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Denied For Gastric Sleeve Surgery.... Anyone Had This Happen?
koriswlj posted a topic in Insurance & Financing
I was denied today because Cigna decided to tell my Bariatric center at the last minute that I had to have my surgery done at a hospital that was a "Center of Excellence". So they gave me the doctor and hospital I have to use. My bariatric office was so mad because they never once caught that when they reviewed my benefits at Cigna. They told me that I am pre-approved through Cigna. So I am hoping that when I get an appointment with this doctor.. The office said they will fax everything over. I did everything I needed to so I hope it gets approved quick. If anyone has been through something similar I would love some feedback. -
What to buy beforehand??
wannaBLean replied to lk77's topic in PRE-Operation Weight Loss Surgery Q&A
I have the Bariatric Advantage brand Protein shakes now- bought from their website, also you will need Multivitamins and skim fat free milk makes the shakes easier to tolerate. Otherwise it's real thin and hard to drink all the time. I prefer the Isopure zero carb Protein Shakes though and intend to go back on those afterwards. It's better as far as carbs and fat and stuff goes and I liked the taste a tad better. Bout the same price too. I also recommend V-8 and soy milk. :sad: Oh and I have this cookbook which I used and pureed the food during my mushy stage: Eating Well After Weight Loss Surgery, Patt Levine M.D., Book - Barnes & Noble I thought the recipes were tasty though I've only made a few of them so far- and they tell you how much to puree for the lapband or for gastric bypass etc. I have a Blender Bottle and use it every day! It's so easy to make the protein shakes with and is easy to just rinse out real quick afterwards and let drip dry- rather than a blender or spoon to stir with. Otherwise, nothing else comes to mind. Congratulations by the way! -
A good friend of mine recommended this site to me for some good support and conversation with fellow Lap Bandees. I'm 24 years old and have always been a "big guy." However, in the last few years, I've become more and more sedentary and thus gained a lot of weight. So around a year ago I started looking into bariatric surgery to get me on track and help me improve my health. Well, on April 3rd, 2008 I was banded by Dr. Darrin Hansen of the South Valley Surgical Center in Sandy, Utah. So far I'm feeling really good and haven't had too much pain. I'm excited to get to a place where I can get exercising and resume a (quasi) normal life. I'm a student and I work full-time for a law firm so this downtime is hard for me to accept. I'm glad to have learned about this site and I feel I will frequent it with questions and for general support. I have a blogsite I've set up for any and everyone to check out and follow my progress. You all are welcome to comment on it. Becoming Half the "Mozart" I Am (My nickname has been Mozart since I was 8 years old...)
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My Bariatric Life Living Larger Than Ever!
My Bariatric Life posted a gallery image in Member Photo Gallery
From the album: My Bariatric Life Living Larger Than Ever!
My Bariatric Life wearing a bold red dress to a black tie affair, New York, NY. Best day ever! Living large after WLS, plastic surgery, and obesity!© my bariatric life, Borne LLC
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From caloric/ bariatric perspective honey and agave are not good options. I have no idea about sorghum.
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My question: What is your bariatric surgeon willing to do for you??? Is he/she going to insist on a doctor to doctor conference call with your insurance company? Remember that most of the time an "approval" or a "denial" is already "templated" for whoever receives your request onto their station/desk--usually not a medical doctor of any kind. Your surgeon can take the easy way out and just accept your self pay offer OR she/he can and should have the facts and figures to stand behind his diagnosis and plan of treatment, then be willing to pick up the phone and "fight" for what he/she thinks is what is in your best interest. That takes the $ out of the equation and replaces it with what is best for YOU. If you truly think that a RNY is not for you, than stand firm and fight---being damned sure your surgeon is willing to do the same. Otherwise, in my opinion, you need a different surgeon. You can always self pay (your words), but here and now, you have the opportunity to do the "right thing". Others following down the same path for years to come will be grateful that you fought the fight not only for yourself, but for them (who probably would not have the privilege of self paying). "Integrity is doing the right thing when no one is watching"
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It's one of the common things that happens post-bariatric surgery, but I think it only lasts for a short period of time. I'm taking Biotin and using Rogaine and Nioxin.
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Care Credit is pretty strict about who they will finance now. The years of "easy" financing even with bad credit are pretty much over, and most doctor's offices now will not finance surgery for anyone. It makes sense - they are in the business of medicine, not in the business of accepting financial risk. So they take credit cards, Care Credit and a few other surgical financing companies. I guess I would either postpone the surgery, pay for it and then get immediately back into a tight budget to replace the money or see if you can get a credit card (which will likely have a high interest rate if you can). I work for my bariatric surgeon and we get calls like this all the time. It is very sad, but getting financing for an elective surgery with poor credit is extremely difficult now. I wish I had better news for you. :hug: You are facing a tough choice.
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My surgeon warned me against vomiting and urged me to be very careful and not vomit if at all possible, that it could cause problems. Sounds like your swelling may have gone down since you are getting hungry. Just sip all you can, be sure you take a high quality, lo carb Protein supplement (made for bariatric patients, not body builders)...that will help quell the hunger. Until you get a fill you won't have any restrictons and will be hungry....in fact it may take 2 or 3 fills. Aftercare and fills are a major part of the success of the band....I'm sorry your doctor doesn't know much about that part. You do need to keep in close touch with a couple of good boards that have experienced wls patients on them to answer your questions. There are some very professional and knowledable people on www.bariatriceating.com so tune in there.
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Thanks for the support everyone; this is exactly why I love this board! Jack, the waiting does/has renewed my dedication; "I'm patient", but ready Magic, I have United Health Care thru my employer.
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Well, I started looking into the lap band proces about a month ago. I have gone to 2 free seminars at Beaumont Hospital in Royal Oak MI. I took my husband to the second one with me. He is very supportive in this decision and is helping me through the thought process. I am really lucky to have him. :thumbdown: I on the otherhand am still not 100% convinced. I need to lose 100 pounds. That is a fact. Can I lose it on my own (again) and keep it off? Most likely not. Do I need a tool to help me get the weight off? Yes, for sure. Do I want to go through bariatric surgery and have my insides re-plumbed.? Not really. So, the Lap Band even with its downfalls (nothing is perfect) seems like the best route to go. So I made my medical exam appointment for April 20, 2009 and I am giving myself til then to make up my mind. I just ordered 3 books from Amazon about the Lap Band which should be a help. That and all the great things I am reading on this very helpful site. I am not hearing a lot of negative, which is a good thing. So that is where I am today. By the way these are the books I ordered: "Laparoscopic Adjustable Gastric Banding: Achieving Permanent Weight Loss with Minimally Invasive Surgery" Jessie H. Ahroni Ph.D. A. R. N. P. "LAP-BAND Companion" Mark J. Watson; "Lap-Band for Life" Ariel Ortiz Lagardere
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Weight loss drives a whole new sex drive
MistyAnnMoon829 replied to HealthyNewMe's topic in The Lounge
I can't give an accurate reaction to this, cuz I just started seeing someone new and that right there is the whole new relationship sex, vs renewed sex lol. But I do find that I enjoy it more and that I sweat less that is for sure! -
Wow! I just watched this documentary called Food Inc. It's much of the same info as the book, Fast Food Nation. I had tried to read the book in the past but just couldn't get into it. I am so glad they made this documentary. I am pretty informed about factory farming, especially where it concerns animals. I was a vegetarian for 13 years and did my share of pamphleting, protesting, and lobbying for animals but I really didn't know the extent of the Nation's food problem until I watched this documentary. It has changed me and will change the way I shop for food. Now that I am able to eat less food, I can afford to switch my family to whole, natural, locally-produced foods and that is what I am going to do. My husband is happily on board (rare since we usually disagree on "green-hippie" issues like this). He watched the film with me and is appalled at the state of our country's food processing methods. Watch it as soon as you can! It will change the way you look at food and what you learn from it could be a good companion to your healthy new lifestyle. Meanwhile, I had another good day with the band. For breakfast, I renewed my childhood love affair with Cream of Wheat. Man, that is good stuff. I added a little varietal (blueberry) honey to it and it was incredible. Later, I made chili for dinner and just ate some of the sauce. I am still having trouble getting all my water and protein, though. My Grandma stressed me out again today and for a second, I felt the old twinge to eat my feelings away. Instead, I just sat there feeling what I felt and then I felt better. I also had a ton of energy and felt like my old self. Since my car accident, I have not been able to do all the things I used to. My house stays messy because I can't keep up with it and it that been a constant source of guilt and anxiety for me especially now that I stay at home and feel it is my job to stay on top of this house. Today, I was able to do a lot of chores and chase after my kiddo and critters for 12+ hours. I even finished cleaning 3 rooms! That hasn't happened in 2 years when, before the accident, I could clean my entire house in a couple of hours. I am really really really happy that I got the band.
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Sleep Test and a few other questions
Lizalee replied to Diamondette's topic in LAP-BAND Surgery Forums
Sleep study - I believe why they order them, other than the fact that many severly obese people have sleep apnea (as described above) and can die from it, it's because most insurance companies won't pay unless there are some "co-morbidities" unless your BMI is extreme. I have it, and use a CPAP machine at night - the change was fantastic - I felt so much better with it, since I wasn't having to sleep sitting up and waking up dozens of time a night) So, you need to know if you have it so it can be treated immediately - leads to high blood pressure, stress on heart, and even death. And because it will be helpful information for anesthesia when they put you to sleep. And because it will be another marker of sucess of weight loss, because weight loss may eventually cure it. Pre surgery diet: My bariatric center required 3 month supervised diet in order to see if I could maintain a healthy diet and loose weight (follow the rules). Many insurance companies require it (some 6 mos to a year). If you can't maintein or loose weight before the band by following the diet, you may be a better candidate for gastric bypass, since the gastric bypass doesn't let your body absorb as many nutritients from the food and has more severe consequences if you over eat sweets (dumping syndrome). Another reason for the pre-op diet is to shrink the liver, which makes it easier for the surgeon. The presurgery diet is basically a healthy diet - low fat, high Protein - 60 - 80 grams of protein a day. Plus lthey wanted me to find a Protein shake that I liked because you need them for the first month after surgery until you can tolerate solids better. Some surgeons require a clear liquid diet before surgery for a week or two - mine didn't. I think that's to shrink the liver. PIll size: I break my pills in half and have no problem. I don't have a good restriction. Post op I used liquid paid meds. I have heard capsules can cause problems, but I haven't had any problem. Talk to your phamacist if concerned about med size - often they can be crushed or you can get liquids, but some meds shouldn't be taken out of the capsule or crushed. And by the way, since my surgery in April, I'm now OFF most my meds, so it's not a problem anymore! :-) Hope that helps. -
Medicaid requirements
citizenlizzie replied to JealousMuch's topic in PRE-Operation Weight Loss Surgery Q&A
It all depends on where you live. Here in Oregon you do tests, diet, see your primary once a month for 6 months for Medicaid to approve. Marijuana and nicotine and psych screens. must lose 5 percent of whatever you weigh when you start. The hitch here in Oregon is if you are obese without certain confirmed co-morbidities, the waiting list is 1-2 years long. However if you have diabetes and a second co-morbidities like sleep apnea or GERD, as soon as you do your 6 months, you can get scheduled. Call a reputable doctor at a hospital bariatric center in your city/state...they'll tell you what Medicaid requires. Sent from my XT1650 using the BariatricPal App -
Dr. Amjad Ali with UPMC Hamot Bariatric Surgery and Weight Management Center in Erie, PA is the best, great bed side manner, very informative and caring, his staff is more than gratious and helpful. If you live in Erie, PA, contact his office. https://www.upmc.com/locations/hospitals/hamot/services/bariatric Best of wishes for you surgery and weight loss, Redhead Assasin.
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Yesterday afternoon, I was just bothered by the whole will they/won't they mind game of insurance approval. Now, I realize I can't even submit for another month. I have one more weigh in for my MSWL program requirement. I called BCBS-TX yesterday and asked her if I had to use one of their Blue Center of Distinction for Bariatric Svc. She put me on hold and came back and said for Bariatric Surgery, no I don't. She told me that it is all up to the policy riders that each employer puts in the coverage. She said our insurance has that requirement for Organ Transplant, but not for Bariatric Surgery. So then I asked her to repeat the requirements so I could make sure I wasn't missing anything. (I'm not. YAY!) I told her that I was stressed out about not being approved and she said that for almost everyone that applies they are approved providing all the requirements are met. She said that 90% of the denials are based on missing paperwork and most of those are approved on the 1st appeal. She was SUPER nice and patient and I realize that she's not the decision maker, but it did help put my mind at ease a little bit. I know I'm doing everything that I'm supposed to.
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Congratulations to you. That has to be very exciting to have an actual surgery date. I will be having my surgery as well in San Diego through Pacific Bariatric. They conduct their surgery at Scripss Mercy Hospital. I haven't actually got my surgery date yet, but it will be sometime in September. Good Luck to you.... and Keep us posted on your progress.!!!!!
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Hello I am new to this site and need a little insight. I had my first bariatric consultation and I am stuck at whether or not I should go for the band or the sleeve. Did anyone else struggle with this decision and if so what helped you make up your mind. Thanks
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Okay, fills... Some of us have surgeons who want to approach the adjustment (what a fill is really called) in a Let's-Get-This-Show-on-the-Road kind of way. They tend to be foreign and/or very experienced LapBand (not just experienced at lap surgery or experienced at bariatric surgery) surgeons. Other of us have the "Let's-Be-Very-Careful-and-Do-This-Slowly surgeons, who tend to be located in the US and/or kind of new at the band. So, what that means is how many fills one has had is completely irrelevant. And, IMHO, the whole little-by-little approach is silly. Because let's say that YOUR ideal fill is 2.3cc's. Dr. Little-by-Little puts in 0.5 at adjustment #1, then moves it up to 1.0cc's at adjustment #2 and so on. When the patient gets to adjustment #4 (2.0cc's), it still isn't enough and then at adjustment #5 (2.5cc's) it's too much and whatever the doctor was worried about in regard to an overfill is going to happen anyway. AND, some of thee surgeons only do fills once or twice a month. So the patient is six months post-op until he/she gets the needed restriction. And we all know how WE deal with that kind of frustration and "failure." And then they say the band doesn't work. Right. Figure out what your doctor is doing. Explain whay YOU don't want to wait six months for restriction. See if you can get the adjustment YOU need. Sue My experience with fills is almost all outside the US. Those doctors used flouroscopy and most got the restriction as tight as they thought I could reasonably handle, and didn't even look at the syringe until I asked them how much saline we were talking about.
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I get a LOT of recipes from Pinterest. Type in the phase # or name ie:mushy or pureed or even bariatric diet and it will pull up plenty. Just be careful I always seem to fall down wormholes when I visit that site.
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Iam going through the Detroit Bariatrics. On location at Barix Clinics/Forest Health Center in Ypsilanti. Dr. Nunn will be my surgeon.
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If You Really Want to Achieve Happiness and Success, Especially with Weight Loss, Stop Looking to Other People For Approval and Applause, When God is Truly the Only Stand Ovation and Applause, that you Really Need!!! Romans 12:2 And be not conformed to this world: but be transformed by the renewing of your mind, that you may prove what is that good, and acceptable, and perfect, will of God.Love All of You!! Sharon
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Waiting for Approval
fire&spice replied to ms. chaval's topic in Tell Your Weight Loss Surgery Story
Good Luck Chaval! I have Blue Cross & Blue Shield Ins. & they approved in less than a week...call your Ins. Co directly (member svcs. dept.) and ask if your bariatric claim has yet been submitted and reviewed. Call weekly if you have to. It doesn't hurt to be proactive. Keep us posted!!! f&s :biggrin: -
male only Pssssst ….. hey guys! You will want to read this ;-)
LoveAfterWLS posted a topic in The Guys’ Room
Alex has graciously allowed me to sneak into the mens room to tell you all about something exciting! I've started a dating website for bariatric patients. I wanted to create a safe place where men and women who've had surgery can meet people with similar goals. I can't think of anything more awesome than finding someone to share this journey with. Our website is TOTALLY FREE! It features profiles with up to ten pictures, private chat, private email, blogging and more. We are just getting off the ground so it will take some time to build the membership but you can help make this a success. If you are single or have other single friends, please send them to check out the site. We've got a fair amount of women to get started but we need men! Please visit www.loveafterwls.com for more information and to get your profile started. http://www.loveafterwls.com
