I think I am ready!

[sleevegenie 0]

Hi , hope it all went well for you. some insurance companies are starting to approve the sleeve, i'm in the appeal process now, hoping for the best, best of luck to you, hopefully soon we will both be on the sleeve train, Jean

[WeekendWarrior 0]

Well I had my consult with the surgeon today. She agreed that the sleeve was probably my best/only option with my nsaid use and history of stomach cancer in my family.

They told me to continue seeing my PCP to document my weight as many insurances pull the physician assisted diet requirement even though there is no mention of it in the policy.

They gave me a checklist and I was able to check off 2/3rds of it already. I still need to get the psych exam.

Maybe I'll get lucky and they will change their policy by the time I get through jumping through all the hoops.

So I guess it's wait time to see when I get my first reject letter.

[Tiffykins 673]

Glad you had a good consult, and that you are willing to put up a good fight for your health.

Keep us posted.

[WeekendWarrior 0]

I guess I should update my Journey a bit.

I have been kind of moving slow since my consult. I don?t know if it is because I am afraid of being denied. Or it maybe I am hoping that by the time I finish the 6 month diet, they will approve the sleeve and I won?t have to deal with deal with the appeal process. I am 99.9% sure they will deny me on the first try.

I just turned in my release of information to my PCP yesterday. They need to send 3 years of records to the surgeon and get my psych evaluation before they will submit to the insurance company. I haven?t scheduled the psych evaluation yet either.

When I talked to the receptionist to turn in my release form to my PCP, I told them to just send the records to me. I figured I could make copies, and keep a set for myself. That way if I decide to seek a 2nd consult, I?ll already have them. The receptionist was somewhat concerned about releasing the records to me. She said they might have to charge me for them if they release them to me, but don?t charge anything if it is being sent to a Dr. That makes no sense to me at all. The records lady is supposed to call me and discuss my options.

I am also waffling on if I should go to another surgeon. There are not many sleeve surgeons in my area that I know of. The one I consulted (Dr. Lamasters) who has only done a dozen. She has done hundreds of RNY bypasses though. I don?t know if there is anyone in Iowa who has much experience at sleeves since hardly any insurance companies will pay for it. Kind of a catch 22.

I don?t know if I should contact Dr. Gary J. Anthone, I know he is a highly regarded DS (duodenal switch) surgeon, so you would think he would be good at doing sleeves as he has 1600 DS surgeries. It also says he has done 250 Open VSG?s, and 25 VSG (I assume these were done Lap). My only concern is he may be great at Open, but are his LAP skills up to snuff? I think I also have concerns that they may try and talk me into getting a DS. I don?t really think I want to deal with the severe malabsorption issues. Ironically, my insurance company would pay for the DS.

I have also been looking at appeal strategies. I think I have a good case that the VSG is the only acceptable WLS for me, since I take NSAIDS twice a day for my ruptured disc in my back, and my father died of stomach cancer. Once concern I have is that according to the WLS policy for wellmark BCBS, they state the following.

?Surgery for morbid obesity, also known as bariatric surgery is based on intestinal malabsorption and gastric reduction. Surgery is considered successful if weight loss is maintained at greater than or equal to 50% of excess body weight for more than 10 years.?

Are they going to wait for 10 years before they approve the sleeve?

Well I guess I should get off my butt, and schedule a psych evaluation and get the ball rolling. I won?t ever get anything done procrastinating. I suppose I can wait to choose a surgeon once I know i've jumped through my insurance hoops.

Wish me luck!

[BeenThereWasThat 2]

Do you have an update for us?

[WeekendWarrior 0]

I started my 6 month Dr. assisted diet 2 months ago, just after my last update.

So far I've lost 20 pounds. Just losing 20 pounds has helped my back pain a lot.

I've been using myfitnesspal and pretty much pre plan what I am going to eat each day. My daughter monitors my progress so I can't cheat.

I started at 1840 calories a day and currently at 1720 per day now due to my 20 pound loss.

My daughter and I have started walking every day. I had problems just walking the 2 blocks to the local park. Luckily they have benches all along the way and I could sit and rest several times.

The last couple weekends we have walked 3 miles non stop on Saturday and Sunday. I was pretty amazed I was able to walk that far.

My 6 month diet will be done in September, and I am hoping that Wellmark will also update and approve the sleeve at that time. They last updated their policy in September of 2009, and they update it at least once a year, so I am pretty confident they will start approving it by then.

So 4 more months to go.

[Tiffykins 673]

Excellent news ! ! ! Great job on your loss, and your walking. . . All this prep work is going to work in your favor once you get your sleeve.

[WeekendWarrior 0]

I guess it's time for another update. Four months have passed, and I am down 40 pounds. BCBS still doesn't cover VSG but it is supposed to update their policy in September.

My daughter and I have been walking 30 min. almost daily. A few times on the weekends we have been walking 3 miles in an hours time.

My daughter and I just purchased a couple of bicycles today. Hopefully we can switch up from the walking and get a little more variety in our exersize.

I am starting to wonder what I want to do if I continue to lose weight. Should I continue with the diet and not get the surgery?

I know I've failed on countless other diets, but this time we have been tracking our calories on myfitnesspal, and it's made a huge difference. I now see how easy it was to eat a little bit of this and a little bit of that and hit 2 to 3 thousand calories a day.

Well I'll report back again here in 2 more months. Hopefully i'll be down 60 pounds and we will find out if Wellmark BCBS will be covering the sleeve.

[WeekendWarrior 0]

Forgot to add that I needed to go out and buy a new belt, and a new pairs of jeans as I have lost 6 inches off of my waist.