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May bubble got busted a while ago

wannaBthinsoon

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wannaBthinsoon    1,634

wannaBthinsoon
Posted

I started this journey last April. Knowing full well that my hubs insurance did not cover WLS. I quit smoking. I had a sleep study and was diagnosed with sleep apnea, and now use a c-pap. I went on a 6 month PCP supervised diet, which was just completed in time for my new insurance to be in effect. Someone I work with told me UHC will require ANOTHER 6 month PCP supervised diet once I have the insurance, beginning in January. WHY?? How does that make sense? The doctor kept record, he kept notes. I kept a food journal. I weighed in each month without fail. WTF?!! Am I worrying for no reason? I contacted the bariatric hospital who works directly with my insurance, and they said that since I did all this (already) I would only need 3 additional appts to be submitted for approval. But my heart is broken thinking I will have to start back at square one. That could damage my attitude beyond repair. Anyone out there know???

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CanyonBaby    1,852

CanyonBaby
Posted

Oh what a heartache, and I can seriously feel your frustration. I actually did self-pay since I knew that my insurance (who demanded 6 month nonsensical pre-crap "We're not gonna let you do it anyway" )would bail out last minute after I did everything. They do that- mine does, anyway. So we dug around and financed it ourselves, cuz it is worth every penny. But hang in there, I firmly believe everything happens for a reason and in the time it was meant to happen, even though we may not be able to see the reason now. If you can, be patient and try to focus on the after-life once your surgery is done. Start planning what you can do, where you can go what you will wear once it's all said and done. In the meantime, continue on as you have been, and know that it'll help all you have already done. Good luck to you and Merry Christmas!

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athena3127    199

athena3127
Posted

If i were in your shoes u would continue with the monthly dr visits... Even I the insurance requires only 6 then you won't be missing any and will have extra. Keep doing what your doing. All insurances are different and I would suggest talking with the surgeons office who will be doing your work. Although I had to have the special 6month dr monitored diet as well my dr had a specific form that had all the specific information. Which my insurance required. Check with you surgeon... They should be able to help you even in advance of coverage so that you will know whAt will be required. Head up and stay positive. If it's ment to be it will be....

Hugs of support

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wannaBthinsoon    1,634

wannaBthinsoon
Posted

Verdict is, UHC says I meet all requirements, and all I have to do now is meet the Bariatric center requirements and set a ,date! So I need to do the psych eval, EGD, dietitian appt and nutrition class. Then it all gets submitted for approval. I was told by UHC that she expects I'll be approved in the next month or so. YAY!!!

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patienceisavirtue    1

patienceisavirtue
Posted

I'm new here and your post was the first one that I read. I'm SO EXCITED FOR YOU!!! I know the insurance companies make us jump through so many hoops, and I know they have their reasons, but I feel like I have been preparing for this my whole life!

I bet you felt like you could jump ten feet in the air! Way to go!

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mykdzmom    387

mykdzmom
Posted

I read your initial post and my heart sunk for you. Going thru the 6 month myself now, I could only imagine how you felt. I am relieved to see you are still on track. Don't give up!!

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

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    • KeeWee

      KeeWee

      It's been 10 long years! Here is my VSG weight loss surgiversary update..
      https://www.ae1bmerchme.com/post/10-year-surgiversary-update-for-2024 
      · 0 replies
      1. This update has no replies.
    • Aunty Mamo

      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. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      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.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      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! 🤣
      · 0 replies
      1. This update has no replies.
    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
      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 
      · 0 replies
      1. This update has no replies.

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