy them growing up and have the energy needed to keep up with them. My though is that BCBS just read 43775 and denied. The appeal board reads what is submitted and looks at you case by case. I did have some references but I don't think that helped much. I also searched the sites for some examples - but wound up just being myself and stating my case. It is important that you meet the requirements stated in their policy and just need the extra push because VSG is still "investigational" Lou

I also started with the intention of getting the Lap-Band. It was faith to me that first the doctor I had turned out to be not so good - but part of the process was to send me to a nutritionist. She was great and worked in the office that my new doctor works out off. Then, out of nowhere, a old friend was in town and invited me to lunch. I noticed he was not eating must but we were talking so much, I let it slip. Then the talk led to a mutual friend's weight loss - that is when he told me he had the sleeve done 2 weeks back. Now he was in Orlando doing the parks and eating regular food. After talking it over and asking many questions - I decided that was the way for me. Also in the don't do column was: The nutritionist said with in the last month - 2 of her patients with the band got food caught and had to have the doctor take fluid out - I ask what else they could have done - she said nothing - if they went to the emergency room - they would not know what to do.. The idea that you need constant doctor visits to fill/unfilled I was told that if I were to fly - I needed to come in and have some of the fluids taken out... I also have a very weak stomach (mind) just thinking about vomiting can make me vomit... I go in 17 for my sleeve and am not looking back Hope this helps Lou

Donna My diet seems strict, but I understand the reason behind it. It's a 1000 cal a day with 4 protein shakes as the basis. I can have all the black coffee, sugar free jello, clear broth, sf popsicles, Crystal Light ... I'm diabetic so it should be interesting, and on insulin. I'll have to test many times a day to make sure my reading are not too low, and if they are adjust. It's not going to be easy. We have my daughter and her 2 son's living with us ( 4 and almost 7) - I'll just have to stay in my den when they eat ... I'm getting ready to go out and get my last "5 Guy's" hamburger.... What is your diet like? Lou

Hi Donna I'm also on the 14th and start liquid diet on the 30th. We bought a few different protein drinks to try before I get started - Atkins advantage, EAS advantage and Muscle milk. All were about $1.50 each. I tried the EAD choclate t bit ago and it was ok. I think the trick wll be to mix it up so they don't get too boring. I did all my pre test this past week since I took a use or loss vaction... many many test.. Next I meet with my doctor on the 8th - pre op on the 12th --- I'm ready. I started the process last December, but at that time it was for the Lap-band. Lou

I have the 14th.... in ORMC Orlando Florida with Dr. Marin Dan Radulescu start my liquid diet Wednesday the 30th.. Lou

Hi I live in central Florida and have a 7/14/2010 surgery date with Dr. Marin Dan Radulescu 77 West Underwood Street 4th Floor, Suite A Orlando, FL 32806 web site: Bariatric Surgery Orlando he and his office staff seem very professional and efficent. I can report back when it is all over if you like. Lou

I was denied from BCBS IL - I sent in my appeal and withing 2 weeks - the exteranl board of doctors approved it : "Reason: Approval is based upon recommendations by an external peer review, after consideration of the member's individual clinical circumstances." I called the phone number on the lettter I received that said it was sent to the revies board - and was told a week before I received the letter that it was ok. Lou

I did get approval from BCBS IL after an appeal. Since the code 43775 is still "investigational" I would guess everyone would get rejected once "43775" is read. For me, the appeal was easy - I just stated the facts and within 2 weeks was approved (surgery scheduled for 7/14) Lou

Sorry don't know how - but would like it if you could email it to me @ steinbl@cfl.rr.com thanks Lou

My surgery date was has been finalized to July 14th @ 9:00 am?Liquid diet starts next Wednesday June 30th. I had vacation this week that really helped with scheduling all the pre test ? UGI, pulmonary, some test today ? don?t remember the name but it?s something about a tube up your nose.. And blood work. Any tips on good protein shakes? For those of you that have already started your liquid diet - what is your normal routine? I'm told I should be in the hospital at least 3 days - does that sound normal? Lou

Ok - add me to this list... I just got approved (or found out) on June 16th and have a tenitive surgery date of July 12. I live in central Florida and Dr. Radulescu is the lucky doctor to do the surgery. His office said that my hospital stay would be a minimum of 3 days and I have a 2 week liquid diet. How does that match the rest of you? I have not read all 5 pages of this post yet ? so some of you might have already listed this. Lou

Hi I would be glade to give you some pointers - but not the letter. I can see it getting back to bcbsil with someone else's name on the header... not good. Lou

The important thing to remenber is their procedure states that 43775 (VSG) is still investigational and is not approved. So as soon as they see that ? it is stopped. Going through the process a few times ? first for the lap-band, I realized ? it only takes one thing to kick it back ? fix that and they continue until the next stop. My advice ? have a cover letter from your primary doctor that states everything ? your BMI, if under the magic 40 ? then your ?comorbid conditions related to obesity?, your 3 month ?Supervised weight loss program? and anything else that is required. That way it?s all in front of them. Saying that ? count on it being rejected for 43775 and an appeal is needed. This goes to a 3rd party group that will actually look at your information and in my case overturn the denail based on the same information previous given ? but this time with a cover letter from me. Hope this helps Lou

Ok ? different story ?. I just called BCBSIL and found out my appeal was approved for sleeve gastrecomy 43775? It took them less then a week ? it was approved on the 10th ? did not find out until I just called. ?Reason: Approval is based upon recommendation by an external peer reviewer, after consideration of the member?s individual clinical circumstances? Now I?m doing the happy dance ? Lou :001_cool:

Hi I could not find a code with these numbers. Any luck finding it? Lou

I also have bcbs il and was rejected a few weeks back for VSG. At the time - they said "43775" was still investigational. I know once they saw the code - they stopped and did not even look at my packet - they rejected it within hours. I started the appeal process. They sent my appeal to their "3rd party" people last week and say it could take 60 days. Someone on another forum stated that their doctor's office got an email from bcbs (a few states one of them was il) just changed their policy to now accept VSG. I check they policy daily and as of this AM, it is still dated 9/2009 and no. Lou

Hey I was just denied last week for BCBS of Illinois because their procedure has not changed and VSG is still "experimental and investigational". Do you know something that I do not? I am in the process of writing up my appeal in an attempt to reverse their decision. Once they saw that I was asking for the VSG code 43775 - it was an instance "no". Has anyone been successful winning an appeal with BCBS of Illinois? Lou

Hi My first post on this board ... I have my first appointment with Dr. Radulescu on Monday March 22. I was working with another doctor in the Orlando area? but when I challenged his staffs ability to process my insurance claim (which was denied because the way it was submitted? another story)? he dropped me.. I?m sure that is a blessing in disguise. The Lap-Band was what I was going for,,, but had lunch with an old friend yesterday and now I am full steam ahead for the sleeve. I was setup with the nutritionist in Dr Radulescu?s office by the other doctor?s office and was very impressed with her knowledge and the good things she said about this office. After talking to the office manager and setting up my first appointment ? it is night and day better then the first doctor? Saying that ? if interested ? I can report back after my visit. Lou

Thanks all for your support. I now have an appointment with a new office - one that seems a lot more organized. Talking to BCBS myself - I now know exactly what is needed to get my approval - all of which was already sent to them but not in away that summarizes and shows them on the cover letter why I should be approved. I go next Monday and hopefully will get thing moving again. Just to put icing on the cake.... the previous doctor sent me a letter saying he was not my doctor anymore - and the office was so efficient they put a "blue card" on the letter to make it so I would have to sign for it but forgot to check to "signature required" box ... Like some of you said - it was a blessing in disguise to find out before the procedure, the quality of service and expertise in the office. I would wager to say that the doctor is probable ok - it is his office staff that messed thing up which he is probable not aware of... Lou

This is my first posting… and I’m sure not my last. I was going to wait until I was banded – but that has been put on hold. My story…. I as many of you have, did a bunch or research and committed in my mind that this was what I needed. It was a very hard decision as I am really addicted to food, my diabetes is getting worst and weight going up. The first step was to find a doctor close by that was accepted by my BCBS. Found one that was the husband of my wife’s doctor who has been great for her. I went to his seminar and setup an appointment the next week. As I did my homework, I brought a bunch of stuff with me to this appointment including the requirements that BCBS insisted on and all my information on my recent 1 year on Weight Watchers. My first appointment really gave me a bad taste for this practice - I did most of the talking and tried twice to give this information to the "assistances" but told they did not need them because they worked with insurance all the time and had their own. I was never sat down and talked to - just given their requirements like make my own appointment with the nutritionist and they would setup one for the psychologist. I completed both of these, got/gave them the required letter from my doctor along with over one inch thick copy of my doctor's file that dated back to 2002. I even went as far as compiling a cover sheet as I reviewed every page from the doctor notes of my weight, BP, AIC and cholesterol reading. So at this point I thought it was a slam dunk - I am 60, weight 265 so BMI = 38 and insulin dependent diabetic. Wrong - I called BCBS and was rejected after 2 weeks. Reason - the doctors office did not follow their requirements. Since my BMI was under 40 - I had to qualify by having 2 of 6 listed "comorbid conditions". Well I had 1 - Diabetes - but no mention or suggestion of any other. They also needed more information about my 1 year on WW. When I called the doctor's office really discussed - they apologized for not doing the "required stuff" and would talk it over with the doctor and call me back. The next morning the office manager called me back and said that the doctor was dropping me and by the way - he found 3 "comorbid conditions" after reviewing my records (if he had found them before and did his job the way he should have - I would have a scheduled surgery date my now). So I am very discussed - all that work, all that hope, all the time and money spent to get to my goal. As I said, I am 60 and want to live a long time. My daughter and her 2 sons (4 & 6) live with us now and I really want the health and energy to enjoy them and them to enjoy me... I have not given up. I did a bit more research and found another doctor's office (the one that I meet with the nutritionist) and they are to call me back today. Sorry for the long post - just had to get it out there... Lou