WeekendWarrior

Looks like they are a bit more restrictive on who they allow to have the sleeve.

Looks like wellmark is covering the sleeve as of today. LINK Sleeve gastrectomy, as a stand-alone procedure or when combined with a malabsorptive procedure, may be considered medically necessary for patients meeting the above general criteria and one of the following weight criteria: •BMI ≥ 40 kg/m2 for at least 3 years Or •BMI ≥ 35 kg/m2 in conjunction with one of the following: ◦Hypertension requiring medication for at least one year ◦Diabetes mellitus type 2 requiring medication for at least one year ◦Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment ◦Documented cardiovascular disease ◦Pulmonary hypertension of obesity AND one of the following: •History of transplant, i.e., any solid organ or allogeneic or autologous stem cell •Chronic corticosteroid use •Anti-platelet therapy, i.e., aspirin, Plavix® (clopidogrel bisulfate), Ticlid® (ticlopidine hydrochloride), Effient® (prasugrel) •Inflammatory bowel disease •History of gastritis or peptic ulcer disease

I see wellmark just changed their policy today. LINK Sleeve gastrectomy, as a stand-alone procedure or when combined with a malabsorptive procedure, may be considered medically necessary for patients meeting the above general criteria and one of the following weight criteria: •BMI ≥ 40 kg/m2 for at least 3 years Or •BMI ≥ 35 kg/m2 in conjunction with one of the following: ◦Hypertension requiring medication for at least one year ◦Diabetes mellitus type 2 requiring medication for at least one year ◦Obstructive sleep apnea, confirmed by a sleep study, which does not respond to conservative treatment ◦Documented cardiovascular disease ◦Pulmonary hypertension of obesity AND one of the following: •History of transplant, i.e., any solid organ or allogeneic or autologous stem cell •Chronic corticosteroid use •Anti-platelet therapy, i.e., aspirin, Plavix® (clopidogrel bisulfate), Ticlid® (ticlopidine hydrochloride), Effient® (prasugrel) •Inflammatory bowel disease •History of gastritis or peptic ulcer disease

I haven't heard. I'll try and call the Dr. again next week sometime.

I just called my Dr. office and and asked them if they have heard if Wellmark is covering the sleeve yet. Their insurance person said that there is supposed to be an annoucement next week some time.

I just called my Dr. office and and asked them if they have heard if Wellmark is covering the sleeve yet. Their insurance person said that there is supposed to be an annoucement next week some time. So you might want to start getting your paperwork ready, you could be the first person approved by Wellmark!!!!!!!!!!!!

Wellmark currently will not cover it due to it's "investigational" status. I don't know if anyone has tried to submit to them lately though. Your Dr.s Insurance specialists might know more than anyone. If you haven't I would start working on the 6 month suppervised diet requirement. I've lost 60 pounds during my 6 month diet so far, and I am now kind of waffling on if I should continue trying to lose or not. My BMI was 50, and now it's 41. I can get down to 35 and still be approved as I have several co-morbid conditions.

Yeah! They finally released a MFP app for android phones! :eek:

Forgot to add that I needed to go out and buy a new belt, and a new pairs of jeans as I have lost 6 inches off of my waist.

I guess it's time for another update. Four months have passed, and I am down 40 pounds. BCBS still doesn't cover VSG but it is supposed to update their policy in September. My daughter and I have been walking 30 min. almost daily. A few times on the weekends we have been walking 3 miles in an hours time. My daughter and I just purchased a couple of bicycles today. Hopefully we can switch up from the walking and get a little more variety in our exersize. I am starting to wonder what I want to do if I continue to lose weight. Should I continue with the diet and not get the surgery? I know I've failed on countless other diets, but this time we have been tracking our calories on myfitnesspal, and it's made a huge difference. I now see how easy it was to eat a little bit of this and a little bit of that and hit 2 to 3 thousand calories a day. Well I'll report back again here in 2 more months. Hopefully i'll be down 60 pounds and we will find out if Wellmark BCBS will be covering the sleeve.

I really like myfitnesspal. It's got about every food know already in the database, and is easy to add stuff if it doesn't. It also allows you to save whole meals, and add all the items at once, and then tweak the quantities or remove things. You can also enter your recipes using the food database and it will calculate the calories. It also will track your excersize and calories burned. I've been using it for my 6 month diet, and so far I've lost close to 40 pounds in 3.5 months. It also has an iPhone app if, and best of all it's all free!

Your body can synthesize glycogen from fat, complex and simple carbs and Protein, but you body can not synthesize protein. If your protein intake is too low, then your body will canabalize your muscles including your heart to get the required protein. Most sleever's eat from 60 to 100 grams of protein a day. 100 grams of protein is only 3.5 ounces, so you would be a long long way from getting any sort of protein poisoning on a normal sleeve type diet. The whole reason they tell sleever's to eat "protein first" is if you don't, you will be full and not be eating enough protein, so too much protein is usually impossible for a normal sleever to get. If a high protein diet is causing kidney problems, you need to see your Dr. ASAP as this is a sign of kidney failure. As with all forum advice, take it with a grain of salt or a Protein shake, and please ask your Dr. if you have any serious issues.

You would have to eat 6 pounds of rabbit and nothing else for weeks on end to get protein poisioning aka rabbit starvation. As long as you eat some fat and carbs you should be OK. I would also doubt an obese person would get it due to them having fat stores to live on.

Surgical staples are made of titanium which has a low electrical signature which is very difficult to detect with a metal detector. Secondly if the detector were set so sensitive as to detect the tiny amount of metal in these staples, your zipper in your jeans contain more metal and would set it off before the staples would.

Some employers have an open enrollment period where you can change insurance coverage and avoid any pre-existing conditions. Some states also exclude any pre existing conditions as long as you have continually been covered by health insurance.