Please Help!! Newbie Onboard

[time4achange 0]

First, I want to say, I been lurking behing the seen for quite sometime. I see how everyone is so supportive, and I hope to have the same support system. I have a few questions and concerns.

I had decided on lapband, until I stumbled across this site and started learning more about the sleeve. I am completely sold and I have all of you to thank for saving me from making the wrong decision.

I am so nervous and scared, just praying everthing work out.

The good thing is I had my last Psych. visit today, and I am scheduled for Surgery Nov.3 YAY!!!!

I am in Raleigh Nc, my Doc is Jin Yoo, with Duke Hospital. Is it normal not to have a pre-op diet? I was told it was not required. Also, is it hard to maintain on the post-op liquid diet? My biggest fear and question is, how long after surgery can a leak occur?

I have Empire BC/BS of New York, has anyone been approved through them? My Doc said to let them handle that and it should not be a problem.

Thanks for listening and for the help.

Thanks you my new family!!!

[standing firm 0]

First, I want to say, I been lurking behing the seen for quite sometime. I see how everyone is so supportive, and I hope to have the same support system. I have a few questions and concerns.

I had decided on lapband, until I stumbled across this site and started learning more about the sleeve. I am completely sold and I have all of you to thank for saving me from making the wrong decision.

I am so nervous and scared, just praying everthing work out.

The good thing is I had my last Psych. visit today, and I am scheduled for Surgery Nov.3 YAY!!!!

I am in Raleigh Nc, my Doc is Jin Yoo, with Duke Hospital. Is it normal not to have a pre-op diet? I was told it was not required. Also, is it hard to maintain on the post-op liquid diet? My biggest fear and question is, how long after surgery can a leak occur?

I have Empire BC/BS of New York, has anyone been approved through them? My Doc said to let them handle that and it should not be a problem.

Thanks for listening and for the help.

Thanks you my new family!!!

[

I am a newbie too, my sleeve surgery is scheduled for next Tuesday. I have heard mixed thoughts on the pre-op diet, but I am glad i am doing something because I am trying many different brands, etc. on Protein shakes to see what is the most tolerable. I have a huge gag reflux and I am not a big fan of milk, so I have had a harder time discovering a shake I like, but I am no longer gagging when i drink them so that is good news. I have BC?BS of Illinois and so far they have been great and approved my sleeve, I do have a BMI of 40, sleep apnea, pre-diabetes, high blood pressure, and high cholesterol, so I am a little nervous about the upcoming surgery, but I also have a peace. Good luck to you!

[Oregondaisy 2,019]

I didn't have to do a pre op diet. Some doctors want one if you have a super high bmi to shrink the liver some before surgery.

I would advise you to go to the food forum and look for a post on where to order samples. Don't buy a big container of anything yet. If you have a GNC, you can sometimes buy samples there.

I didn't find the post op diet hard.. I was so happy to be losing weight every day and I was never hungry.

There was someone who just posted that they got a leak at 3 weeks post op. Leaks are rare though. Just follow your doctor's instructions on the post op diet so you don't put any pressure against your staple line.

[TexasT 99]

If you have a Vitamin Shoppe near you, they will let you return anything you buy that you don't like (Protein shakes, etc.). That was really nice to help find something I liked and not having to worry about losing money from keeping something I didn't.

I didn't do a pre-op diet because I was switching from band to sleeve. Just did liquids for a couple of days before to "clean everything out." Also, keeping up with the liquids post-op is not usually too hard. You're not going to be very hungry anyway post-op, so liquids is not a big deal for a first few weeks. I actually was very slow going from mushies to harder foods, making sure each new food was tolerated. You think now that you'll want to eat everything in sight, but it won't be that way. You'll be amazed how your relationship with food will change.

Best wishes and good luck!

[time4achange 0]

Thank you for the replies, at my psych eval I was asked about my support system, I told her that I will have vertical sleeve talk family as a big support system!! I have a BMI of 48. I am getting so excited, just hope my insurance don't damper my happinest!!

[M2G 1,836]

Congrats on your sleeve date, I hope the insurance part goes smoothly!

Much like you I was leaning towards the band and this site saved me from going down that path (that and my husband who is doing this too, and insisted I do more sleeve research.) You are lucky that you can actually schedule a date without being approved yet (did I read that right?)

Anyway, I did not have to do a pre-op diet per my surgeon. I did 6 months of weight monitoring through my insurance (UHC) and all of the hoops of course, but I was not required by either my surgeon or my insurance to lose any weight. My surgeon's office only requires a liquid diet for 24 hours pre-op, although all of my paperwork says 48 hours. So I went with what I had in writing even though everyone verbally says 24. I wanted to be cleared out, and honestly I was just ready to "get this show on the road." I didn't go crazy this week eating, and sort did low carb this week. It really has helped me to visualize food left over in my tummy when my surgeon is cutting (I know totally gross, but it helped me to work on sticking to plan!)

So I sit here sipping on my Isopure protien drink and Water, and realizing that I have less than 24 hours before surgery. I'll have to answer the post-op ? later...from the sounds of it I doubt it will be hard since you are mostly focused on healing.

[hapsterbrat 0]

hi! I'm new too, I'm rounding up for a December surgery.

I do work for a insurance company, and the coverage ins and outs are pretty complex. I would leave it up to them, but here's another good idea to try.

Call the insurance provider, get a customer service specialist, and ask them a few good questions.

1. What is the criteria for a obesity/bariatric surgery coverage?

2. Are there any exclusions listed for or about obesity surgery, bariatric surgery, gastric sleeve, lap band, or surgeries assosicated with weight loss? (tricky words but use each one as a individual question - TRUST ME)

As they attempt to explain the criterias or exclusuions to you, write them down, and ask for further clarity on each one your unsure of.

Once you've made this list, see if it applies to you, but make the facts list 1st. With that being said, the other option is to see if your plan offers this policy online, Cigna does, and it allowed me to know what the criteria was up front.

Let me know if I can help clarify more; I've worked in the insurance industry for more than 8 years (if I dont know, I can find someone who does).

[chiquitabananaz14 224]

hapsterbrat or anyone that know...please help

I have a question for you... I just recently got my benefits from my job and they are active as of November 1 and in the Exclusions and Limitations section of the benefit summary it has any weight management or surgery on the list. Does that mean I am totally S.O.L? Because the limitation part is giving me hope at this point. MY BMI is 45 and I definitely qualify but does the fact that it is on the list of Exclusions and Limitations mean that there is no hope to get VSG paid for through my insurance? I have Aetna Value Network ***. Please any help would really be appreciated, the whole insurance world is like a foreign language to me... thanks!

-mariela

[Oregondaisy 2,019]

If there is a WLS exclusion on your policy, it's doubtful that they will pay. My insurance booklet says no WLS

is covered for any reason. What is the wording of yours?

[chiquitabananaz14 224]

Oregondaisy~

I states that any weight management including weight loss surgery, appetite suppressants etc...even for the morbidly obese and people with co-morbid conditions. So yea

I am basically SOL...I don't get why employers exclude that out of their insurance packages, I get that it saves them money but obesity is the number one killer in our country...that should be covered. I'm bummed but I am going to an orientation at kaiser on Monday because I found out my husbands insurance will cover it, I'm just scared because he works construction and when work is slow the benefits get cut off. I hope I can get the ball rolling and I hopefully get the surgery before then.

what is your plan since WLS is not covered for you?

[feedyoureye 3,087]

Oregondaisy~

I states that any weight management including weight loss surgery, appetite suppressants etc...even for the morbidly obese and people with co-morbid conditions. So yea

I am basically SOL...I don't get why employers exclude that out of their insurance packages, I get that it saves them money but obesity is the number one killer in our country...that should be covered. I'm bummed but I am going to an orientation at kaiser on Monday because I found out my husbands insurance will cover it, I'm just scared because he works construction and when work is slow the benefits get cut off. I hope I can get the ball rolling and I hopefully get the surgery before then.

what is your plan since WLS is not covered for you?

Mine is stated like this:

Principal Exclusions and

Limitations

The following services and supplies are excluded or limited:

28) Weight control surgery or procedures including without limitation gastric bubble, gastroplasty, gastric bypass, gastric stapling, liposuction and HCG injections; and any Experimental Procedures for the treatment of obesity. However, Medically Necessary services as determined by WHA for the treatment of morbid obesity with Prior Authorization are covered.

At first it looked like I was SOL too, but my Dr. said my insurance is one of the easiest to work with! So call and check just to make sure it is NEVER covered. The last sentence in my exclusions wording is the "loophole".

Someone here will know better than me, but Im pretty sure that Kaiser has you do a 6 month supervised diet and other stuff... so you need to be on the plan for a while to get it done. However you might be able to be a single payer for a while between your husbands job coverage. It might be cheeper to self pay in Mexico in the end....AND you wouldn't have to wait so long to get it done. (just the little matter of saving up the $$$!!!)

Good luck in your journey... don't give up!

[jane 2]

First, I want to say, I been lurking behing the seen for quite sometime. I see how everyone is so supportive, and I hope to have the same support system. I have a few questions and concerns.

I had decided on lapband, until I stumbled across this site and started learning more about the sleeve. I am completely sold and I have all of you to thank for saving me from making the wrong decision.

I am so nervous and scared, just praying everthing work out.

The good thing is I had my last Psych. visit today, and I am scheduled for Surgery Nov.3 YAY!!!!

I am in Raleigh Nc, my Doc is Jin Yoo, with Duke Hospital. Is it normal not to have a pre-op diet? I was told it was not required. Also, is it hard to maintain on the post-op liquid diet? My biggest fear and question is, how long after surgery can a leak occur?

I have Empire BC/BS of New York, has anyone been approved through them? My Doc said to let them handle that and it should not be a problem.

Thanks for listening and for the help.

Thanks you my new family!!!

RE: 6Month Diet

+The six-month diet is a requirement for insurance purposes. HOWEVER, there are some doctors who require a patient with a BMI higher than 50 to lose weight and won't operate on them until they reach it. There are doctors who will work with patients over 50BMI and don't require the diet. However, it is helpful to keep in mind, that losing some weight before surgery does nothing but make your surgery that much safer. Also, it helps the liver shrink, which decreases the risk of the liver bursting during surgery.

RE: Insurance Coverage

My surgeon told me that VSG is NOT covered by many insurances because it is considered too "new" a procedure in comparison to the other WLS options. HOWEVER, he told me that he works out of what is called a terciary center, which means that his staff handles high risk morbidly obese people whose obesity is hard to treat. He stated that he has had much success in getting the procedure approved when it's medically necessary. My guess is that if you get a consultation with a good surgeon who can make the case for the necessity of your surgery, he and his staff will help you deal with your insurance.

I have CIGNA ***, which covers "weight loss benefits" and pays for the surgery if one goes through the hoops, but only if one gets the surgery done at a pre-approved "Center of Excellence." I heard that Blue Cross Blue Shield is one of the best insurances out there however, and it really shouldn't be a problem. Amazingly enough, a lot of doctors accept Medicare too for WLS. Basically it boils down to, "Does the cost of surgery outweigh the cost of maintenance of weight-related comorbidities?" and proving to the insurance that the answer is yes.

BTW, Duke is considered a good place to get the procedure done. Good doctors, good reviews and stuff.

[ImdownwithVSG 0]

I am in Raleigh and was just watching the news. Check this out.

http://www.wral.com/news/local/story/8700929/

[BZButterfly79 19]

Hi welcome and I hope you will find as I have(also a Newbie) support and information to help you through this transitional period as well as encourage you to keep heading towards the finish line. It sounds like you are in good hands at Duke, I have military insurance and therefore cannot speak for the one you have but my surgery is on Dec. 8 and I am also scared, excited, there is even some feeing of relief. Everyday of my life for the past eight years I have woken up praying that this is a nightmare that I am not as fat as I look and that I will wake up from this bad dream, of yo yo dieting, self-punishement, and whatever else other psycho bable word you can add to the equation. I have a chance now, I have a chance! Good luck to you and as Bob Marley said: "Every little thing, is gonna be alright!"