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After crying in my beef burrito, I'am back.



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I don't know if you read my post last week. After my go around with Kaiser.I not sure what do. For days I have been myself to just forget the whole thing just try again on own. Now I am starting to get my fight back on.. I am not sure which way to go, fight the under 40 BMI with my HP,HC fatty liver, or gain some weight plus put weights in clothes. What do you think is the best route?

NIH Requirements for Weight Loss Surgery

The National Institutes of Health (NIH), a division of the US Department of Health and Human Services, is considered one of the world's foremost medical research centers. The NIH has set patient criteria for weight loss surgery which states that eligible patients should have a BMI of 40 or higher (morbidly obese) or a BMI of at least 35 with co-morbidities (obesity related health conditions) such as diabetes, sleep apnea, heart disease, high cholesterol, or hypertension (high blood pressure) and non-alcoholic fatty liver disease. Eligible patients must also have attempted and failed at previous weight loss efforts and need to pass a psychiatric evaluation to be recommended for weight loss surgery.

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I would say first thing to try is the appeal. The consider your other options.

I am sorry that you are having these issues with the insurance. I was sort of in same boat. I did not even attempt with the insurance because of my lower BMI and lack of comorbities.

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do you have co-morbidities? If so, I would reeapeal.

If not, kaiser has other really great weight loss programs you could look into. they have a medical weight management class (where to do meal supplements and so on) that is supposed to be really great. Just because they say you can't have surgery doesn't mean you can't lose weight.... it just may be in a different kind of program. Plus, if you try their other programs and your body does not respond, that gives them more reason to approve you for weight loss surgery as well.

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Appeal, and keep fighting. Self pay may be another option, think Dr. Aceves...

Do not gain weight in order to qualify for your program! That is counter productive and not good for your body!

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    • Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
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    • BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
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    • BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

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      I haven't been able to advance my diet past purees. Everything I eat other than tofu makes me choke and feels like trying to swallow rocks. They warned me it would get worse before it gets better, so lets hope this is all normal. I have my follow up on Monday so we'll see. Living on shakes and soup again is not fun. I had enough of them the first time!! LOL 
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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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