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Help! New to site. Denied. UHC Employer Lifetime Max $15k? 5+yrs history
Jordy423 posted a topic in Insurance & Financing
Hey all, I need your assistance! I'm new to this site. My aunt had her VSG last August and looks amazing. I attended a seminar 3 weeks ago that my aunts surgeon asked her to speak and share her experience. She and my doctor recommended this surgery and I was so hyped to learn of this procedure, turned in my insurance information at the seminar and enrolled into "the program" Thispast Monday was my appointment to go over insurance, and she immediately told me my UHC Premium PPO has a lifetime max of $15,000 and I must have a 5 year history in order to qualify. My out of pocket would be $3200 which is do-able... however the surgery will cost well over $15,0000 and I do not have a 5 year history My weight has gone up and down, up and down over the last 10 years, and I've moved so much within the last 5 years I didn't have health insurance for awhile and no record of 5 year history. My BMI is 39.5 now after losing 10 lbs due to new migraine medication, (before it was 40.3) with multiple comorbidities (hypertension, high cholesterol, PCOS, foot pain/arthritis, GERD and urinary incontinence which is all new to me that started 2 years ago.) I'm at a loss. The insurance nurse told me I need to find other insurance. Do I really need to find another job to get this procedure done? I had an interview with JPMorgan Chase last week who I believe goes through UHC as well, but the nurse believed they worked better. I don't want to risk getting a new job making less money, just to find out I'm denied. I called the number on the back of my insurance card to confirm if this was in fact true, and they said yes and would have a bariatric case nurse from UHC call me within 5-7 business days... but they will probably just confirm this awful news that my employer is requiring all this and has this cap. I need help. Anyone's thoughts, experience, knowledge? I'm in tears. I don't wan't to lose all this weight again, just to have it gained all back and more like I have my whole life. My body can't take it anymore, especially now that I have all these new comorbidties. Any work for Chase and has UHC that could inform me of the requirements? Or any help. I'm desperate. Your responses would be so much appreciated. Thanks Comorbidities -
My menu for today, at 4 weeks out: Breakfast: Premier shake 160 cals, 30 protein Snack: Chobani Greek "hint of Strawberry" yogurt 120 cals. 12 protein Lunch: 1/5 of a hormel prepared meal with 20 g of protein 200 Cals, 10 protein Snack: Turkey/cheese roll up 142 cals 5 protein Dinner: 1/2 serving of bariatric cookbook "Egg Roll in a bowl" 134 cals, 10 protein Snack: 1/2 Premier shake 80 cals, 15 protein I try to get between 800 and 100 cals per day, but some days I don;t make it. I ALWAYS make my 75 or more of protein. Today looks like about 830 cals, 82 protein, 42 net carbs, 8 fiber, 27 fat. I am losing about .65 pounds per day according to my app. I have not yet stalled, although I'm sure I will.
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I Feel So Guilty For Wanting The Gastric Sleeve Surgery This Year...
indi1 replied to indi1's topic in PRE-Operation Weight Loss Surgery Q&A
Thanks, I don't feel so bad now.I called BCBS and they said that when they approve it, it can be used at any surgeon in the network. I checked the next hospital that is a "Blue Distinction" Bariatric Center in the network. (Which is what I meant by "High Profile", I just couldn't remember what it was called at the time Unfortunately,they are booked as well. Tomorrow I will go further out and try the next one. -
Just got submitted for insurance approval...AAH!
Catgyrl68 replied to Catgyrl68's topic in PRE-Operation Weight Loss Surgery Q&A
Thanks, everyone! It really must be fate for me to have this surgery. My dad had a last-minute chemo appointment today (we didn't know he would be going until this morning), and the first person I saw when I walked in was my bariatric coordinator! (my surgeon has an office next to the Infusion center). I had just completed my bloodwork a few hours before. I also saw the bariatric director, as well as the nurse who has been helping me. Only person I didn't see was the surgeon. LOL! Praying my bloodwork comes back okay. -
Hi my name is Jackie. I am working through all the hoops that are required before I can have bariatric surgery. I had my psychological evaluation and there was concern about my suffering from depression and my obsessive eating. I was wondering if anyone out there had the surgery and had the same problem I have, depression and obsessive eating. How have things worked out for you? Any help is greatly appreciated thank you
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Weight loss journey
Briswife15 replied to Felicia Leader's topic in PRE-Operation Weight Loss Surgery Q&A
Well, all I can say is that bariatric surgery was the right decision for me. I am no longer diabetic! No longer have high blood pressure! Can walk up stairs without dying, and feel so much better. My weight loss is not fast, but I have lost 90 pounds since my high weight, and 73 pounds since surgery. I still have a ways to go, but it's progress! Good luck to you!! Sent from my SM-N960U using BariatricPal mobile app -
surgery switch not welcome news
DLCoggin replied to rhfactor272's topic in General Weight Loss Surgery Discussions
There are approximately 160,000 bariatric surgeries performed in the U.S. every year. If you personally knew 1,600 friends that had the same experience, that would be 1% of the U.S. surgery population for a single year. Consider re-visiting your logic. Do you really want to make a decision as important as this one based on one person's experience? The majority of doctors do not recommend the sleeve for patients who have a history of GERD, even in the absence of Barrett's. You don't have to look any further than this forum to read stories from folks who have had the sleeve and are now having revisions to the bypass because of severe reflux issues. The sleeve is a highly successful, safe and effective option with a slightly lower complication rate than the bypass. But in your case, your doctor is making a medically based recommendation that the bypass would be a better choice. If you're not comfortable with that recommendation, then by all means seek a second opinion. To walk away from this life-changing opportunity to live a happier, healthier and longer life, free of obesity, is a terribly high price to pay based on one friend's experience. Go for it! You're gonna love the new you!! -
How to reassure my kids?
Pixie Dust replied to Judymday's topic in PRE-Operation Weight Loss Surgery Q&A
That's a tough one....I'd be in the same boat, if I told my children. I chose not to tell either one of my children exactly for this reason. They also watched a program with me about a 693 lb woman who had bariatric surgery & died within a month of complications. The last thing I'd do now is tell them but I have told my oldest son (17) that I'm having "hernia surgery." My 11 y/o son is autistic so I'm not going to worry him so far in advance (still have no surgery date) but I will tell him of the "hernia surgery" maybe just a few days prior to my sleeve surgery. With all that said, if my children DID find out in advance of my surgery plans, I was going to approach it with before & after pics of the wonderful people on this site that have shared their photo's with us. This way it's "visual" proof that not only did they not die from surgery but that they all looked so healthy in their "after" pics. We've learned to do a lot of visuals in my household due to my son. So that would be my suggestion, especially being that he's so young still. Pics might do the trick! Good luck to you! I'll be anxious to see what some other responses are! -
Well..she told me that they usually just refer to Crown Bariatric if you don't request PBSMG. I told her specifically that I wanted to go to PBSMG. She then asked me did I know which doctor? I gave her Eugene Rumsey who is the same doctor that conducted my mom's RNY back in Dec.2009. He's awesome!!! She was able to put that into the system so that the case manager sends the referal to PBSMG.
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hi teresa, so funny you ask about insurance on this... my insurance since the beginning of this journey said "NO BARIATRIC SURGERY". So when this problem occurred, I thought for sure it would be cash only. I think since it was becoming a big problem, I think they filed it as urgent (and it was) and they covered 80%. good luck and keep us posted on your journey. josie
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Hi everyone, well I had my lapband removed yesterday and I feel great. The operation went very smoothly and relatively speaking...it doesn’t hurt. When I had it put in I was laid up for 2weeks. I think advances in anesthesia has a lot to do with it. . So glad to be able to eat a fruit, salad, veggies without getting that weird look on my face. First off I’m soooo glad I got the lapband in the first place. The trajectory of my life changed so much for the better. But the band is a tool. We must still put disciplines in to achieve our goals. The reason i had it taken out, a few months ago I had a really bad virus and I think from throwing up my band slipped. So coupled with the fact I’m at my goal weight ... I felt it was time. Would I do it again? In a heartbeat. I’d probably go with the sleeve since I hear maintenance afterwards is easy. The band has quite a bit of post-surgery management. If one does choose the lapband... make sure the doctor’s staff is knowledgeable, efficient and they like their job. You’ll work with them on a lot of things. Dr Spivak (Houston) put mine in and I can’t say enough about his staff. They were wonderful. And a few of them had bariatric surgery so they totally understand what we were going through. Unfortunately for us he moved to Israel. Dr Erik Wilson took the lapband out yesterday He is great. Smart, efficient, etc. As great as he is......The workings of his office aren’t great. I haven’t worked with him long but the staff was not that nice and everyone told me to contact someone else for answers. Could never find anyone. So I’m not sure I would have him put the lapband in based on that fact. On surgeries that don’t require a lot of follow up, I most definitely would use Dr. Erik Wilson (by the way there are 2 of them...his brother is Dr Todd Wilson )
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Finally made my decision...New member!
worm2872 replied to cat1342's topic in PRE-Operation Weight Loss Surgery Q&A
Cat, Welcome and congrats! One thing I will say is you may still be on pain meds at that point so you will not be able to drive. I would plan for the following week. Also, that will give you time if you have complications. I did and there was no way I could go back in two weeks. Also, I am Sr. HR person with my company and a lot of companies have medical leave options if you are not yet qualified for FMLA. I had mine at 6 months. I know you are excited to have your surgery but make sure you plan for complications and contingency plans if you maybe not reacting well to the surgery. I did not tell really anyone at work, not even my manager. However, she did see my return to work note from the bariatric center. -
New with lots of ???'s (Las Vegas)
georgebals replied to pappyny's topic in PRE-Operation Weight Loss Surgery Q&A
Can't type to well. If you come to group meeting 1/15 @ 6PM SWCC I'll give you a copy. 1. 3 meals daily 2. 4 ozs. only 3. solid foods 4. no carbonated bevs 5. 30 min. per meal 6Don't eat while doing anything else 7. liquids only 1/2 hour before & after meal 8. your in control of your weight 9. renew your commitment every day. I wish you the best of luck. Hasta Pronto, George:thumbup::laugh::thumbup: -
why can't i do it myself...
BluAlert replied to devonmae's topic in PRE-Operation Weight Loss Surgery Q&A
I heard the same thing from two of my friends (both over weight). One of them said her moms friend had it about a month ago and had to go back in the hospital due to complications (but shes 20 years older than me and smoked for like 30 years). And my coworker says her aunt is a bariatric nurse and told her about all the complications. I just changed the subject bc I don't need to hear that crap 2 weeks pre-op...I'm scared enough. Plus ive done my research. But I'll be interested to hear what they have to say 6 months from now. I won't be surprised if they are asking for my Dr's name and number! -
Hi everyone! Has anyone been successful in qualifying for bariatric surgery with the Scott and White Health plan? I have been frustrated with the process so far in my research. My hospitalization fees (includes all MDs) should come down to $250 a night, maxing out to $750 per stay per insurance policy, but the Scott and White Bariatric Center quoted my yearly max out of pocket (>$4500!!!). I have called insurance to verify, but the customer service reps I talk seem to be confused by the the entire policy (one stated only >40BMI but policy documents clearly indicate > or equal to 35 with at least one co-morbidity). Anybody recently approved? What are the requirements? Any thoughts on the Scott and White Hospital in Temple, TX? I am considering changing insurance to BCBS FEP next year, but that may push my surgery date into the latter half of 2017. Thanks!
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Relationship issues after surgery
Healthy_life replied to NewBodySoon's topic in Gastric Sleeve Surgery Forums
Bariatric therapist is a great idea. I hope you will work through all this and overcome the struggle. Have you thought about marriage counselling to address what going on in the relationship? -
Anyone get surgery without "needing" it?
Cl@ireyBearry replied to Ryanasaurus's topic in General Weight Loss Surgery Discussions
I got surgery to improve my quality of life. I’m 30, no medical issues and fairly active and healthy. I walk my dog daily, no reflux, apnea, don’t have problems moving, no back,joint pain. But that doesn’t mean that they couldn’t develop as I got older. I got surgery as a weight loss tool when nothing else has worked- I have tried everything else too. The frozen meal plan, the pills- good and bad ones, slim fast, the WeightWatchers, personal trainer. I love my body, I’m ok with all the curves that I had when I weighed around 225 in 2016. But the weight kept packing on. And as a teacher I was always on my feet, and eating those frozen meals to help lose weight, and I still packed on 30 more pounds In 2017, then lost some- 20 lbs, but it came right back and more. Come October 2018 I was around 280. I told my partner that if I even hit 300, I wouldn’t be able to live with myself anymore. Then, when 5 pounds a month kept tacking itself on even with walking and making changes to eating healthier nothing helped, since every time you lose weight it makes it harder to keep it off because your fat cells are already ready to grow again, I had to do something drastic. I made the decision to do Bariatric surgery, the DS LOOP, so that I would have a tool for weight loss- the only one that I have never tried before. My BMI at around 45 was the qualifying factor that made me a candidate- so my insurance would cover it. NOW I am 57 POUNDS down and my quality of life is truly so much batter. I realized I had stopped really looking in the mirror except for a quick glance, and now I can stand to ADMIRE. It doesn’t always feel like I’ve lost that much, or that I look that differently than before, so I take out the pre surgery pictures to remind myself that all the sacrifices are worth it. This is THE BEST GIFT I HAVE EVER GIVEN TO MYSELF. And even though it can be difficult, you see results immediately. Every time you choose the right foods 2 days in a row, you lose weight and don’t feel sick. It’s really up to you once the surgery is over. But it’s the easiest “diet” I’ve ever had! -
Before my surgery, I had to get an exam done by a bariatric counselor. They talked to me about how I felt about giving things up, or how I plan to succeed. I am a mental health professional so I told them what I knew they wanted to hear bc I wanted the surgery (I know.. I know.) But after surgery, I felt like there was some unresolved issues with food, much like yourself, and so I'm doing the process to go back to the counseling center. Honestly, looking for eating disorder counselors might be a good first step for you.. because overeating is a disorder.. I imagine most people think "eating disorder" and imagine anorexia or bulimia. Which isn't 100% the case. Mood disorders is something completely different. When you talk to a therapist, you get to interview them first. You have to make sure that THEY are a good fit for YOU. Even if it's just to go 1x a month, I bet it'll be helpful. If you don't feel comfortable with them, then ask for a change. You can request a specific gender if you'd like. Look at their credentials and see how long they've been in practice. healthgrades.com is also a good place to get some reviews. Making a call will also help you establish how they'll treat you. Trust your gut with it. I know you've had a bad experience in the past, but that doesn't mean that all experiences will be bad. I had a horrible exp in college with a therapist and swore I'd never go back. Now I've been in therapy for 3 years now and it's changed my life. Good luck!
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Thanks for the info. I heard Dr.Suh was really good as well. In fact I heard the two choices for the Corona program are either Crown Bariatric with Dr. Suh or Pacific Bariatric that I previously mentioned. Three weeks is what I've been hearing concerning the referral. I have attended the Pacific Bariatric Seminar and have completed all their paperwork. They're just now waiting for Kaiser to send them the referral and then I can get started on their process. I can't wait!!!!!!!!!!!!!!!!
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1st surgical consultation complete!
hopeliveshere posted a topic in PRE-Operation Weight Loss Surgery Q&A
Hello friends, Well i had my first meeting with the surgeon this passed thursday and everything went well. He made me feel at ease as did the coordinator of the bariatric dept. (she almost made me cry when she told me ill never be in this spot again ---totally normal to get emotional right?). The surgeon answered all the questions i had. I keep thinking that its going to be so long to have this 6months to wait ( i have to weigh in with my PCP for 6 consecutive months) but i think now its going to go really fast. I have so much to do. i want to try to get all my testing and evaluations done before i go back for my 2nd cosultation in 3 months which will be in aug. Come august ill be on my 5th of 6 weigh ins. I have to have blood work, see a pulmonologist, cardiologist, gastroenterologist, nutritionist, psych evaluation etc etc. I think im putting off the gastro til last. im s**t scared of getting an endoscopy. The surgeon wants me to avoid or limit my intake of cake bread rice and Pasta. so right now i practicing eating on smaller dinner plates and trying to strecth my meals out. Hope everyone is doing well! -
Has anyone tried that brand???
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Did anyone else have to submit a application at the seminar?
NewAshes posted a topic in PRE-Operation Weight Loss Surgery Q&A
They gave me two packets to fill and one was for the bariatric team to approve or deny me the other was to take to my first appointment if approved. I'm assuming its for them to see if my insurance even covers my surgery if I fell into all the requirement cause it asked for my insurance information and what kind of health issues I have. If anyone else or everyone else had to do this how long does it usually take for them to get back to you? On the paper it said applications are done in order of received and I filled mine out at the seminar but just curious. -
New here new to the journey
MrsGamgee replied to Momtokaitlyn's topic in General Weight Loss Surgery Discussions
HI... I'm new here too. My journey started last January when I first talked to my GP about getting a referral to the bariatric program at our local hospital (things work a little differently here in Canada), and my doc was so excited that I asked about it I thought he was going to fall out of his chair. It took a few months to get into the program, but now I have appointments once a month with different people (my nurse, my surgeon, nutritionist, mental health, etc). I know there are a lot of hoops to jump through ... just had my gastroscopy last week. All good! ... but I'm hoping that I'll get a surgery date sometime in the spring or summer. I have a wonderfully supportive husband and 2 great kids (7 & 5). Most of my friends and family are supportive, but some have accused me of 'taking the easy way out' (haha... as if). I'm looking forward to getting to know people on here, and following their stories. -
how long does it take to be approved?
marlena_marie replied to myshine84's topic in PRE-Operation Weight Loss Surgery Q&A
Every insurance company has different standards and guidelines for approving a bariatric surgery. To ease your mind, you could call them and have them give you their guidelines so you know if you meet or have met all the criteria for approval. Nobody can tell you how long it will take except for the insurance company itself. Good luck on your journey! -
Emotional Eating
WLSResources/ClothingExch replied to Inner Surfer Girl's topic in General Weight Loss Surgery Discussions
If I may, another resource is http://shrinkyourself.com whether you opt for the free or pay version. It's about emotional eating, not bariatrics or any particular method of weight loss.
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