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NYC DOE Teachers - Having or Have Had Sleeve Surgery



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Hello!

I am new to the message board and am looking to get as much information and advice as I can, but also get relevant information to my experience and what I have before me.

I am a NYC DOE teacher, so I think our insurance is GHI CBP? I have spoken with insurance reps on the phone and they have confirmed that they cover the procedure at 100% (minus the $300 hospital copay and specialist/appointment copays) as long as you have a BMI of 40+ or a BMI of 35+ with a comorbidity. Has anyone else who is a teacher had this procedure and can confirm additional expenses or how it was to deal with the insurance? How long did the insurance take to approve you for the procedure?

I had some confusing information, mostly from just reading message boards online. I was under the impression that I would have to lose weight prior to the procedure, and I was concerned about this as I am right at the BMI of 40 threshold and do not have any comorbidities. I didn't know if losing would disqualify me from coverage. I have since heard that they actually want maintenance of your weight for 6 months, but is there any point where the insurance company requires you to lose weight or undergo a supervised diet/weight loss before surgery?

I attended an initial consultation with a surgeon on LI in October and then took some time to think things through - I am starting the process now with hopes that I will have the procedure done during the summer. I read a lot about so many fears but honestly mine are a lot more primal - I'm terrified of dying during the surgery, of having a stroke during and being incapacitated for the rest of my life, or of developing a major infection or negative side effect after. I have read some of the stories of people who have great surgery experiences but then develop serious complications months and years later. I feel like I'm just trying to quantify the problems that others have so that I can make an idea of myself of what this might look like! I'm also afraid of losing a lot of hair. Of course I'm also afraid of acid reflux, gas pain, dizziness... but I feel like if I power through, these will pass quickly.

Any advice or suggestions that anyone has had that have used this insurance or maybe had similar fears going into surgery would be very welcomed!

Sorry - also on a final note, I've been reading more about how some people have to have an endoscopy beforehand? Is this required by GHI? How bad is it???

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Having an endoscopy is a breeze. the put you to sleep and before you know it you have woken up none the worse for wear.

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you won't die. These fears are based on bariatric surgeries that were performed in the 1960s and 70s, when they WERE high risk. Almost no one dies anymore. Techniques have vastly improved, and these have become very routine surgeries. Gastric bypass has a 0.3% mortality rate, sleeve is even less. So that means you have at least a 99.7% chance of pulling through just fine. This is one of the safest surgeries there is - much safer than a hip replacement, even, and they do those every day. My surgeon has been at it 30 years and has yet to lose one patient...

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also, re: Hair loss - some people never lose any. Some have it come out in clumps. The majority of people, though, just shed. They notice it - but no one else does. And it grows back.

I worried about hair loss incessantly. But I'm here to say that in retrospect, I don't know why I wasted even ONE brain cell worrying about that. No one noticed my hair loss, and I am SO MUCH HAPPIER being normal weight that I don't know why I was even worried for one second about my hair. It's a small price to pay - and if you're like most of us, no one is going to notice your hair loss except for you.

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I had a BMI Of 40 and many comorbilities. I'm in NJ and have Blue Cross. I was required to have 6 month supervised medical visits. Because I was right At the mark, I was not allowed to lose or gain any weight during those six months. I needed to be the exact same weight. The surgery was easy. Quick and easy healing. Only issue I had was with the anesthesia made me very sick and kept me an extra night in the hospital. Otherwise, piece of cake!

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On 1/15/2020 at 1:27 PM, newyorklady20 said:

Hello!

I am new to the message board and am looking to get as much information and advice as I can, but also get relevant information to my experience and what I have before me.

I am a NYC DOE teacher, so I think our insurance is GHI CBP? I have spoken with insurance reps on the phone and they have confirmed that they cover the procedure at 100% (minus the $300 hospital copay and specialist/appointment copays) as long as you have a BMI of 40+ or a BMI of 35+ with a comorbidity. Has anyone else who is a teacher had this procedure and can confirm additional expenses or how it was to deal with the insurance? How long did the insurance take to approve you for the procedure?

I had some confusing information, mostly from just reading message boards online. I was under the impression that I would have to lose weight prior to the procedure, and I was concerned about this as I am right at the BMI of 40 threshold and do not have any comorbidities. I didn't know if losing would disqualify me from coverage. I have since heard that they actually want maintenance of your weight for 6 months, but is there any point where the insurance company requires you to lose weight or undergo a supervised diet/weight loss before surgery?

I attended an initial consultation with a surgeon on LI in October and then took some time to think things through - I am starting the process now with hopes that I will have the procedure done during the summer. I read a lot about so many fears but honestly mine are a lot more primal - I'm terrified of dying during the surgery, of having a stroke during and being incapacitated for the rest of my life, or of developing a major infection or negative side effect after. I have read some of the stories of people who have great surgery experiences but then develop serious complications months and years later. I feel like I'm just trying to quantify the problems that others have so that I can make an idea of myself of what this might look like! I'm also afraid of losing a lot of hair. Of course I'm also afraid of acid reflux, gas pain, dizziness... but I feel like if I power through, these will pass quickly.

Any advice or suggestions that anyone has had that have used this insurance or maybe had similar fears going into surgery would be very welcomed!

Sorry - also on a final note, I've been reading more about how some people have to have an endoscopy beforehand? Is this required by GHI? How bad is it???

Hi there. I work for DOE too. I however, have the HIP prime. I Am having a revision. You aren’t going to die. The medical field has made great stride. What surgeon are you meeting with? Each program require a different things. Emblem health who covers ghi and hip doesn’t require the 6 months visits anymore (stopped last year) that is what certain programs want. They want to be able to see that you are committed to this.

also if you’re afraid of acid reflux I will highly consider doing your research on the sleeve and GERD. I know of a few people at my program who revised from the sleeve to RNY due to developing gerd after the sleeve.

Edited by Repeatingthoughts

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Hello!
I am new to the message board and am looking to get as much information and advice as I can, but also get relevant information to my experience and what I have before me.
I am a NYC DOE teacher, so I think our insurance is GHI CBP? I have spoken with insurance reps on the phone and they have confirmed that they cover the procedure at 100% (minus the $300 hospital copay and specialist/appointment copays) as long as you have a BMI of 40+ or a BMI of 35+ with a comorbidity. Has anyone else who is a teacher had this procedure and can confirm additional expenses or how it was to deal with the insurance? How long did the insurance take to approve you for the procedure?
I had some confusing information, mostly from just reading message boards online. I was under the impression that I would have to lose weight prior to the procedure, and I was concerned about this as I am right at the BMI of 40 threshold and do not have any comorbidities. I didn't know if losing would disqualify me from coverage. I have since heard that they actually want maintenance of your weight for 6 months, but is there any point where the insurance company requires you to lose weight or undergo a supervised diet/weight loss before surgery?
I attended an initial consultation with a surgeon on LI in October and then took some time to think things through - I am starting the process now with hopes that I will have the procedure done during the summer. I read a lot about so many fears but honestly mine are a lot more primal - I'm terrified of dying during the surgery, of having a stroke during and being incapacitated for the rest of my life, or of developing a major infection or negative side effect after. I have read some of the stories of people who have great surgery experiences but then develop serious complications months and years later. I feel like I'm just trying to quantify the problems that others have so that I can make an idea of myself of what this might look like! I'm also afraid of losing a lot of hair. Of course I'm also afraid of acid reflux, gas pain, dizziness... but I feel like if I power through, these will pass quickly.
Any advice or suggestions that anyone has had that have used this insurance or maybe had similar fears going into surgery would be very welcomed!
Sorry - also on a final note, I've been reading more about how some people have to have an endoscopy beforehand? Is this required by GHI? How bad is it???

First . The gas pain is worst right after surgery... but doesn't last long for many of us. The other things you listed may come and go during rapid weight loss... but there are ways to mostly prevent them. I haven't experienced Hair loss. And endoscopy is really nothing... you are sedated so you dont feel or remember it. As for the mandatory weight loss... depends on doc and insurance requirements. I had to loose at least 1 pound a month. I was worried because of my low bmi... but I did fine. I transitioned to their diet more slowly than they would want most people. And the nutritionist gave me tips to comply without disqualifying myself. But sorry... I work in AZ so dont have your other answers.

Sent from my SM-G955U using BariatricPal mobile app

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oh - and the serious complications you've read about. Very rare. I think you might think they're more common than they really are because people post about those because they're looking for advice and support. People who are 3-5-10-15 years out from surgery generally don't post to let the world know that everything is hunky-dory. I don't personally know anyone who's had any seriously complications, and you'll run into very few people on these and other boards who do. Most complications are minor and appear during the first few months (like strictures - which happen to about 5% of RNY patients). The only things I can think of that might happen long term are bowel obstructions (very rare) and Vitamin deficiencies. Almost all vitamin deficiencies are preventable by keeping on top of your Vitamins. The only exception I can think of is Iron. There are some people whose bodies can't absorb oral iron properly, so they have to get occasional infusions. But other than that....??? Suffice it to say, serious complications are rare. Many of us never have any complications at all, and for those who do, they're almost always minor and "fixable" (I had strictures - one of the most common complications of RNY. I mentioned they happen to 5% of RNY patients. I would hardly call a 5% rate "common", but that does give you some idea of how common problems are. That is, they're not....)

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On 1/15/2020 at 1:32 PM, mcfluffington said:

Having an endoscopy is a breeze. the put you to sleep and before you know it you have woken up none the worse for wear.

Thank you! It just sound so intimidating - I don't know anyone who has done it!

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On 1/15/2020 at 8:21 PM, Kimberly3 said:

I had a BMI Of 40 and many comorbilities. I'm in NJ and have Blue Cross. I was required to have 6 month supervised medical visits. Because I was right At the mark, I was not allowed to lose or gain any weight during those six months. I needed to be the exact same weight. The surgery was easy. Quick and easy healing. Only issue I had was with the anesthesia made me very sick and kept me an extra night in the hospital. Otherwise, piece of cake!

Thank you! That makes me feel so hopeful! I feel like the maintenance of the same weight is seemingly the hardest part right now! I'm aiming to do it during the summer so that I give myself the most amount of time to recover afterward. I have my fingers crossed that my experience is as positive as everyone here!

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On 1/16/2020 at 8:38 PM, Repeatingthoughts said:

Hi there. I work for DOE too. I however, have the HIP prime. I Am having a revision. You aren’t going to die. The medical field has made great stride. What surgeon are you meeting with? Each program require a different things. Emblem health who covers ghi and hip doesn’t require the 6 months visits anymore (stopped last year) that is what certain programs want. They want to be able to see that you are committed to this.

also if you’re afraid of acid reflux I will highly consider doing your research on the sleeve and GERD. I know of a few people at my program who revised from the sleeve to RNY due to developing gerd after the sleeve.

Thats some good advice, thank you. I will be going to have a meeting with the nutrition advisor at my surgeons office next month so I can find out for sure what my insurance requirements are. Regardless, I think I still want to wait until summer for convenience. I'm going to Dr. Kella at Winthrop Bariatric.

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On 1/19/2020 at 9:40 PM, newyorklady20 said:

Thats some good advice, thank you. I will be going to have a meeting with the nutrition advisor at my surgeons office next month so I can find out for sure what my insurance requirements are. Regardless, I think I still want to wait until summer for convenience. I'm going to Dr. Kella at Winthrop Bariatric.

That’s great!! Good luck. Yess is so much better to do it Over the summer. I’m having mine done during spring break. Hoping that allows enough time for me to heal. Good luck again.

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