I’m month 5 in to this medically supervised weight loss and have lost weight up until this month I gained a pound...anyone know if that will disqualify me? My PCP said she is almost positive that it won’t and said the insurance company just wants to see a loss overall.

Just getting frustrated because initially my insurance company said they didn’t even have any supervised weight loss requirements (I was told this on multiple occasions when I called) but when the surgeons office submitted the paperwork I wasn’t approved and was told I needed to.

I have lost a total of 35 pounds since August started the process and have only gained this one month...I am devastated...my patient navigator is no longer employed with the doctors office and they didn’t give me a new one so now I have no one to talk to about my concerns.

I went to the seminar in July and got my referral from reg doc to start the program. My first dietitian appt was in August 2017. I also had to see the surgeon that month to be in he program. All was out of pocket until November 217. But some things are not covered at all by insurance so had about $450 out of pocket in December 2017 but that also covers the first year of seeing the dietitian, fitness person and nurse ,,, all who are working with the dr in the program. Only took 8 days to get my approval from insurance.. but I’m one of those kind of people who get things done before I’m asked which turned out well, because the insurance asked for ekg and chest X-ray due to my age but I had done then the day before they asked for it. I have a new reg doc and she was on board with this from day one and had already ordered those things. Yeah!!!! What I paid out of pocket is nothing compared to the happiness of the next chapter..... I know I will be sore after the surgery but I also know it will be worth it ...

1 hour ago, deana63 said:

Congratulations!! I know you must be really excited to finally get a date Hopefully I won’t be that much further behind you… I’ll be thinking about you and saying a few prayers on the 30th that everything goes well and you recover quickly… I too am lucky I only needed To lose 100 pounds.

Thank you,,, I’ll keep you in my prayers that you’re will be very soon as well... when the nurse called me at work to tell me, I think she was more excited than I was!! Lol she said the best part of her job is letting people know that they are approved. She has also had the bypass and I like that she can relate to what we are going through. I had to giggle because I told her I didn’t really want the 31st as it was a full moon lol but I would take any day they would give me.

Please keep in touch! I will watch to see how things are coming along with you. ?

I just turned 54 last month so it’s nice to know we aren’t all spring chickens... lol. I am so ready for this...I have been working all but 4 days a month so I can afford to take a month off. I have short term disability but it takes forever to start getting a check it seems like.

On 1/20/2018 at 2:04 PM, deana63 said:

I just turned 54 last month so it’s nice to know we aren’t all spring chickens... lol. I am so ready for this...I have been working all but 4 days a month so I can afford to take a month off. I have short term disability but it takes forever to start getting a check it seems like.

I just turned 57 on 1/12.. would have loved to have had my surgery that day but this will be close enough. ? I’ve been working every Saturday to store up some time to have a week off, no vacation time until April ... but I’ve talked to several people who’s had the surgery and was able to go back to work after a week... including the nurse.. I’ll be taking naps on lunchtime I’m sure lol ...

Are you having the RNY? I would love to be back to work in 2 weeks! I am a registered nurse (midnight pediatric so I am off my feet most of my shift and have a room I can go lay down in) and am seriously debating on just taking a “vacation” instead of a medical leave. I have short term disability but it can take forever for checks to start coming in.

1 minute ago, deana63 said:

Are you having the RNY? I would love to be back to work in 2 weeks! I am a registered nurse (midnight pediatric so I am off my feet most of my shift and have a room I can go lay down in) and am seriously debating on just taking a “vacation” instead of a medical leave. I have short term disability but it can take forever for checks to start coming in.

Yes.... I used to be a hospice nurse,,, but years ago injured by a patient but now have a “mostly” desk job out of the medical field.. I live only 2 miles from work so it shouldn’t be so bad. Be careful about the disability pay, they may not think of this as disability issue...

i get a hour lunch so may nap in car or see about leaving a hour early until I have more energy.. ?

I am not worried about qualifying for that we have had ladies get eye and carpal tunnel surgeries and they paid out...just took a while...I pay extra for the short term and long term policies. I would prefer to be back in a couple of weeks anyway though because I love to work...and I know I would be better off working because I won’t just lay in bed and sleep and get dehydrated...not to mention having 4 other nurses right down the hall at work.

Yes,, I agree. I’d rather be working and I think that will keep the energy levels up... I have a love/hate relationship with my printer. I’m the only one in office who’s printer is completely across the room from my desk.. but as much as a hassle it is to keep getting up to go to it,,, it is exercise lol. I will only have one week off.

Can’t wait to hear how you do with your surgery....keep your fingers crossed for me...hoping to hear back from insurance company tomorrow...they only told the hospital they wanted my sleep study and BIPAP settings as well as my A1C results and that was faxed on Friday afternoon. At least it wasn’t denied

Yes!!! I will be and look forward to hearing the great news!!! I was lucky that my insurance updates online throughout the day for the doctors offices so the nurse got the program was able to check throughout the day.. once the got my ekg and chest X-ray it was only about 20 mins before she called me back... ?

So the navigator called me today but she didn’t leave a message… I sleep during the day because I work nights.Now I have to wait till tomorrow morning to find out what she was calling me for

I honestly needed this six months to get all the appointments and tests in that are required. It seems like I have appointment every week, sometimes two, for the next 6 weeks.

My insurance requires at least 6 months of nutrition visits and 3 Trainor visits, I'm on month 4 my nutritionist isn't worried much about weight loss just maintain and not gain. I've lost a couple pounds which for me is good, Having PCOS and being insulin resistant makes it hard. I was told last visit they are waiting for my psychiatric evaluation to come back then everything will be sent to my insurance for approval. Good luck!!

5 minutes ago, star2017 said:

My insurance requires at least 6 months of nutrition visits and 3 Trainor visits, I'm on month 4 my nutritionist isn't worried much about weight loss just maintain and not gain. I've lost a couple pounds which for me is good, Having PCOS and being insulin resistant makes it hard. I was told last visit they are waiting for my psychiatric evaluation to come back then everything will be sent to my insurance for approval. Good luck!!

We are almost identical! I have PCOS and insulin resistance, we're very close in height and weight. I am also planning on the sleeve. My six months are not up until April. I had my exercise consult today. Nutritionist next week, EGD week after that, sleep study, primary and EKG the next week, exercise follow up the week after that. I will say that the athletic trainer I met with today was very positive and I left feeling excited.

14 minutes ago, Jerseygirl4523 said:

We are almost identical! I have PCOS and insulin resistance, we're very close in height and weight. I am also planning on the sleeve. My six months are not up until April. I had my exercise consult today. Nutritionist next week, EGD week after that, sleep study, primary and EKG the next week, exercise follow up the week after that. I will say that the athletic trainer I met with today was very positive and I left feeling excited.

That's awesome!!! PCOS and being insulin resistant is such a pain I also have a leaky heart valve so I had to get clearance from cardiologist and did all the required testing. I'm thinking if all is approved my surgery will probably be the end of Feb or sometime in March. It's been a long road but worth it!! Good luck on all your testing, you've got this ?