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Hello all! Here is my ridiculous story involving the insurance end of things, and a few questions to follow. Back in August, I made my first call to start the journey toward surgery. I had UHC at the time and they covered the surgery and required every darn thing on earth, except the 6 month diet prior to surgery. My plan with them was ending 1/31/16 because my employer switched providers. My entire surgical team, along with every Dr I saw during the process knew that I had a deadline. And it seemed like I had plenty of time. Well, after many miscommunications, ball dropping, wrong fax numbers, etc my surgery was finally scheduled for January 27th. Talk about last minute! Well, to make it even more last minute, as I was being prepped for surgery at the hospital, everything came to a halt. Insurance still had not processed my claim. So they rescheduled me for 2 days later, and then 3 days later-they were willing to operate on a Saturday because they knew what a mess I was in. Long story short, UHC left the claim as "pending," most likely because they knew my plan was ending and they didn't want to pay for it. Thanks a lot United! Anyway, my new plan with Anthem Blue Cross California started today. And they require the six month diet. I've been dieting and working out ever since starting this journey, but it hasn't been documented because it didn't need to be. I've seen many posts online about submitting the claim anyway and it being approved without the diet, but all the posts seem to be quite a few years old. Has anyone had surgery through Anthem BC California recently? If so, what was your process like? Did they require the full six months documented diet? How long did approval take? Any information you can give me would be appreciated. I'm hoping my Dr can explain the situation directly to Anthem and get an approval. This has been the most stressful 5 months of my life!
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Where are all the Canadians ?
trackerchik replied to canadianchick's topic in Gastric Bypass Surgery Forums
Langley, BC - Had RNY Dec 15, 2015 -
Just like with WLS you'll hear all sorts of birth control horror stories. Pills make some crazy, people say shots make them gain weight, etc. I'm on my third IUD and have never had a complication. I also already have two kids and don't plan to have more. Personally I would not recommend am IUD to one without kids. I'm so out of the loop with bc options since I've had an IUD so long, but take others experiences lightly... Everyone reacts differently
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Disappointed doesn't even begin to describe what I currently feel...
Renkoss replied to sassyfrass23's topic in PRE-Operation Weight Loss Surgery Q&A
I'm just wondering here if when they told you a 6 month wait for surgery, they were not stating it from all the pre-op stuff required. So basically, you have to have 6 NUT appts, and you can only do 1 a month for 6 months. During that time you also need a Psych eval. Once you have satisfied all the requirements, then your application or file is submitted to insurance for final approval. From there you get scheduled for surgery. I have BC/BS, and my requirements were 6 NUT visits, 1 per month, a psych eval, 2-3 appts with a Nurse Practioner or D.O. I just finished a 4 week group support for binge eating (part of psych visit). I have final psych visit in a couple weeks. I have my last NUT appt in a couple weeks. I've completed the Nurse/D.O. appointments. So, by end of February I should be submitted for final approval from the insurance. If approved, then I'm scheduled by surgeons office. I'm just wondering if this is nothing more than a misunderstanding of the wording by the insurance. It makes no sense to have to wait 6 months after final approval is received. BTW, I work with insurance companies all the time. They can be quite confusing. -
What have I done?
mrslopez replied to kristennichole's topic in POST-Operation Weight Loss Surgery Q&A
Good info...to add it will get better you have to adjust im 6 weeks out and i went through same thing even cried bc i wanted to eat, but couldnt. The smell of foods made me want to eat but i knww my stomach could not handle. It will get better, i cant eat anything sweet bc my stomach wont let me -
I should be ashamed for asking this but im 6 weeks post op gas anyonr eaten hot wings not breaded bc i dont wanted breaded wings. Is it ok to eat?
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Weight loss pre surgery?
ava32 replied to time4change16's topic in PRE-Operation Weight Loss Surgery Q&A
I'm at the beginning of my 6 month supervised weight loss. I agree completely! Why are you making me lose weight prior to surgery when that is the reason I want the surgery? I've been told BS how insurance companies want to see how well you do with a structured lifestyle similar to the one after surgery. To me I'm just continuing living a miserable life for 6 months. Also I asked my dietician about losing too much weight and my BMI not being within range for insurance coverage. She told me if it gets close to below the range that there are ways to maintain that BMI prior to surgery. -
Not Eating Well (6 weeks - post op)
Mistie replied to Kaishek's topic in POST-Operation Weight Loss Surgery Q&A
Regarding hunger - I think there's a difference. I do not feel 'hunger,' as in a desire to eat. However, there are times my stomach is empty and wants to be fed. The prob is, I don't want the food - it's a strange predicament! I am just over 3 months (hit Tuesday). The first two months, I hated food. It was a chore to eat. Then it got better. The last week it has been bad again - I simply have no desire to even put food in my mouth, even when my stomach is empty. So I am really having to focus on a schedule of intake and on consuming Protein first before I cannot eat. It is a challenge, but we HAVE to get the calories/protein in, want it or not. It's for our health. Just pace yourself and keep at it! -
Changing surgeons after getting approval from insurance
Ohsosleeved replied to gomezk2's topic in Insurance & Financing
Did everything go smoothly? I am in the same situation. I have been approved but the surgeon's office cancelled my surgery due to 15 lb weight gain since August. They are requiring me to lose the weight before they will put me back on the schedule. This would be fine if I wasn't starting a new job in a couple of months and NEEDING to have surgery done before I start. It's either now or wait another 6 months and that is out of the question. It took me 6 months of a preop diet, another month before I got insurance approval, scheduled a month out only to be taken off the schedule a week before my surgery date. Taking 3-4 weeks to lose the 15 lbs and waiting a month before surgery will kill my timeline. I feel like I need to get the ball rolling with another surgeon ASAP. I really don't have time to wait. I have BC/BS of Michigan. Please help! -
The Start of my New Life in 2016
Sammysmiles replied to Ruth1ess's topic in Tell Your Weight Loss Surgery Story
Hey there! I'm having mine done at Mayo too. I have my last 2 classes on feb 9th and then follow up with Dr Lynch on the 10th. Then I'll just be waiting on insurance approval. I'm hoping to have surgery the last week of April or 1st week of May (bc of school schedule). Good luck to you and maybe we will meet and support each other! -
At the Crossroads - revision?
VDLT replied to Snufflegus's topic in Revision Weight Loss Surgery Forums (NEW!)
You don't mention what kind of revision you are seeking. Are you thinking of just redoing sleeve or converting to a DS? I am also in Florida. I live in Orlando but had my band and revision to sleeve in Miami. My insurance (BCBS FED) covered my revision from band to sleeve even though I self paid for band. There is a new doctor in Celebration doing the DS if that is what you are looking for. Best of luck! -
What, specifically, caused you to become obese?
Dizzeepinkee replied to careya123's topic in Gastric Sleeve Surgery Forums
Entering puberty: My grandma used food to keep my brother and I happy. Not her fault, we were out of control, and she fed us what ever we wanted. Moved in with my Dad and step mom as a teen, she got me eating healthy. Didn't start to gain weight until my early 20's. No exercise and brown bagging it every day, lots of hamburger helper (carbs carbs and more carbs). Always worked in a field service industry, so I would eat poorly on the go. Yo yo'd back and forth, even hitting goal weight at 29. Got bigger on the rebound every time. Biggest downfall.....cheesecake. Or chocolate. Or peanut butter. Or.... -
FYI...there are NO plans in VA that cover weight loss surgery for individual self pay...such BS!
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Healthcare Exchange: States that do not cover Bariatric Sugery
refocus replied to OutsideMatchInside's topic in Insurance & Financing
How is possible that some state allow the surgery and others don't? Total BS. Is there any way to make insurance pay for surgery even if they say they don't cover it? -
What vitamins would you recommend?
shelly7 replied to shelly7's topic in Tell Your Weight Loss Surgery Story
Wat was the probiotic for. ? You will see MANY MANY posts on these forums about constipation post-op. I never had any problems at all with constipation since surgery and I thank my probiotic for it. I think it really does help! Often in those threads, I see many posts from people saying they take a probiotic and don't have trouble with constipation and most of the people who DO have trouble, don't take a probiotic. Thriving gut bacteria is essential for proper digestion. Most of the ultra-pasturized, anti-biotic fed foods we get in stores today don't provide the proper flora for a healthy digestive system. Taking a probiotic daily can help restore gut bacteria and then eating prebiotic foods helps to feed those bacteria. [/quote What brand of probiotic ? -
What vitamins would you recommend?
JamieLogical replied to shelly7's topic in Tell Your Weight Loss Surgery Story
Wat was the probiotic for. ? You will see MANY MANY posts on these forums about constipation post-op. I never had any problems at all with constipation since surgery and I thank my probiotic for it. I think it really does help! Often in those threads, I see many posts from people saying they take a probiotic and don't have trouble with constipation and most of the people who DO have trouble, don't take a probiotic. Thriving gut bacteria is essential for proper digestion. Most of the ultra-pasturized, anti-biotic fed foods we get in stores today don't provide the proper flora for a healthy digestive system. Taking a probiotic daily can help restore gut bacteria and then eating prebiotic foods helps to feed those bacteria. -
My 600 Pound Life: 2016 Season
gowalking replied to Inner Surfer Girl's topic in General Weight Loss Surgery Discussions
I watched 600 lb. life and Skin Tight last night. Was glad to see June get her act together. I was sure she was going to be another Penny. As far as Skin Tight, I agree completely that there is an obvious bias against WLS. Most of those who've had surgery also change eating habits and spend alot of time at the gym so I call BS on it being thought of as the easy way out...but heck, I'm preaching to the choir here. We all know how hard we still have to work. All I kept thinking is that both of these folks who lost it the 'old fashioned way' would likely gain it back. We all know losing it is easy compared to maintaining. -
what vitamins and protein sources did you love the best?
southernbelleAU replied to southernbelleAU's topic in PRE-Operation Weight Loss Surgery Q&A
Thank you for the helpful tips! i start my 7 day liquid diet on Monday. This will be tough for me as i have headaches when i dont eat. I hope it goes well. I had heard that unjury was a good brand and my Surgeon's office told me to try prohealth bariatric Vitamins bc you'll only have to take one a day + a calcium supplement. I'm so encouraged! KEEP THE TIPS COMING! -
I think nearly everyone who is a "regular" on the forum post-op goes through a period where they get sick of seeing the same posts over and over again. Either you get over it, become more patient, and try to help the newbies or you get fed up and spend less time on the forums. I know I had my own stretch of angst over so many repetitive topics. But I just try to remember we all started somewhere and I had my share of stupid and repetitive posts back in my early days. So I try to suck up the frustration and be as helpful as possible. If it weren't for people being patient with me in the beginning, I never would have gotten to where I am now.
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I do have a desk job and need the release form for HR. I guess I would feel better if the doctor saw me prior to going back to work to make sure I didn't have a set-back once returning. Also, the BP and BS needs to be addressed and really hasn't. I guess this is the new medical like the new math???
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What Did You Learn About Insurance? Share Your Wisdom!
AnA92212 replied to Alex Brecher's topic in General Weight Loss Surgery Discussions
Called our insurance company. At the time we had BC/BS. However, we live in Alabama and the insurance was from Maryland, but my husband's company was in Virginia. Anyway, after being told one thing and then getting confirmation that we did NOT have to do the 6 month supervised diet, it was fairly straightforward. We had to be 100 pounds overweight and do a psych evaluation. Those were our only two criteria. The first person that answers the phone usually doesn't have the in depth knowledge you need. You have to be persistent. Surgeon submitted paperwork on a Friday, and got approval a week later. -
I had one week post op visit with my surgeon's NP. I did receive a release for work, but that was at my request because my HR required it. Since I work a desk job, my surgical team was OK with me deciding how long I wanted to stay off work. I will have a one month post op visit with the Nut and then a 6 week follow up with my surgeon's NP again. In regards to bp and bs, both of those had to be controlled prior to hospital discharge. They checked my bp at my one week post op, however, any issues would have been referred to my primary care for follow up.
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Cellulite at Goal - Did It Go Away?
VSGAnn2014 replied to careya123's topic in General Weight Loss Surgery Discussions
Uh ... Not meaning to be harsh, just realistic, with this post. Unless you're 18 years old, and you haven't lost and gained weight several (much less many) times before losing weight via WLS, you aren't going to wind up looking like a swimsuit model when you reach your weight goal. BTW, most swimsuit model pix are airbrushed. About three women in the world look like we all think we deserve to look. I gotta say I think there are some unrealistic ideas of what we're going to look like at goal. Most of us have really abused the bodies we were born with. We've stretched our skin and under-exercised our muscles for the most part, some of us for most of our lives. And we have not fed them the most nutritious foods or enough Water. Some of us have damaged our joints and spine. We aren't starting with a clean slate. I say this really to say that we have so much to gain from WLS. But we should also be realistic about what we can expect as our best outcomes. -
Valentine's Day Weight Loss Challenge
NoMoreWeightNJ replied to vsgSarah3's topic in Gastric Sleeve Surgery Forums
178 up 1 but retaining water bc of time of month so hopefully will be back down again next week -
I too, have Fed BC/BS, I had BMI of 53 at the time of my consul, but now at 46. Surgery is tomorrow. I have sleep apnea as well, but I also have diabetes, and my surgeon listed me at morbidly obese for the insurance. So depending on what your surgeon puts down, it's possible.
