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I just received very bad news..... United Health Care TNCare has denied me to have the gastric sleeve due to my BMI being under 40 and my blood pressure is controlled with meds. Of course my BP is controlled with meds...what do they want me to do? stop taking my meds and have a heart attack???? This is awful. My surgeon now wants me to send a copy of my sleep study report that was done in 2014 and they will submit that with my paperwork and try again. I never knew it even mattered if your comorbidities were controlled by meds or not. Any suggestions or info is greatly appreciated at this point. I am sooooo upset. I have done everything that has been asked of me ...jumping through hoop after hoop and now this. I am 5'2" and currently weigh 203 lbs with a BMI of 37.1 if have high blood pressure, sleep apena, GERD.

:(

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I know this is all new to you and is extremely upsetting, and I am sorry you are having to go through this right now.

However, I bet this is not your bariatric surgeon's first denial for one of his patients. His office will have a "plan B" ready to go for you. --like the one they suggested and is working on--the sleep study.

Talk to the office Medical Secretary/co-ordinator. She/he will be the person "in the know" about this.

It probably won't, but if "plan B" should fail, then a "Doctor to Doctor" direct phone call will get the approval.

You have had another hoop to jump through, and I'm sorry about that. Just remember that the people who approve or deny procedures sometimes are not doctors or sometimes they are not even medical people. Sometimes their expertise is in finance. Sad but true.

Try (I know that's a huge task right now) not to worry. Let this play out.

Prayers going up for you!

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How low was your BMI? When I went in a few years ago 2011, the BMI was 35. I was told that was going to be lowered (I guess so more people would be able to get the lapband).

haven't heard anything since.

Or it could be your insurance specifically?

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I'm at a 38bmi and am 5'. I have not been submitted yet but my doctor had completely reassured me as long as I didn't go below 35 I'd be just fine.

I'm sorry your going through this. This whole even is emotional enough. I wish you luck the second time around and hope they find a way to pass you this time.

I too am on maintenance meds for thyroid, herniated discs and gerd.

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I know this is all new to you and is extremely upsetting, and I am sorry you are having to go through this right now.

However, I bet this is not your bariatric surgeon's first denial for one of his patients. His office will have a "plan B" ready to go for you. --like the one they suggested and is working on--the sleep study.

Talk to the office Medical Secretary/co-ordinator. She/he will be the person "in the know" about this.

It probably won't, but if "plan B" should fail, then a "Doctor to Doctor" direct phone call will get the approval.

You have had another hoop to jump through, and I'm sorry about that. Just remember that the people who approve or deny procedures sometimes are not doctors or sometimes they are not even medical people. Sometimes their expertise is in finance. Sad but true.

Try (I know that's a huge task right now) not to worry. Let this play out.

Prayers going up for you!

Thanks so much

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How low was your BMI? When I went in a few years ago 2011, the BMI was 35. I was told that was going to be lowered (I guess so more people would be able to get the lapband).

My BMI is 37.1

haven't heard anything since.

Or it could be your insurance specifically?

Hopefully plan B will work

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I hope plan B works for you. If not, Mexico is a wonderful alternative. My insurance wouldn't consider covering my surgery at all and my bmi was 57. So I did some solid research, found a respected company in Mexico and paid out of pocket.

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      · 0 replies
      1. This update has no replies.
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      1. Selina333

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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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