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Feeling Frustrated and Disappointed...



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After years of research and finally making up my mind to make the choice to improve my quality of life. I am starting to feel this will NEVER happen..and I am bombed about it. I have been waiting for this surgery for years now. I did my research and decided on which I wanted and I made up my mind do have gastric bypass. At the time the insurance I had did not cover bariatric surgery. I swicted jobs a few years later and FINALLY the ins co I had would cover... I made up my mind to have surgery! I called my insurance company to see what was necessary I was told that my plan did NOT require the supervised weight loss. My surgeon's office was told them same thing. In January 2015 I was diagnosed with early stage breast cancer, so of course wls was put on the back burner. I am over that and all healed up so I go back to my weight loss journey. I get to one of my last appts last week (Nutrition) and was advised that I my insurance requires me to be on a 6 mo medically supervised weight loss plan...WHAT?!!!!! I know that a lot of people have to do this so when I 1st called my insurance company to see what was necessary I specifically asked that question and I was told that my plan did NOT require the supervised weight loss. My surgeon's office was told them same thing. I really wanted to get this done this year because I have met my annual deductible and the surgery would be covered by my insurance co 100%. ..a 6 month diet plan means I wont be done until December. Which will probably push my approval (surgery) into 2016..I can not afford to pay the high deductibles and fees. I am sooo disappointed and hurt. I was really beginning to accept this was going to happen...I am crushed...devastated!! I just want off this ride. Hopefully something can be worked out somehow...but if not...I am afraid that the "life" I have now is what is as good as it is going to get. has this happened to ANYONE else or does anyone know about how long the approval process takes???

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All the appointmentsame for Dr visits to see even if you were eligible, orientation, nutrition and even a couselor appointment all count as part of your be months if they weighed you every time which they all do. So think back to when you first started talking about it with your Dr and it is probably noted in your records of the surgery and current weight.

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I head told I had no wait also, but my BYN dr has guide lines so I went from December 2014 to May 6 2015 b4 I got mine I had so many test done that the dr required b4 surgery it took a long time I was ready to give up and my day was here. I say talk to the Dr you first saw and see if he can help you with your insurance problem I bet he will. Good luck

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I was able to get mine done in 4 months as long as you have documintaion from like weight watchers etc I did all my dr appt and gave my journals was approved by ins in 2 days my process started in April and my Surgery was Aug 4th

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    • 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. 
       
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    • 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.
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    • 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! 🤣
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    • 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 
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    • BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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