Hi all,

I am just beginning my exploration into bariatric surgery, and am trying to figure out the insurance logistics of it all. The BCBS RI website isn't very helpful besides to say the surgery is covered after my deductible. Does anyone know if they have the 6 month nutrition requirement? I have seen people from other states say the requirement has been removed from their BCBS, but nothing for RI. Also, what about all the preliminary tests and appointments? Are copays due for all those visits? I plan to go through Miriam hospital if I decide to do it. My initial consultation isn't until November and I am trying to research as much as I can before then.

25 minutes ago, briae13 said:

Congrats Subaru! & good luck itsmytime1985! Have my class for nut clearance next week and then waiting begins

It doesn't seem like there will be too much waiting. I've been calling Dr. Stafford's office every day to follow up on things and check on the status. (I've held off so far today, but it's haaaarrrrrrdddd!) It seems like some of my pre-surg testing has been scheduled. (I can tell from a lifespan notification that I received.) There must be a couple of other things they are scheduling because his office hasn't called to give me the appointment info yet. But I'll call later today....

(I'm terribly impatient and not a good wait-er.)

Best of luck at your class next week!

2 hours ago, Subaru said:

It doesn't seem like there will be too much waiting. I've been calling Dr. Stafford's office every day to follow up on things and check on the status. (I've held off so far today, but it's haaaarrrrrrdddd!) It seems like some of my pre-surg testing has been scheduled. (I can tell from a lifespan notification that I received.) There must be a couple of other things they are scheduling because his office hasn't called to give me the appointment info yet. But I'll call later today....

(I'm terribly impatient and not a good wait-er.)

Best of luck at your class next week!

UGH! The Drs office initially told me (2ce), once I get insurance approval they schedule me back with the surgeon and for pre-op testing and that surgery is typically within a month of that surgeon visit. Today I got my date for the pre-op testing (Dec 11) but won't see the surgeon until after that, probably on the 13th. (Initially they told me I'd likely do my pre-op visit with the surgeon within a week or so of getting insurance approval.) The coordinator in my surgeon's office is new, and different surgeons in the group do things a little differently, so I know she's giving me the best info she can at the time. But. UGH! Now I have a month of sheer waiting. And I'm so impatient!!

You'll get there@Subaru ! Just think of this time as some extra time to focus on the holidays and prepping for surgery focus on the prep and the things to get done during this busy season and before you know it the month will fly by! [emoji4]

10 hours ago, briae13 said:

You'll get there@Subaru ! Just think of this time as some extra time to focus on the holidays and prepping for surgery focus on the prep and the things to get done during this busy season and before you know it the month will fly by!

That's exactly what I'm trying to do! I can't exactly complain. I realized this morning that, while I waited two months for my initial consult, that appointment was on October 4, so it's only been a month and a half to get to approval. I'm going to try to stop whining. TRY!

Sooooo, because I can't seem to go a day without calling my Drs office, I called today just to make sure I understand what's what. Even though I don't see the surgeon until 12/13, it's still very likely they will get me in before the end of the year. (Apparently they aren't going to be very busy that week. Hah!) So, while I still am doing the hurry up and wait thing, I do have targets for all of the final steps. Yippie!

Hooray!! That's super exciting! I just STARTED my journey today with the first consultation. I'm excited for you @Subaru!

Side topic, do any of you RIers know if we're eligible for TDI after the surgery? My surgeon told me recovery time would be 4-6 weeks and at most I may have 3 weeks saved up by the time I have surgery.

58 minutes ago, ItsMyTime1985 said:

Hooray!! That's super exciting! I just STARTED my journey today with the first consultation. I'm excited for you @Subaru!

Side topic, do any of you RIers know if we're eligible for TDI after the surgery? My surgeon told me recovery time would be 4-6 weeks and at most I may have 3 weeks saved up by the time I have surgery.

Who is your surgeon again? Congratulations! There is a lot to do but it keeps you busy during the wait.

As far as TDI is concerned, as long as you are eligible for TDI you would be eligible to receive it while you are out for the surgery. You can’t apply for it until your actual surgery date, and it takes them about three weeks until they pay you. But they do pay you back to the first day. The delay is a drag, but it’s suoer helpful to have the added income. It is also not subject to employment taxes.

Dr Siva V through University surgical associates and miriam hospital.

Thanks for the info! I have plenty of time to look into it. But I do need to decide if I want sleeve of bipass. He told me he'd be ok with either for me unless tests found something we don't know about. Such big decisions!

14 hours ago, ItsMyTime1985 said:

Dr Siva V through University surgical associates and miriam hospital.

Thanks for the info! I have plenty of time to look into it. But I do need to decide if I want sleeve of bipass. He told me he'd be ok with either for me unless tests found something we don't know about. Such big decisions!

I have a friend who is seeing him for a bypass revision. He's supposed to be excellent!

From what I've read, the biggest decision points for sleeve vs. bypass are these:

-GERD/reflux (can be an issue with sleeve)

-Malabsorption

-Amount of weight to lose

-Dumping (which some consider a positive reinforcement to help keep one on track)

From a very general perspective, they both seem to be good options with great success rates so they key factors are (as they should be) which one is right for you and your particular health concerns. Best of luck in your search!

(Also, I forget if you've got to any of the group sessions at the Miriam. You'll have to attend at least 2. Info is on their website and you can go at any time. You don't need to wait.)

15 minutes ago, Subaru said:

I have a friend who is seeing him for a bypass revision. He's supposed to be excellent!

From what I've read, the biggest decision points for sleeve vs. bypass are these:

-GERD/reflux (can be an issue with sleeve)

-Malabsorption

-Amount of weight to lose

-Dumping (which some consider a positive reinforcement to help keep one on track)

From a very general perspective, they both seem to be good options with great success rates so they key factors are (as they should be) which one is right for you and your particular health concerns. Best of luck in your search!

(Also, I forget if you've got to any of the group sessions at the Miriam. You'll have to attend at least 2. Info is on their website and you can go at any time. You don't need to wait.)

Thanks for the breakdown, that seems to be the main differences I'd found so far too. I also want to look more into complications and recovery time differences. I asked people to weigh in on RNY vs sleeve on the Miriam success striders fb page too and am getting a lot of great feedback. People have negative and positives to say about both. There is no clear cut answer, I just need to figure out what is best for me. But even then you never know for sure how your body will react to things, so it's a guessing game to some extent.

I thought deciding IF I wanted the surgery was a big decision, but now deciding WHAT surgery is another big one! Sigh...

I did know that about the support groups, thanks! I went to one in September, but couldn't make October and will be away this month, so I'm shooting for December now!

3 minutes ago, ItsMyTime1985 said:

Thanks for the breakdown, that seems to be the main differences I'd found so far too. I also want to look more into complications and recovery time differences. I asked people to weigh in on RNY vs sleeve on the Miriam success striders fb page too and am getting a lot of great feedback. People have negative and positives to say about both. There is no clear cut answer, I just need to figure out what is best for me. But even then you never know for sure how your body will react to things, so it's a guessing game to some extent.

I thought deciding IF I wanted the surgery was a big decision, but now deciding WHAT surgery is another big one! Sigh...

I did know that about the support groups, thanks! I went to one in September, but couldn't make October and will be away this month, so I'm shooting for December now!

I've tried to join that group but so far I'm not in it I don't think. I'm going to look for it again and try!

And good luck as you weigh your decision!

Just an update: completed my nutrition class & no I just wait for approval! [emoji4] hope everyone enjoys a happy holiday season!

17 hours ago, briae13 said:

Just an update: completed my nutrition class & no I just wait for approval! hope everyone enjoys a happy holiday season!

Congratulations! As soon as I completed everything I called the surgeon's office to let them know, and once I knew they submitted to the insurance company I called insurance as well. It made me feel like I was doing something and that I knew where things stood. It also got me from "I finished my stuff" to "insurance approval" in three business days.

I hope you hear very soon as your holiday gift to yourself!

I'm approved! Just waiting to hear back about scheduling testing appointments [emoji4]

3 minutes ago, briae13 said:

I'm approved! Just waiting to hear back about scheduling testing appointments

That's fantastic!! Congratulations! Mine were scheduled about 4 weeks out (give or take). When are you hoping to go in for surgery? What all testing are they having you do? (I've got an EKG and an upper GI, plus blood work to be done within a week or so of surgery.)

Are you getting excited? I don't get nervous for surgery typically, but I'll admit I'm getting a bit nervous for this!