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Frustrated

EJamiFan

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EJamiFan    7

EJamiFan
Posted

Once I make up my mind I am all about getting things done. I am beyond irritated with the process of getting approved for surgery. I have completed my psych eval and met with the nutritionist. Dr wants a sleep study before surgery. As far as I can tell it is the Dr requesting and not an insurance issue. I was fine having it done until my insurance denied it, saying I don't meet the required criteria. Honestly I think the nurse of my primary care Dr didn't know what she was doing when she tried to get the precertification. She called me last week asking why I needed it, I explained the issue and she misunderstood and thought I wanted to do the sleep study it just to have the test. I told her I have had sleep apnea symptoms for years and that is why the surgeon wants the test ran but I think she still mucked the process up. Sorry to be so negative, but I am upset about it. I emailed the surgery center to let them know that my insurance will only cover an at home pulse ox monitor test, hopefully that will be good enough.

I am stressed about qualifying for surgery. I have BCBS, which is good, but my BMI is in the 38-39 range. I have HBP, takes meds for it and borderline diabetes. I know with comorbidities I could qualify with less than 40, but I'm not sure if they would consider the borderline diabetes or not.

My consult is next Thursday, I guess I will find out soon, just stressed about it all and am worried I won't qualify. I have spent the better part of 20 years obese. Diets worked to bring my weight down, but I never seemed to have enough willpower to stay on them once I lost the initial 50 lbs or so.

Thanks for "listening" to me vent.

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LaceSleeve    76

LaceSleeve
Posted

I know how you feel. Took me 2 years to get approved, worried the whole time I wouldn't qualify. But eventually I did, and it was all worth it. Keep your head up and don't give up, you won't regret it, I never have regretted the struggle to get approved :) good luck with your journey.

DrmBig4Evr reacted to this

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LaceSleeve    76

LaceSleeve
Posted

Don't feel bad, stories are different but they can be just as frustrating :) it helps to vent none the less.

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Lisa's Hope    421

Lisa's Hope
Posted

Don't feel bad. Just keep on trying to get approved no matter how long it takes. My insurance denied it out right and said it was one of their exclusions. I had no choice but to borrow the money and self pay for the surgery myself. I meant I was going to do this no matter what. I'm still making payments but don't regret it at all. So, keep trying. Don't give up. I think you will get approved. Even with me being self pay, I still had to jump through a lot of hoops to get the surgery. It is just a process and sometimes a looonnng process. Good Luck! :)

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vlb4vols    16

vlb4vols
Posted

EJamiFan .... The exact same thing happened to me! After I didn't qualify for a sleep study (only the home study) my Sleep Dr. wanted me to stay over night to be "titrated" for my sleep Apnea machine ... I waited till 2 weeks for my apt. and they called me and said my insurance would only approve me to have a self pap from a company to take home myself .... I called my Dr.s office after my home study was read and they went ahead and sent my information in for approval based on the diagnosis of Apnea ... I have a BMI of 40.7 anyway. Maybe your Dr. will do the same...it only took 3 days for my home study to be read.

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vlb4vols    16

vlb4vols
Posted

I go Friday to pick up my Cpap machine but already heard back from my Insurance with approval for a surgery date of April 25th :)

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EJamiFan    7

EJamiFan
Posted

Thanks for the info! I am sure I am stressing too much about it. Kind of had a crappy day and I have been down about the possibility of it not happening, or not as soon as I would like it to.

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vlb4vols    16

vlb4vols
Posted

II was so frustrated I cried about it ... I felt like if I had just kept my mouth shut about maybe having sleep Apnea I would have been approved a month ago but it all worked out ... Be sure to ask if they will go ahead and submit your Approval when your home study gets read :)

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EJamiFan    7

EJamiFan
Posted

Oh wow, I have thought the same thing about writing down apnea symptoms on my paperwork.

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EJamiFan    7

EJamiFan
Posted

OMG!!!! So excited! Got my insurance approval! Now just waiting for surgery center to get me scheduled!

Home sleep study went well, PCP said I passed. Very glad I won't have to do the in lab one.

Can't believe I could be having surgery soon!!! Pinch me!

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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      Question for anyone, how did you get your mind right before surgery? Like as far as eating better foods and just doing better in general? I'm having a really hard time with this. Any help is appreciated 🙏❤️
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      1. NickelChip

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        I had about 6 months between deciding to do surgery and getting scheduled. I came across the book The Pound of Cure by Dr. Matthew Weiner, a bariatric surgeon in Arizona, and started to implement some of the changes he recommended (and lost 13 lbs in the process without ever feeling deprived). The book is very simple, and the focus is on whole, plant based foods, but within reason. It's not an all or nothing approach, or going vegan or something, but focuses on improvement and aiming for getting it right 80-90% of the time. His suggestions are divided into 12 sections that you can tackle over time, perhaps one per month for a year if a person is just trying to improve nutrition and build good habits. They range from things like cutting out artificial sweetener or eating more beans to eating a pound of vegetables per day. I found it really effective pre-surgery and it's an eating style I will be working to get back to as I am further out from surgery and have more capacity. Small changes you can sustain will do the most for building good habits for life.

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        That sounds awesome. I'll have to check that out thanks!

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