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BCBS State (Tennessee) & 6 mos diet plan...have ?s



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Hello, I am new here. I have decided to have the sleeve surgery and it seems my insurance (BCBS) is requiring me to do the 6 month conservative therapy documented by my doctor and be at 40 bmi or greater. They also state "Failure of conservative therapy is defined as an inability to lose more than ten percent of body weight over a six-month period and maintain weight loss." So at 268 lbs, during the next 6 months I cannot lose more than 26.8 lbs, but actually I can't go below 248 to keep my bmi at 40. Every diet I have ever attempted always results in a 10 lbs weight loss in the first 2 weeks because I know most of it is Water weight.

Does anyone here have the BCBS of Tennessee insurance? I am a state employee, so it is actually BCBS "State" which is a little different than the regular insurance. I'm looking to hear your story. Did you have any problems getting approved? How long did it take to get approved? I am hoping to have my last PCP 6th month visit in July. I need to try to have the surgery by August because I am going on a cruise in October and my doctor doesn't want me traveling out of state, much less out of the country, for at least one month after my surgery.

Thanks!

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Can't help with your question but we have same surgeon so wanted to say hello! My surgery is Friday!

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I have Regence Blue Shield and had to do the 6 months of visits also. My nutritionist told me that she submits the weight I was at the beginning of the visits, not what I am at the time of the submission. I asked her if people get denied because they lose too much weight in that 6 month period and she said she had never seen that happen. I would ask your doctor's office what their experience is with your insurance and see what they say. I was 287 at the beginning and 268 at the time of submission. Still higher than the BMI requirement that my insurance has though.

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    • LeighaTR

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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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