kkandrod

Congratulations!!!!! How exciting for you!!! Can't wait to see all your awesome "after" posts on your progress. What a blessing!!! Krystal

I think you'll probably be ok. Do you watch the Biggest Loser? Sam on there was WAYYYY bigger than you are and he's lost a ton of weight. I think they lose faster on there than after surgery. (I'm still a hopeful pre-op by the way) Anyway, he has alot of skin but in my opinion, he is still attractive with his shirt off and like I said he had to have had a BMI of way over the 42 that you are at. So, I'm sure you may have some but I bet you'll look better than what you are thinking you will. Especially since you will be exercising. I rep for a company that has products that I will be using if I have surgery all along the way to combat that and if I wind up not being approved after this sleep study thing then I'll be striking out again on the road of exercising and strict dieting and I'll use the products then too. We've got some reps who've had WLS and used the products before becoming reps and it helped them tremendously. Their pics are pretty cool. Wishing you lots of success! I know from your posts that you are big time ready to start the next phase of your life. Have fun on the ride!!!

Hi there. I'm a Louisiana girl too so I'll be interested to see the responses to this as far as cash price goes. I know that Dr. Merriman in Shreveport costs around $14,500 cash. I talked to a surgeon in OK who used to be in North Louisiana and he said the only docs he knows personally and would recommend in Louisiana are Dr. Hargroder (sp?) and I think the other is Bellanger. They are partners in practice I believe. Anyway, he said they are awesome and have the most experience in Louisiana with sleeves that he knows of.

Ok, so I got a denial today from UHC because of BMI below 40 and no life threatening co-morbidities. SO, here's what I have going on and would love some successful appeal'ers to please help me know where to start and what to do with this info: Lower back pain due to all excess weight being in front abdominal area Hip pain from the same thing Knee pain PCOS putting me at higher risk of diabetes, heart stuff and other things and the excess abdominal fat making those risks even higher Cholesteral trending higher but not on meds yet Diagnosed Reflux & Ulcer I also have symptoms of sleep apnea but no sleep study done so I guess I should ask my PCP to order that for me if he will. Ok, where do I go from here appeal'ers????? Thanks in advance!!!

Ewwww! Bless your heart!!!! I'm so sorry you had to deal with that! I have wondered what sleevers would have happen with broccoli because like ouroborous, there aren't many veggies that I actually like. Brocolli, purple hull peas, salads and hominy are pretty much it so I don't know what I would eat after having the sleeve if those are problem foods. Maybe give it a few more weeks and try again. Is this the first time you've had something like that happen? Hope ya dont have to deal with it anymore because it does not sound like it was fun!! Ugh, you poor thing!!

Becky, you are too cute! But, don't pray for me to get sleep apnea, LOL. If I do already have it, it'll be a blessing that it's found cuz then I'll know what to pray for healing of :-) I should be doing the Pulse oxegen test around Monday night. If anything shows up, then I think I'll still have to go for an official sleep study, NOT wanting to do that because I know I'll never fall asleep for them to be able to get any results and I really don't want to have to be driving home at 6 am for 2 hours after not sleeping well. The girl at the doc's office said that this test would be enough for a diagnosis if I have it and he'd be able to prescribe the cpap machine from it but the girl at the place that will be bringing the test out said it would only indicate that I might have sleep apnea and if it did then I'd still have to go for the sleep study so I have no idea who to believe, LOL. But anyway, it'll all work out. Just keep praying that whatever is supposed to happen will and I will accept it either way, even if I do pout about it for awhile if it means not having surgery. I'm sure our Heavenly Father is used to us pouting every now and then and then praising Him after we get over our fleshly desires and quit pouting

I haven't posted in awhile so I wanted to let all of you who are newly sleeved and about to get sleeved that I'm thinking of you all and praying for you. I don't feel like I have much to offer on most of the threads since I don''t know what I'm talking about yet, LOL. But, I am on here several times a day reading and learning. Anyway, point is, just wanted to let y'all know that there's someone out there praying for you and learning from you! Still no word on insurance approval for me :-( It's been a week and a day since it's all been submitted. Just trying to keep the faith and trying not to take it out of God's hands. There's a part of me that wants to say so badly "forget the insurance, just finance it and self pay" but then my spirit says "hold on, let God do His thing with this and it will all work out" so I'm going with the latter :-) But it's soooooooooo hard, lol. Anyway, y'all keep on truckin'!! I'm so excited for all of you!!! God Bless! Krystal

Thanks Carla!! We must have been posting at the same time because I didn't see your post when I was replying that last time. Yeah, I'm having that at home Co2 thingy done since it's hard for me to be away at night with a 6 year old and all, lol. My PCP seems to think that if I have sleep apnea that this test will be sufficient enough to be able to see if I should be diagnosed with it and prescribed the machine. So, we shall see :-) Thanks for the prayers, I need 'em!!

Thanks Becky, I really appreciate it!! I am having the at home Co2 test thingy done here soon to see if I have sleep apnea. If I don't, from what I'm understaning, appealing without an official co-morbidity on their list is useless. So, I would be down to self-pay and I truly don't think my husband will go for that. We have alot of things going and are about to try and build an RV park on our land that we have in the northern part of the parish to take advantage of all the oil/gas and pipeline traffic that's in the area so we can't afford to do anything right now. But, who knows, the Lord may provide in an amazing way with that and I could do it later. So, we'll just see what happens with the sleep test and go from there. It will all work out and if it doesn't then I'll know it wasn't in God's plan for me and I'll just have to suck it up and try and lose weight on my own....again, lol. But I know the Lord can help me with that too so my feelings on the whole weight loss subject are alot better now than they were yesterday, for sure. Thanks for the support y'all!!! God bless ya!! Krystal

So is the following the standard response to the question of how to get an appeal together to the insurance ppl at a surgeon's office? Here is her response to my last email asking that very question: "Well, unfortunately, we don't unless your high cholesterol gets worse or is not controlled after you start taking medication for it. Which will mean, you will have to take your medication for a month, go back and have labs drawn, have your physician adjust medication accordingly and repeat the labs in another 4 - 6 weeks and it still not be under control by then, only then can i show a "life threatening" co morbidity." If this is the norm then I won't be aggravated but I guess I just thought they would be a little more willing to help. I mean, she never even said sorry or how bout we help you with financing for cash pay or anything. Just that I was denied and why in the first email and then this when I asked about appealing. I'm a little disappointed :-(

Well, I got my answer this afternoon. It's denied. I'm gonna start a new thread for it. I believe in miracles and I know that He can give me favor with an appeal approval or provide the funds for me to pay to have this done. First step is appeal. Keep me in your prayers for this if ya don't mind slebme :-)

Hey there! You have been on my mind so I'm glad you posted an update. Bless your heart, you have been through it haven't you! I'm so glad that you are on the mend and the problem causer is now gone and you can get on with healing and life with less and less pain!! I have to go for a Hidascan on the 14th. Not looking forward to that. But, Dr. Merriman's office knows about it being ordered by my PCP so they are all over wanting me to call them if I end up having to have my gallbladder removed so he can do the surgery for me, LOL Still no word on approval from UHC. Tomorrow will be a week since it's been submitted. Say a prayer for me! I pray the Lord just places His healing hand on you and that each day you wake up you are surprised at how good you feel!! Take care of yourself!! Krystal

Thanks MlkPas and Warrior for posting that link! I think that will help a lot of us!! I didn't find anywhere in there either where the money had to be spent in the US to be deductible so hopefully that works out for Gary!! I think that deduction is awesome for those that had to self pay!!

Not necessarily, Warrior. If he went to Mexico, that could be a whole different ballgame. Not knocking the Mexico surgeons because I don't have any knowledge on them so this is just a question....Have they ever turned someone away from surgery because it wasn't "medically necessary"? If they have certain criteria that have to be met before they'll consider doing surgery on you then, it might be ok. But, then you still have the whole "out of country" issue to figure out on if that's allowable or not. When I called my mom to ask her, I got the number details but then she had to run out before she had a chance to dig around and find out about having medical procedures out of the country and if they still counted or not. And remember, you can't take medical expenses alone. You have to have the other deductions to qualify you to itemize period, only then do you get to take the amount of the medical expenses that are over the 7.5% of your AGI. But, mileage is in there too somewhere. I'll have to ask about that, if medical mileage can only be taken if you are able to take medical expenses or if you get to take that regardless if you are filing long form. I know one year we had a tremendous amount of out of pocket medical expenses that we took and just the mileage alone got us hundreds of $$$'s in deductions because all of our doctors were 2 hours away with many, many visits that year. That was a rough year in itself so getting to take those deductions helped our feelings in a major way.

Gary, my mom does taxes/bookeeping and for medical expenses, doctor ordered, you can take whatever the amount of the expenses are that are above 7.5% of your Adjusted Gross Income. And you have to be able to itemize, which means you have to have enough other deductions that amount to more than your standard deductions you are given on a 1040 form. So if you have that, and the surgery is doctor ordered and your medical expenses are more than 7.5% than your adjusted gross income, then you can take it. For instance, you earn $100,000 AGI this year. 7.5% of that would be $7,500. Whatever your cost for medical expenses alone are ABOVE the $7,500 is the deduction you get to take. Hope that makes sense, LOL

Hey girl. Just wanted you to know that I'm praying for your healing and thinking of you! Keep faith, rest and take care of yourself. You know your body better than anyone so when you don't feel right you keep speaking up. Keep us updated, I know all of us here are waiting anxiously for your next post letting us know you are good to go!

And the only thing wrong with me that would help toward surgery is my bad cholesterol is 151 and she said it should be 100 or below and no meds needed. Just diet and exercise...hmmmmm. So yeah, not looking good on the co-morbidity front for insurance approval. But, I am thankful and praising God that I am healthy as far as that goes. It just aggravates me that according to the surgeon's insurance girl, some of the stuff I've seen other companies approve as co-morbitities won't fly with UHC. But, I absolutely refuse to purposely gain weight to get my BMI up 4 points. If it doesn't happen, I may hang out with y'all still and be a wanna be sleever and try and take some things from y'alls way of eating and such and try once again to do it without surgical help. Cuz I just plain ole like y'all!!

Well, she informed me today that my cholesteral had to be life threatening and it be shown in medical records were I was put on medication so either she isn't willing to go the extra mile for me or UHC is great about approving but has a very short list of accepted co-morbitities.

Cool Carla, thanks for that info! Do you know if UHC told you anything about joint pain stuff? I'm keeping faith!! My God is a God of miracles! Watched my little boy be healed of meningitis last school year in the hospital right in front of me with no meds in him (I say that so ppl know that it wasn't anything he was given that made his neck loosen up, made him sit up and color and eat and laugh and know what he was saying), had just got in his quarantined ICU room! He can make me approved for surgery without any co-morbitities if it's His will Speaking of shorter, I've thought all my life I was like 5'7 or 5'7 & 1/2 but nope, turns out I'm 5'6, LOL So, that's already happening, heehee

I have lower back and hip probs and pain in my right knee but she said that couldn't count as a co-morbidity for me with UHC. Crazy huh.

@ the ankle weights thing. LOL! I would have to put 30 lbs of weights on my feet to do that, I could see myself weeble wobbling into that office, they'd be like "get her surgery STAT! She's got some major stuff goin' on!" lol

So, I just got an email from the insurance lady and she asked me where I got that I had to be on meds for high cholesterol for it to be counted as a co morbidity, LOL So, I emailed her back and told her that's what I had understood her to say and that I sure was hoping that I completely misunderstood her, LOL There may be hope yet!! :-)

Congratulations!!! I talked with a doc in OK day before yesterday and he said that your doc and his partner were the best and most experienced in the state, that he was aware of. Sounds like you were in good hands!!! I've actually thought about contacting them myself if nothing happens with insurance with the doc I've chosen in Shreveport. Do you know if your docs down there will fight for you with the insurance companies? Take care of yourself! It's so great to hear you newly sleeved peeps doing so well right after!! God Bless! Krystal