mountain_lover

Thank you very much! I was having trouble all day yesterday and today getting my doctor's office to fax my monthly weigh-in office visits and my thyroid test results to the bariactric center. They told me it would be sometime next week when they would fax them and I decided to finally go their office and sign a release form for the information to be given directly to me. She was not happy about it and made some strange comments, then told me that she would try to get them done but I would have to wait. I told her that I would wait. She realized that I was not going to leave, so then she got them done and it did not take her very long. I left and hand delivered them to the Bariatric Center, which they faxed it right then to the woman who takes care of submiting it to the insurance to try to get the approval. She called me immediately to let me know that she received them and that she had submitted them and she should hear back from them by Friday or the beginning of next week. I had been trying to get those records for over 2-3 months. I am hoping that they do not need anything else so that there is no more delays. I started weigh-ins in Feb. of this year and at that time I was told that I had to have 6 months weigh-in supervised by my family physician, which would have put surgery date sometime in August, then I was told that insurance increased it to 7 months weigh-ins. After all that I went through finding out I had H-Pylorial positive test and had to take antibiotics and be retested and finally it came back negative. Also I found out during all this time that I also had an Autoimmune disorder and thought that it might prevent me from having the surgery because they told me that it was Lupus, which after several test they found out that it was "Mixed Connective Tissue Disorder" instead. I got confirmation that it should not prevent me from having surgery. So after all of that, when my family Doctors office was not cooperating with us to get those papers faxed, I really was losing my patience. I am glad that I was able to get it taken care of today. It could have delayed surgery until possibly the beginning of next year, also it would have been that much longer that I would have to wait to see if I would get approved and then I would have had to wait for a surgery date. Now there is a chance that if approved, I may be able to have the surgery in Nov. I have really tried hard to hang in there and not give up. It has really been stressful this year, But I am hoping that it will all be worth the wait, if I get to have the surgery. As they say it is easy to put on, but hard to take off.--- SO TRUE!!.-- I am so happy that people on this forum do really care and understand what we are going through. Thank you. I will let you know as soon as they let me know if I am approved.

Hello RubyTuesday, I am so happy that you are having your surgery soon. I understand how you must feel, I have been more nervous, excited, and worrying about if I will do ok with all the changes that will take place soon if I get approved for the sleeve. I will find out hopefully this week or the first of next week. The closer I get the more I experience all these new feelings and thoughts racing through my mind. I am finding it more difficult to get regular sleep. I wonder at times if I am driving my family nuts with my constantly bringing the subject up and I know they can tell I am more excited. I am sure if you keep looking on here you will find just what will help you out at the time you need it the most. Here lately I get on this forum every night and sometimes more than once a day. I wish you all the best!!

Hello JoAnne, I posted the following item earlier, I don't know if you noticed. If not, please read it very carefully. It may be difficult to understand. I was thinking that maybe if you were to show this following message to your surgeon, he might find it very interesting. I am sure due to the fact that he is a surgeon, that he would understand what the message is all about and he could possibly use some of it to help in your appeal. It may not help, but it might be worth trying. I am understanding from my surgeon Dr. Husted here in Somerset KY, that the vertical sleeve procedure is now being coverered by Medicaid for some patients. Just a few months ago when I went to my consult with him, they were not being approved by Medicaid, but he told me he was going to be speaking with Medicaid about getting them approved here in KY. He must have been successful or something has changed, because recently a few of his patients have been approved for the sleeve by Medicaid. I sure hope all this is true, because it has so much to do with me being able to have the sleeve done in my situation. Maybe if it is true, then other States will make it possible for Medicaid patients to get approved for a safer surgery. Also people could stay in there own area and not have to go elsewhere if they find a good surgeon who accepts Medicaid for their sleeve procedure. PLEASE READ THE FOLLOWING AND POSSIBLY LET YOUR SURGEON READ IT IF YOU THINK IT MIGHT HELP IN YOUR APPEAL!!! JSM---------- Note: this was included in your insurance policy *Biliopancreatic bypass with duodenal switch *Sleeve gastrectomy, performed either as a stand-alone restrictive procedure, or as a first stage procedure of a planned biliopancreatic bypass with duodenal switch for patients with a BMI exceeding 50. Hello jsm, I would like to point out something that maybe someone is overlooking or is misunderstanding at BlueCross/BlueShield. I may be wrong, but it is something for them to consider. If you notice above the Biliopancreatic Bypass with Duodenal Switch is approved, and it says nothing about any requirements on the BMI. But notice that when the Sleeve Gastrectomy is performed as a "FIRST STAGE PROCEDURE" of a Biliopancreatic Bypass with Dueodenal Switch, it is only approved for "PATIENTS WITH A BMI EXCEEDING 50. However, the Sleeve Gastrectomy is approved when performed as a "STAND-ALONE RESTRICTIVE PROCEDURE", it does not say any specific BMI . It stipulates that it is EITHER, Or. --------------------------------- " performed EITHER as a stand-alone restrictive procedure" "OR as a first stage procedure of a biliopancreatic bypass with duedenal switch for patients with BMI exceeding 50" -------------------------------- As I stated in my post earlier that I learned that the Duodenal Switch was being performed on patients, but if the patient had a very high BMI and health problems which made it more risky to have the Duodenal Switch, then doctors would perform the Sleeve (Which is the First part of the duodenal surgery and only restrictive), hoping that the patient would lose weight down to a SAFER, LOWER BMI, then the other part of the Duodenal surgery which is Malabsorptive could be performed without all the risks that were present before the Sleeve, so that the patient could lose more weight to reach their goal. ------------>>>>> What many doctors were discovering was that many patients continued to lose the weight and was reaching their goals with only the Sleeve, and the second part of the surgery did not need to be performed. So then many doctors started performing The SLEEVE as a STAND-ALONE RESTRICTIVE PROCEDURE. Now the sleeve is becoming a more sought after surgery by doctors and patients, because it is a less expensive, less evasive, and less risky surgery. Also the doctors know that there are less complications and healing time is faster with the Sleeve vs. the other procedures.--------------->>>>>>>> Medicaid and Medicare are now approving some Sleeve procedures. As I stated in my other post, WHY PAY FOR MORE IF IT IS NOT NEEDED. When the insurance company pays for the duodenal, the sleeve is the first part of that surgery. People with LOWER BMI and no severe health issues other than obesity, are having success with only the sleeve; so why have people put at more risk just so that they have a covered procedure according to what the insurance company understands the terms to be. Could the insurance company be misunderstanding or misinterpreting the policy coverage, because they might not have all the facts or they might not be reading the sentence above in their policy as it might be intended? If you have any thoughts on this or any more questions, it would be very interesting to hear from anyone. Thank you for taking the time to read this. Also you may get more information on this from doctors who are performing the Sleeve and are able to get it covered by different insurance policies. Have a good day from mountain_lover!!

Thank you everyone for your comments. It is getting closer. I found out today that the Psych. Eval. was faxed to the bariatric center. But I found out something new, now they need to fax my thyroid test results and each months weigh-ins for 7 months. I had asked my doctor's office for copies of each doctor's office visit for the weigh-ins, but they gave me one paper with the dates and weights and told me if I needed more to let them know. Now the bariatric center is having them to fax all my records back to the beginning of the year, that way they will have everything they need. (I hope!!!!!) The woman that is taking care of all the information to turn into the insurance company is so nice and has really been a big help. She works out of her home and she has took my calls or called me back as soon as possible. She has been a blessing. She works for Dr. Husted's office here in Somerset KY. She told me that as soon as she sends it into the insurance we should find out real soon, it only takes a few days to see if I get approved. I am learning what patience is, I am getting more and more anxious to find out. I have not lost much more weight, but I have been exercising at the Y, my clothes are fitting much better. I am getting into some that I could not get into 3 months ago. I think I am firming up some. I have went to the Fun and Fitness swim class for the second time now (1 hour each session). I really enjoy it, I think it will become addictive. I am glad to hear that you are doing so well Ky.hen!! Wow 23 pounds already since Oct. 1, that is great!! I am so happy for you. You have been a big inspiration for me to hang in there.

Hello jsm, Please let us know if anything changes. I hope and pray for everything to work out for you.

My Psych. Eval. is done and all typed up. I am hoping that it is faxed to the bariatric . I am going to check on it today. The woman who takes care of the insurance told me as soon as she receives all of my information and tests that she will submit it to see if I get an approval. She said it usually takes about up to a week to hear back from the insurance. I am really getting more and more anxious. I have fell off the wagon a few times and my eating got out of hand, but I just try to do better afterwards. I have been going to the Y to exercise and I went to my first AQUA-FITNESS SWIM CLASS. I really enjoyed it and am looking forward to going again. I haven't lost much weight. My clothes are fitting better. I weighed 242 the last time I weighed at the doctor's office. With my clothes off in the mornings, I have been weighing under 240 pounds. Two days I weighed 235 and it goes up and down. After swimming on Oct.22 I weighed myself on some doctor office type scales in the locker room after getting dressed and my weight was 239. If I get approved for surgery and get a date I will be starting on the Pre-Op diet so I am sure I will lose some more before surgery. I will let everyone know what happens with the insurance.

I agree with you. I want to be happier, healthier, live longer, enjoy my family, less pain, look pretty, reach my goal weight and keep it off until I take my last breath on this Earth. I am ready for a change!

Thank you, It is very incouraging to hear that. I am so grateful to have everyone posting on this forum and finding it when I did. I am trying to stay positive even in the down moments. I am hoping to hear if I get an approval this week from the insurance. If everything had went as planned, I would have had surgery back in August of this year, but I am getting closer now that I have made it through all the setbacks. I am getting more and more anxious to have the surgery, maybe that is one reason that I have been turning to comfort foods. I will get back on track, because I will be starting on my pre-op diet soon, if I get approved for the surgery. How much weight have you lost in 7 weeks? I hope you continue to do fine. Have a good day!

Hello, I have been going through something similar. I am getting closer to finding out if my surgery will be approved and I am getting more anxious. I fell off the wagon big time the last day or so. I went to the store and I bought some sweets and went overboard. IS THIS NORMAL BEHAVIOR FOR MOST PEOPLE PRE-OP? When I told someone what happened, they said that is what they are worried about if I will do that after I have the surgery and put all my weight back on. I feel better after reading this and knowing that others have had similar experiences. I hope that it is just a phase and not an indication that I will be a failure after surgery. Any comments on this subject will be helpful, I want for this surgery to be a success and I want to be successful at losing weight and maintaining a healthy goal weight. Thank You!!

I am really glad to hear that you are doing ok. Thank you for adding me to your friends list. I am going to add you to mine now. Thank you! Wow, 16 pounds in 10 days is great.

JSM---------- Note: this was included in your insurance policy *Biliopancreatic bypass with duodenal switch *Sleeve gastrectomy, performed either as a stand-alone restrictive procedure, or as a first stage procedure of a planned biliopancreatic bypass with duodenal switch for patients with a BMI exceeding 50. Hello jsm, I would like to point out something that maybe someone is overlooking or is misunderstanding at BlueCross/BlueShield. I may be wrong, but it is something for them to consider. If you notice above the Biliopancreatic Bypass with Duodenal Switch is approved, and it says nothing about any requirements on the BMI. But notice that when the Sleeve Gastrectomy is performed as a "FIRST STAGE PROCEDURE" of a Biliopancreatic Bypass with Dueodenal Switch, it is only approved for "PATIENTS WITH A BMI EXCEEDING 50. However, the Sleeve Gastrectomy is approved when performed as a "STAND-ALONE RESTRICTIVE PROCEDURE", it does not say any specific BMI . It stipulates that it is EITHER, Or. --------------------------------- " performed EITHER as a stand-alone restrictive procedure" "OR as a first stage procedure of a biliopancreatic bypass with duedenal switch for patients with BMI exceeding 50" -------------------------------- As I stated in my post earlier that I learned that the Duodenal Switch was being performed on patients, but if the patient had a very high BMI and health problems which made it more risky to have the Duodenal Switch, then doctors would perform the Sleeve (Which is the First part of the duodenal surgery and only restrictive), hoping that the patient would lose weight down to a SAFER, LOWER BMI, then the other part of the Duodenal surgery which is Malabsorptive could be performed without all the risks that were present before the Sleeve, so that the patient could lose more weight to reach their goal. ------------>>>>> What many doctors were discovering was that many patients continued to lose the weight and was reaching their goals with only the Sleeve, and the second part of the surgery did not need to be performed. So then many doctors started performing The SLEEVE as a STAND-ALONE RESTRICTIVE PROCEDURE. Now the sleeve is becoming a more sought after surgery by doctors and patients, because it is a less expensive, less evasive, and less risky surgery. Also the doctors know that there are less complications and healing time is faster with the Sleeve vs. the other procedures.--------------->>>>>>>> Medicaid and Medicare are now approving some Sleeve procedures. As I stated in my other post, WHY PAY FOR MORE IF IT IS NOT NEEDED. When the insurance company pays for the duodenal, the sleeve is the first part of that surgery. People with LOWER BMI and no severe health issues other than obesity, are having success with only the sleeve; so why have people put at more risk just so that they have a covered procedure according to what the insurance company understands the terms to be. Could the insurance company be misunderstanding or misinterpreting the policy coverage, because they might not have all the facts or they might not be reading the sentence above in their policy as it might be intended? If you have any thoughts on this or any more questions, it would be very interesting to hear from anyone. Thank you for taking the time to read this. Also you may get more information on this from doctors who are performing the Sleeve and are able to get it covered by different insurance policies.

I am glad you let us know how you are doing. It is so encouaging to hear good news. I hope to have surgery soon if all goes well. Wow 21-22 lbs. is great in only 1 month. Please let us hear about your journey, story and pictures along the way. You will be a great inspiration for all of us that are waiting to have surgery. I am hoping to have my VSG surgery in about a month if the insurance gives me an approval. I wish you all the best.

I hope you get the clearance. You are in our prayers. I had to take the tests required for bariatric surgery several months ago, and I found out that I tested positive for H-Pyloria, which is a stomach infection (contagious also) that I did not know that I had. It can cause stomach ulcers and stomach cancer among other things. I Thank God that he lead me in the right direction to have Bariatric Surgery and to having the tests, before it was too late. I had to take what was called a Prev-PaK, which was a two week antibiotic treatment and had to have more tests to see if it was cleared up. I did receive a negative test, which now I have that part of the clearance over with. It slowed down everything for a little while and I got upset at first, but I realized that it was a good thing that I found out when I did, because may have saved my life. I just found out that my Psych. Eval. is ready to be faxed to my Bariatric Center and then all my tests will be in to turn into insurance, I may have an approval or denial in a week or so. I am getting closer. I am getting more and more anxious the closer I get to having the surgery. I can only imagine how disappointed you were. I am glad that you have come to this forum for support. It has really been a big support for me right when I needed it the most. May God bless and keep you in his care!!

Hello, I enjoyed looking at your pictures and reading your postings. I wish you all the best!! I hope you can lose your belly too. I went to a support group at the Bariatric Center and that night a Plastic Surgeon was there. I learned about the tummy tuck and penniculectomy. One is somewhat different than the other. Most procedures are not covered by insurance, But He said that the penniculectomy is covered by Medicaid and most insurance companies. You might read about that procedure, and if you have insurance you might find out if it covers that procedure. (It gets rid of alot of the loose skin hanging down after weight loss surgery, but it is better to wait until you are real close or at your goal weight), I hope this helps you.

Hello, Please let us know how you are doing now. How has the past few weeks been going for you? Hope you are doing better!

Hello, Have you had your surgery and how are you doing? Please let us know. I will check other postings to see if you posted your post-op recovery and how much weight you have lost since your surgery day.

I have a question: Does BlueCross BlueShield approve The Duodenal Switch and if so what are the requirements? Why I am asking is to let you know what happened to me. I changed my mind about having a band and decided to have a Dueodenal Switch or a VSG surgery. When I had my first appointment with Dr. Husted here in Somerset Ky., he told me that he would prefer that I had a VSG instead of the Dueodenal Switch. I assume that is because of my BMI being at 43 at the time. I found out that the Dueodenal Switch was covered by Medicaid, but at the time the VSG procedure was not. He told me not to worry about it, because he was going to submit more information to Medicaid to try to get it to be a covered procedure. Now several months later I have been told that Medicaid is covering it for some patients. From what I understand the VSG is the first part of the Dueodenal Switch. The Duedenal Switch is a more evasive surgery with much more involvement than the VSG. The VSG is only restrictive and the Dueodenal Switch is restrictive and Malabsorptive. The Vsg has less comlications and surgery time is less and heal time is faster. The patients with very high BMI's and other health issues who needed surgery but were not heallthy enough to have the Dueodenal Switch, would have the first restrictive part of the Dueodenal Switch where part of the stomach was removed, so they could lose enough weight and be at a healthier place in time to have the other part of the Dueodenal surgery where everything is rearranged for it to become Malabsorptive. What the Doctors found out over time was this; the patients were losing weight and most of them were becoming healthier in the process and they were getting closer and closer to their desired weight. Many doctors and patients discovered that the other surgery was not required. So the VSG surgery is becoming a more popular and excepted procedure among the healthcare professionals and insurance companys. It is safer and less expensive than some of the other surgeries. As they say; IF IT WORKS, DON'T FIX IT. The insurance companies will eventually all agree that it will be better to do the VSG surgery before doing the more evasive riskier procedures. Then if that doesn't work for some, then they might still have to go in for the other part of surgery, to complete it for more weight loss for those who have had very high BMI's or other health issues. (Why pay for more than what is needed and Why put the patients through more than they need to go through, just so that the insurance companys don't have to change their current policies or have to deal with any hassles?) It all makes sense to me now and that is why I am hanging in there and hoping that Dr. Husted and his team can do what is best for me and get the VSG surgery approved for me, that way I will not have to go through the more evasive surgery unless I absolutely have to. I am really happy with their services and their concern for my well being. I hope the best for you and the others that are having difficulty getting the VSG surgery approved by your insurance. BEST WISHES!!

Hello, Everything you have said sounds similar to my story. I have learned so much here on the forum from all the posters. I also had my mind set on only the Lap-Band, but after reading all the information on here, and finding out that I had an autoimmune disorder, my plans are to have the Sleeve. I found out that sometimes problems arise from having a foriegn object in your body such as the band, if you have an autoimmune disorder. I don't understand how the staples are any different, but I have not been told about any problems which might occur with them. I had surgery on my knee last year and the knee replacement involved having a metal device put in my knee and it has done ok so far, but at the time I was not aware that I had an autoimmune disorder. Also the other thing I did not like hearing about the band was the need to have to go back all the time to be stuck in the port for any adjustments. It sounded like there would be alot of aftercare. That right there was enough to change my mind to have a VSG instead of a Band. I wish you the best on your upcoming surgery.

Hello, I have read this entire thread on your story and I am here to tell you that now you are one of the ones helping others for sure. I have not had my surgery yet, I hope it will be soon. As soon as they get my Psych. Eval typed up and sent to the Bariatric Center then it will be turned in to insurance to see if I get approved. I am getting closer and closer. Everytime I read a story such as yours, I am always encouraged to hang in there. I had a total knee replacement 1 1/2 years ago, so I didn't want to have surgery again, but here I am hoping to have VSG surgery soon. To hear that you have already lost 10 pounds and you are already home gives me more hope and faith that I am doing the right thing. I keep coming on here to get help and each time I always find someone's comments that lift me up whenever I need it. One of these days soon my experience of having the surgery will help others just like your story and other's have helped me. I hope and pray for the best for you and everyone else on your journey!!

I hope the best for you. I enjoyed reading your thread. I am getting so close to possibly getting a surgery date, only have my Psych. Eval. to turn in this week or so. The closer I get the more anxious I get. I even took one of my anxity pills last night, but I still am having a hard time with it. I am having a hard time getting sleep, I am thinking so much about it coming up soon and wondering if it will get approved soon. I am glad I read all about this happening to others, it helps me to understand why I have been so worked up here recently and can't hardly sleep. For anyone that has read any of my other posts, I changed my profile picture. This picture shows more of me and it really helps me want to go exercise at the Y every time I see it. I think you will agree with me that I really need this sleeve!!