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BMI and insurance approval

Hi there. I was banded in Oct. 2008, had a slippage/repair in August 2013, and am now looking for a sleeve conversion. I lost about 50# with the band over the last 7yrs (lost, gained back, lost again.... you know the routine). I have gained all but 13# back. Today was the first appointment with my surgeons office to get the process started. They unfilled my band and said I have to do the 6 months of appointments/supervision before I can set my date. I go for a. Upper GI tomorrow to check for another possible slippage as I have been having horrendous reflux issues. Today, my BMI was at 40. I do not have co-morbidities to do the 35 BMI approval. My concern is that with ANY weight loss in the next 6 months will put me under the 40. Does the insurance approval go by my starting BMI of 40, that I am today, or whatever I end up with if I lose weight at the end of the 6 months?

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860971

Sent January 7, 2016 - 11:52 PM

I am married and a mother of 4 ages 15-23. I am Having my surgery in Milwaukee Wi on the 14th of January. I have only told a handful of people that I am having the surgery. Would love to keep in touch.

860971

Sent January 8, 2016 - 9:47 AM

I am sorry if you sent me a message it didn't come across. May have been my fault. New to this site today. Still learning how to navigate this website. Please be patient with me.

LosingLily16

Sent January 8, 2016 - 7:47 PM

Oh I would love to keep in touch. I'm single mother of an 8 year girl I adore and hope to teach the correct way to eat. I could cry thinking she's have the same problem as me. So hopefully I'll have the tools to protect her as much as I can. I live in queens New York and as you know January 13. Yeah

860971

Sent A minute ago

Having a hard time swallowing. Doc says it is because my esophagus and entry to the stomach is swollen from the surgery. The sleeve went very well. Didn't cheat on the preop diet and list 13 lbs. my doctor said my liver looked great and it made it easier for him to do the surgery.

← My Conversations

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860971

Sent January 7, 2016 - 11:52 PM

I am married and a mother of 4 ages 15-23. I am Having my surgery in Milwaukee Wi on the 14th of January. I have only told a handful of people that I am having the surgery. Would love to keep in touch.

860971

Sent January 8, 2016 - 9:47 AM

I am sorry if you sent me a message it didn't come across. May have been my fault. New to this site today. Still learning how to navigate this website. Please be patient with me.

LosingLily16

Sent January 8, 2016 - 7:47 PM

Oh I would love to keep in touch. I'm single mother of an 8 year girl I adore and hope to teach the correct way to eat. I could cry thinking she's have the same problem as me. So hopefully I'll have the tools to protect her as much as I can. I live in queens New York and as you know January 13. Yeah

860971

Sent A minute ago

Having a hard time swallowing. Doc says it is because my esophagus and entry to the stomach is swollen from the surgery. The sleeve went very well. Didn't cheat on the preop diet and list 13 lbs. my doctor said my liver looked great and it made it easier for him to do the surgery.

Finally one week post surgery and I was able to sleep 9 hours straight thru drug-free. Woke up this morning feeling normal. Was able to drink almost pain free. Did eat some egg drop soup. Its liquid right? Egg=protein. I have a doctor appt tomorrow. Hopefully moving to the pureed phase. I see crab-legs, salmon, cottage cheese, opens things up a lot.

  • Author

Finally one week post surgery and I was able to sleep 9 hours straight thru drug-free. Woke up this morning feeling normal. Was able to drink almost pain free. Did eat some egg drop soup. Its liquid right? Egg=protein. I have a doctor appt tomorrow. Hopefully moving to the pureed phase. I see crab-legs, salmon, cottage cheese, opens things up a lot.

So glad to hear you are doing well!! I wouldn't have thought of egg drop soup, but I like that!! :)

Well had my 1 week post op appt. my blood pressure was 120/78. Yea! Can't tell you the last time it was "normal" . My varicose veins do not bulge anymore and they are not glowing blue/purple under my skin. So here is my progress so far. I am 5'7" when I scheduled the surgery in 11/15 I weighed 259. Jan 2, 2016 at start of the pre op diet I was 255. Day if surgery on jan 14, 2016 I was 243. At my 1 week post op appt. I weighed in at 230.4. I am more than happy with my results so far however, i realize I have been on such a low cal diet. I am finally in the puree stage of my recovery. I did have some crab for lunch about 1 oz. i did well with that. Tonite I am going to try 1 oz of hot ham and some mashed potatoes. Chewing the meat until it almost doesn't exist has been ok. I practiced that so much before my surgery. I do still want something to drink with my meal. That takes all of my will power. I think climbing Mt. Everest would be easier to learn than eating without drinking. I just need to remember that I am not putting too many calories into my smaller stomach so I can't drink and push it thru too fast. I need all the nutrients from the food I eat as Possible. Hope everyone is doing well on their journey to a healthy future.

I am new to this journey. Just this last week I called my insurance to ask what the qualifications are to have weight loss surgery. I am just above the 40 BMI so I asked the insurance's nurse case manager what happens if I lose enough weight during the 3 month required weight monitoring to put me under 40. She told me that they base the approval on the weight measurement from the initial visit, not the 90 days later. In fact, they want me to lose 5% during that 90 days. I highly recommend calling your insurance and asking them the questions, it really reassured me!

  • Author

I do still want something to drink with my meal. That takes all of my will power. I think climbing Mt. Everest would be easier to learn than eating without drinking. I just need to remember that I am not putting too many calories into my smaller stomach so I can't drink and push it thru too fast.

That is so hard. I struggle with drinking while eating meals. Very hard habit to break!!

Some of my puree meals; Noodles and Co Hot Pot in the food processor ( which I like better than how it is served at Noodles), stroganoff, and ham and mashed potatoes. I actually like the meals pureed. If you combine the right items you will enjoy it.

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