I want the sleeve not the rny!!

[erudite_diva 0]

I just found out that my insurance will ONLY cover the sleeve if my BMI is 50 instead mine is 47.8! I am SO ready to scream because I just KNEW this would be a non-issue. So now, my doctor is pushing for the RNY because I don't want to even bother with the Lap Band and all those issues. I am SO disappointed!:thumbup1:

[Tiffykins 672]

Don't settle, you can appeal. Or you can strap some ankle weights under your jeans, and stick rolls of quarters in your bra, to hit the 50BMI mark. Yes, there are people out there that have done this to get approval.

Don't do the band, it sucks. I wouldn't do the RNY, but if you really want to have surgery for me the RNY is the lesser of 2 evils between the band and RNY.

I know it's frustrating, but many people have won on appeal. Do you have any medical reasons why RNY would not be a good option for you?

[Papillon 7]

Try to appeal the decision... if you really want the sleeve surgery it may make a difference. It is really crazy that a procedure that is malabsorptive is covered but the sleeve isn't. Talk to your surgeon about writing an appeal if he is willing to help it will hold more weight with the committee. Good Luck!!! I am worried about the same thing.... *hug*

[erudite_diva 0]

I thought about appealing but I'm on a tight schedule here. I need this surgery done before school starts since I am a single parent and know I'll have to be unable to drive for a week or more. I also am trying hard to change jobs and while i KNOW my present insurance will cover gastric surgery 100%, I need to go with what I have. If I felt I had time to appeal it, I would but I'm at the point where I'm just needing to be healthy and unfortunately, I don't have the funds to pay. So I have to go with what I know will be paid for and is permanent. I need surgery within the next 3-4 weeks.

Don't settle, you can appeal. Or you can strap some ankle weights under your jeans, and stick rolls of quarters in your bra, to hit the 50BMI mark. Yes, there are people out there that have done this to get approval.

Don't do the band, it sucks. I wouldn't do the RNY, but if you really want to have surgery for me the RNY is the lesser of 2 evils between the band and RNY.

I know it's frustrating, but many people have won on appeal. Do you have any medical reasons why RNY would not be a good option for you?

[erudite_diva 0]

My surgeon also has been pushing for the RNY and recommends it for me. He wouldn't be willing to help me with an appeal anyway.

[Tiffykins 672]

I'm sorry to hear that your surgeon would not help you. I know many people that end up with RNY because they do not or can not fight for the sleeve. Best wishes with your RNY, and during your surgery and recovery. I'm sure you are disappointed.

Like I said, you could always strap some weights on your ankles, and other stuff to tip the scale in your favor. Sorry, I know it's not "right" or the moral thing to do, but I can 100% tell you that if VSG would have not been an option, I would of had my band removed, and stayed fat. The long term complications with RNY are just not worth it. I'm not trying to scare you, but if you haven't, check out the revision forum on obesityhelp.com and see just how many people are revising from RNY to either ERNY or DS.

I know you need permanent, I know you need surgery. I understand all of that, but why not possibly find another surgeon that will work with you, and why is he trying to force RNY on you? Does he not sleeves? Does not have many sleeves under his belt? I mean, RNY is a more expensive surgery by several, several thousand so that is a big reason why some surgeons push it instead of the sleeve. I'm not saying that's the case for your surgeon, but it's happened, and I know people that have been in that position.

[lootzie 0]

I agree with Tiffy. No one should dictate to you what you should have. I think you need to find yourself a different surgeon who will work with you instead of against you. You know what's right for you and I find it unsettling that he's not behind you 100%. Also, gain some weight - aim for a BMI of 50. It's not that much 10 pounds?? Hope you get your sleeve !!

[ChiGirl 0]

Try not to let your tight schedule and doctor's unwillingness to help (red flag!) sway you. You will only regret it later and you do not want to add stress to your life post-surgery. I just had my surgical consult and was worried he would try to talk me into a RNY. I got lucky, he didn't. He thinks the sleeve is good for me. Also lucky (I guess) that my BMI is over 50. Now it's up to insurance to OK it. If they don't, I'm willing to wait until they do. I, too, am feeling a sense of urgency because my insurance carrier may change in the next couple of months. But I had to step back and decide that it's one step at a time. This decision is going to impact the rest of my life in a big way and I don't want to screw it up. Good luck with whatever you decide, but if you really want the sleeve, try to wait it out. My surgeon told me that insurance companies are changing their policies every week.

[educationrulz 18]

diva,

I totally understand your issues as a single parent. I am also an educator so I appreciate your interest in being somewhat back to normal by the time school starts. (I assume that's what you mean when you talked about needing to be able to drive). However, I would say that if there's anything you can do to get the surgery you want - including changing surgeons - then you should go for it. I would seriously caution against letting the school calendar be the primary reason for stopping you. Yes, your surgery may be delayed and it may affect your child's time in school. In the grand scheme of things, everyone (including the attendance clerk) will get over it.

I've had some bad feelings myself about how my slowness to get back to normal has affected my daughter. I've had a lot of days where I've been dragging around, feeling weak and out of breath, and just plain pitiful. Poor little thing was stuck in the house alone with me, no where to go, and no one else to interact with (once my sister left to go back home). I had to keep telling myself that I was doing it for her as much as for me and that this too shall pass. And it's getting better every day. We've been getting out more and more and even made it to the park several days in the last week or so.

My point is that things are going to be rough after surgery for a minute no matter when you do it. It'll be ok. Just have some help for the first week and you should be fine after that. If your child misses school for a few days, get someone to bring the makeup work to you and do it at home. If it ends up being the difference of a few weeks to get the surgery you really want, why pass up on the opportunity. And I totally agree with Tiff that you should strap on some weights or something if it's not too late to document your weight with the insurance company. I wish I had done that for my first consult and I wouldn't have driven myself crazy trying to lose weight right before surgery.

However, if you decide that the bypass is the right surgery for you, then I think you should go for that. Just be aware that that may not work out to your time schedule either.

[pcindy 8]

OMG, get AWAY from this doctor! He is not God, and who is going to live the rest of their life with this surgery? Not him, YOU. Find a doc with whom you can have a good rapport, strap on those weights (GREAT idea, Tiff! -no reason to risk your health by actually gaining weight) and get sleeved. I'm a nurse and have seen the horrors of diversionary surgeries first hand. DON'T DO IT. You want a sleeve? Get a sleeve.

[brittu 42]

Just wondering... Is the doctor telling you the BMI requirement is 50 or did you actually read that in the benefits statement? What insurance do you have? Maybe I can take a look for you. It sounds to me like the BMI requirement for a DS (in which the first half is a VSG). I've never ever heard of a VSG requirement higher than 40. I think there might be a mistake here on the part of the doctor's office. Maybe they even submitted the wrong procedure code? There's a new one for VSG.

[sleevegenie 0]

my insurance denied me because they say the sleeve is investigational, my surgeon wanted to do the rny but i was totally opposed to doing that, he refused to help me appeal so i did it myself, i got a letter from someone else who appealed and won and i won. i got my sleeve about 6 weeks ago, you are talking about the rest of your life, don't let a couple of weeks compromise you. If you really think you can live with the bypass then i wish you the best, but if you're like me i say fight it, good luck

[sandra stembridge 0]

what was your procedure for fighting for the sleeve. I have anthem blue cross and i am rolling my sleeves up for battle. Any ammo would be great.

[sleevegenie 0]

Hi Sandra, i live in California, here we can request an Independent Medical review where 3 independent doctors review your case and vote i won 2-1. I'm 60 and i have arthritis, so the sleeve studies indicate this is the best option for older people and the only procedure that can still take nsaids. i have a copy of my appeal letter on ObesityHelp.com my user name is the same as on here and you are welcome to look at my profile page and read the letter, copy and edit it with your own info if you like, i wish you all the best. Studies also indicate this is a great option for people with a lower bmi, my bmi was 38.? with co morbidity of high bp arthritis and borderline diabetes, hope this helps, good luck jeani

[sleevegenie 0]

if you are denied d/t investigational they will send you the info about the IMR (independent medical review) i faxed them my appeal letter and it took about 5 weeks to find out i won, good luck jeani