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Hi I only need my last visit then my file will be submitted?!just want know has anyone got denied with the insurance i have now?! Highmark bcbs pittsburgh...

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Hi I only need my last visit then my file will be submitted?!just want know has anyone got denied with the insurance i have now?! Highmark bcbs pittsburgh...

Hello!! Yes I was but my bmi was 42. If your bmi is 50 or over you will be fine. If not prepare to fight for it. But it will be worth it bcuz my surgery is this Tuesday, June 26th!!

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Congrats...could you pls tell me what u did to get approved?! I live in dallas tx btw...or could u give me any hints...pls i dont want the gastric bypass...why reroute my insides when i could just get a partial of my stomach removed :)...

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I did an expedited appeal which you have to get a letter from your doctor to send with it to get a response in 3 days. Of course they denied that. Then I had to do an external appeal with an IRO (Independant Review Organization) and they approved it so now Highmark has to pay for surgery. If you have to do an appeal just make sure you put a lot of medical facts in your letter & state your case as to why the vsg is better for you than rny or the band.

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Oh god...so i have to write a letter saying why i should get the sleeve...does it have to be prefect?! Like as in proof read and correct spelling, punctuation marks and the whole writing thing with foot notes and printed out on white paper?!..or just note book paper and a pen..do u have any websited where i could get ideas from nd what IRO the one in texas or does ot matter what state?!

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Okay now i get it....what ur sorta talking about ...i read the form(IRO)...after my first denial ill then send my paper wrk to the IRO... I was so clueless becuz ive never dealt with insurance or had any surgery done what so ever...im not gonna worry so much about it...i have faith :)

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Yeah I had no clue what I was doing either. Let me know if u have anymore questions.

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I have to go with the bypass becuz my ins coord said its the ins policy,not only tht but i wasted my tyme there...The surgeon tht was goin to do my surgery doesnt do bypass...if it wasnt for this forum and some research i would still be goin with no worries...thank god i found out..

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I found another surgeon who is going to do what he can to get me approved for the sleeve...i wanted to ask you did u do the supervised excerise for 6months...?! Or just the nutrition diet thingy?!

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    • LeighaTR

      I am new here today... and only two weeks out from my sleeve surgery on the 23rd. I am amazed I have kept my calories down to 467 today so far... that leaves me almost 750 left for dinner and maybe a snack. This is going to be tough for two weeks... but I have to believe I can do it!
      · 0 replies
      1. This update has no replies.
    • Doughgurl

      Hey everyone. I'm new here so I thought I should introduce myself. I am 53y/o and am scheduled for Gastric Bypass on June 25th, 2025. I'm located in San Antonio, Texas. I will be having my surgery in Tiajuana Mexico. I've wanted this for years, but I always had insurance where bariatric procedures were excluded. Finally I am able to afford to pay out of pocket.  I can't wait to get started, and I hope I'm prepared for the initial period of "hell". I know what I have signed up for, but I'm sure the good to come will out way the temporary period of discomfort and feelings of regret. I'd love to find people to talk to who have been through the same procedure or experience before. So I look forward to meeting you all. Hope you have a great week!
      · 0 replies
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    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. LeighaTR

        I hope your surgery on Wednesday goes well. You will be able to do all sorts of new things as you find your new normal after surgery. I don't know this from experience yet, but I am seeing a lot of positive things from people who have had it done. Best of luck!

    • Alisa_S

      On day 4 of the 2 week liquid pre-op diet. Surgery scheduled for June 11th.
      Soooo I am coming to a realization
      of something and I'm not sure what to do about it. For years the only thing I've enjoyed is eating. We rarely do anything or go anywhere and if we do it always includes food. Family comes over? Big family dinner! Go camping? Food! Take a short ride or trip? Food! Holiday? Food! Go out of town for a Dr appointment? Food! When we go to a new town we don't look for any attractions, we look for restaurants we haven't been to. Heck, I look forward to getting off work because that means it's almost supper time. Now that I'm drinking these pre-op shakes for breakfast, lunch, and supper I have nothing to look forward to.  And once I have surgery on June 11th it'll be more of the same shakes. Even after pureed stage, soft food stage, and finally regular food stage, it's going to be a drastic change for the rest of my life. I'm giving up the one thing that really brings me joy. Eating. How do you cope with that? What do you do to fill that void? Wow. Now I'm sad.
      · 1 reply
      1. summerseeker

        Life as a big person had limited my life to what I knew I could manage to do each day. That was eat. I hadn't anything else to look forward to. So my eating choices were the best I could dream up. I planned the cooking in managable lots in my head and filled my day with and around it.

        Now I have a whole new big, bigger, biggest, best days ever. I am out there with those skinny people doing stuff i could never have dreamt of. Food is now an after thought. It doesn't consume my day. I still enjoy the good home cooked food but I eat smaller portions. I leave food on my plate when I am full. I can no longer hear my mother's voice saying eat it all up, ther are starving children in Africa who would want that!

        I still cook for family feasts, I love cooking. I still do holidays but I have changed from the All inclusive drinking and eating everything everyday kind to Self catering accommodation. This gives me the choice of cooking or eating out as I choose. I rarely drink anymore as I usually travel alone now and I feel I need to keep aware of my surroundings.

        I don't know at what point my life expanded, was it when I lost 100 pounds? Was it when I left my walking stick at home ? Was it when I said yes to an outing instead of finding an excuse to stay home ? i look back at my last five years and wonder how loosing weight has made such a difference. Be ready to amaze yourself.

        BTW, the liquid diet sucks, one more day and you are over the worst. You can do it.

    • CaseyP1011

      Officially here for a long time, not just a good time💪
      · 0 replies
      1. This update has no replies.
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