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YAHOOOOO! I got a tentative surgery date! :biggrin2: Looks like it will be 12/28/11! I don't know how I feel about it not being sooner but I guess this way I can enjoy Christmas without feeling tired. So I guess I will look on the bright side of it and be happy that my surgeons office FINALLY got back to me! I have to see the surgeon on 12/6/11 for a final weigh in and to go over the procedure one more time. I am excited! I am seriously hoping I can keep off the 15lbs I had to lose. This will be a true test since I will have to be good for the holidays. Hopefully I will be ok when all those special treats start calling my name! :decision:

thank you all so much! I cannot wait to start my new life! I love that this forum will be here for me. I will be able to communicate with people who will know exactly what I am going through! I hope you all have a wonderful Thanksgiving!

Drum roll please! Ok, it looks like I am going to be a December Sleever! :seeya: (so what is our call sign? Are we the December Divas? or something else?) My tentative surgery date is 12/28/11 with Dr. Ramin Sorkhi at Pomerado Hospital in Poway, CA. At first I was upset that it was not going to be sooner. I feel like the girls in the surgeons office really dragged their feet with getting a scheduled date. But, I am choosing to look at the positive. I can thoroughly enjoy Christmas and I can finally start the new year off right! I am so excited! We are all finally on our way! :grouphug:

I would contact the facility directly and speak to their business office. They usually can make payment arrangements as long as it is not a "copay". For instance, if it were a deductible, they can usually work with you. Good luck!

Unfortunately, I had to do my own appeal. If they deny you save yourself the trouble and just reschedule with the surgeons office and go in being over a 40BMI. It might save you some frustration.

I need someone to talk me down from the ledge! I am so flippin frustrated with the girls at my surgeons office. They keep dragging their feet with getting my surgery scheduled. I love the surgeon but the office staff leaves a bit to be desired! They scheduled me for a pre op appt on Dec 6th but I am still waiting for a surgery date! The scheduler is out sick so the other girl says, "Sorry, I don't do the scheduling." Seriously! Do you or do you not work in the front office? Why are you not cross trained? They are not supposed to schedule a pre op appt without a surgery date so I wonder if they even have any clue as to what they are doing.

Hi there! I got denied because I did not have the qualifying comorbs with a bmi of 39. If by chance you get denied, put back on the weight to get over 40 bmi. That was the only way I got approved. Good luck! Here is the United Healthcare guidelines: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools%20and%20Resources/Policies%20and%20Protocols/Medical%20Policies/Medical%20Policies/Bariatric_Surgery.pdf

Hello all, I have a question about having my blood work done. I have my upper GI scheduled for 11-23 and the last thing is my lab work. Because I will not be given a surgery date until all of these things are done, my question is when should I have my blood work done? How long are the results good for? I have been told 2 weeks prior to surgery or up to a month. Not sure which is correct though. Does anyone have any input on this? Also, how tired were you after the upper GI? Did you have any problems with it? Thanks!

I completely understand the frustration. You are not alone. I was told that I would need to lose 15 lbs to be scheduled for surgery. When I started the process I weighed 234. My pcp told me I would have to lose weight. So by the time I saw the surgeon I weighed 229. Now I am being told that I need to weigh 214 at my pre op appt on Dec 6th. I have lost 15lbs (as far as I am concerned I weigh 216). But I am being told that the surgeon is going to go by the weight of 229 so I need to weigh 214 when I see him. I am hoping that I can lose and maintain the additional few pounds especially because the holidays are right around the corner. I think they should count my beginning weight of 234! I mean good grief I did lose the weight. But we shall see! If anything, I am going to have to be my own best advocate and tell my doctor as much. I literally feel like this process is taking FOREVER! I am supposed to call my surgeons office tomorrow to get a tentative surgery date. I have come so far so I am going to make sure I do nothing to mess it up. I wish you the best of luck on your journey. I know how frustrating dieting is. But just think of it this way, This diet is a SURE thing! How many diets have you ever been on that could guarantee that?! :biggrin:

Disregard the previous link. This is the most current guideline for Highmark: https://secure.highmark.com/ldap/medicalpolicy/wpa-highmark/G-24-035.html

I went through an appeal with UHC H M O. My insurance covers the sleeve and I did eventually win my appeal. The only thing I can tell you is if you really want this you HAVE to fight for it. Nobody else will do it for you. The girls in my surgeons office did nothing to help me with my appeal. You are going to have to be your own advocate and you are worth it. Unfortunately, if they do not cover the sleeve you can't fight that but you could get approved for whatever other procedure they cover. I did a little research and came up with this link: https://weightloss.clevelandclinic.org/images/file/Insurance%20PDFs/HIGHMARK%20BCBS.pdf I highly recommend that you read this and use their policy against them in your appeal and you should also send them a copy of their policy with your appeal (I would recommend you get a copy of your specific plan sent to you in writing, I just used the link above based on the Highmark BCBS which may not match your plan exactly).You have to write an appeal letter that documents everything you have done on your own. You also should gather as much documentation as you can get your hands on to support your claim that this is medically necessary. You have to get your medical records to prove your comorbs. You also have to show proof of the medically supervised diet you have been on. You literally have to blind them with paperwork. They want you to give up. In your appeal letter you need to also reference the NIH guidelines on obesity and send a copy of it with your appeal letter. You should also reference how being obese has affected your life, your daily challenges etc. If you send me your email by private message I will be happy to send you a copy of the appeal letter I used. Please do not give up! Your life is on the line here. Do not let them take that from you! Good luck! Cheri

that is great news! I have 2 appts left before I can get my surgery date. Meanwhile I am trying to keep off the 15lbs I had to lose in order to get a surgery date and with the holidays around the corner I am getting anxious! Keep us posted on your journey!

I think we all started off wanting the Lapband. Probably because you hear about it wherever you go. Billboards, radio, TV. It's hard to get away from it. The thing that sold me on sleeve was that is was permanent and it helps alleviate the hunger hormone. The thought of having a foreign body inside of me along with having to get fills just to turn around and have it removed in 10-15 years did not sound very appealing to me once I found out about the sleeve. Some people have a hard time thinking about having a portion of their stomach removed. I am ok with it because aside from it being smaller it will still operate the same way not like bypass surgery. Good luck!

are you allowed to have any Soups? Like Cream of chicken or even broth? Try eating/drinking something every 2 hours. I have been dieting to lose the required weight so that I can schedule my surgery. I am drinking Protein shakes and having soups. But I am not on the actual pre op diet yet. Just keep drinking Water, chew gum and remember why you are doing this. You can do this! Living a life of obesity is way worse than a liquid diet. The hard part is not before you it is behind you. Just keep your chin up! YOU GOT THIS!!!!

I am right there with you! The girl at my surgeons office told me that they will not even schedule my surgery until I lost 15 lbs. I still have time because I am not scheduled for my endoscopy until 11-23. I have lost 9 lbs. But the girls in the front office said that when I first had my consult with the surgeon I weighed 229. Well, when I first was seen for WLS I weighed 234. So in my mind I have already lost the 15 lbs. But I can't take any chances so I will do what I can do lose and keep off the last 6 lbs. I just know it is going to be a struggle because the holiday's are right around the corner. :nonod: My question is will they really cancel you if you are only 3 or 4 lbs off? That seems so wrong to me! If we could lose weight and keep it off we wouldn't need this surgery! Anyway, good luck!

Congrats! :hurray:

My goodness this seems like a never ending roller coaster of emotions! :whatchutalkingabout I found out yesterday that I was approved for surgery after having sent in my appeal. I started this process back in July. Back in May I had a full physical, blood work, chest xray, abdominal ultrasound, pelvic ultrasound, mammo, and pap done. I did it all! Now I am going to have to have the endoscopy and gallbladder ultrasound done and more blood work and finally the psych eval. I guess I did this backwards? My last appt with the NUT is on 11-9-11. I have an appt tomorrow with the PCP to request the preop work and psych referral. I am trying to gather everything I can to speed along the process and it's driving me nuts. I am almost afraid that if I don't hurry this up the insurance company may change it's mind lol! I was told some of the tests I would not have to redo since I had them done within the last 6 months. Let's hope they are right. :confused5: Then to top it off I got a call from the surgeons office letting me know that the surgeon is putting in an auth request for the ultrasound and endoscopy and that he also wants me to lose 15lbs prior to surgery. The good news is that I had my first drs appt at 234.4 and today the NUT weighed me at 227. So only 8 lbs to go! I am hoping to reach that goal when I meet with her in a week. I think I am going to go on a liquid diet to speed along the process. I feel like I have come so far that I will do anything and everything to make sure that this happens! :wink_smile: So now my question is, what am I forgetting and what do I need to do now? Anybody out there have any insight? Right now the only thing I am concerned about is the psych eval because I don't know how long it will take to get the referral and appt.UGH! Then to top it all off, I have a real chance of getting a job. I have been unemployed and wouldn't you know it I had an interview yesterday that shows real promise. So now I am stressing! What if they offer me a job? How will I squeeze in surgery with a new job!? Somebody have any words of wisdom? I am pulling my hair out! Ok, thanks for letting me vent!

So here is the latest. I had my chest xray and ekg on Thurs and Friday and my psych appt on Saturday. I was very surprised to get an appt so soon. After meeting with the psych guy I had to do a MMPI test. 567 questions. Are you kidding me!? So I went home and finished it. He wanted me to turn it in at our next appt next Saturday. Well, I didn't want to delay the process for another 2 weeks (it will take him about a week just to review it and submit the results). As soon as I finished it I went back to his office and left it outside his door because he was in session. Not sure if this makes me a crazy person but I feel like I have waited long enough already! On Monday I have the gallbladder ultrasound. Then I need to have my endoscopy but I do not have an appt for that yet because I am waiting on the authorization. I am hoping to get that on Monday so I can make the appt. The very last thing I am going to do is get my blood drawn. Honestly, I am really surprised I have been able to get a lot of this done within 4 days of getting my approval. Oh and I have one last appt with the NUT on Wed. So maybe this is the week I will have everything submitted and they can schedule my surgery. Fingers crossed! Now comes the dilemma of deciding whether to do this before or after Thanksgiving. My husband told me to just do it asap. He thinks I have waiting long enough too! This has been a whirlwind experience but I really am excited! I just wish it was not so close to the holidays. But I would rather miss Thanksgiving so I can enjoy Christmas with my kids. So how is everybody else doing with their approval process? Any good news to report?

thank you so much! I am finally settling down. I think I was afraid the insurance company would change its mind! But the diet is self imposed at the moment. I want to make sure that my liver is shrinking so I can get scheduled as soon as I get everything else done. Believe it or not, I actually love the protein shakes and they do help me stay full. I am finding that this diet is easier because I am not being forced into it. I want to do it because I have come so far and want to make sure I am in good health prior to the surgery. It has been very easy for me so far. Fingers crossed it stays that way!

that just stinks! Why in the world would they require a 6 month diet? Good move on starting one now. I hope that they overturn your appeal. You just never know with the insurance companies. Sometimes you get people who know what they are doing and then other times you get those that really should not be involved with the medical field. I have heard of people getting approved if there are complications with the band. Do you have any that can help with your appeal? As for me,I am trying my best to get a hold of a psychologist to schedule an appt. It is turning out to be a challenge. I have left messages with 3 different places. So whoever calls back first is going to be who I see! Hang in there and keep us posted. Look under the revision forum on this website and see if anybody can give you an idea of how they got approved. I know someone there can definitely help you! Cheri

After months of waiting I found out today that United Healthcare overturned the medical groups decision that denied my surgery! I am finally approved. I am so flustered right now I can't even think straight! I started this process back in July. My BMI was only 39 and I was denied for the consult because I did not have a qualifying comorb. In Sept I went back to my PCP and my BMI was 41. I was denied for the consult stating I needed to show motivated attempts for dieting for 6 months. I submitted the medically supervised weight loss program I was on for 2 years and was finally approved for the consult. Then the surgeon requested the surgery and I was denied citing I needed to have a BMI of 35> with one qualifying comorb. Problem was they were quoting a Medicare plan and not my specific evidence of coverage. I appealed and today I won! BIG HAPPY DANCE! I have an appointment to have my pre-op paperwork with my PCP on Thursday. I will have to request a referral for a psych eval at that time. Tomorrow I meet with the NUT for the 2nd visit and will only have one left after that. They are going to require labs, ekg, chest xray and a medical clearance from my doctor as well. I am hoping to get all of this done so that I can have surgery at the end of this month! Wish me luck!

good luck!

Thank you so much for your words of wisdom EnjoyingWhoIAmBecoming! I definitely needed some outside support on this from someone who understands what this is feeling like! I had my preop appt today with my PCP who has VERY supportive! She came in and gave me a hug. I had my chest xray done today as well. On Monday I have the gallbladder ultrasound. I am waiting on the endoscopy referral to go through and to find a local doc for the psych clearance. Trying to get a hold of a psych doctor is proving more difficult than anything else. She gave me the lab work but I will wait until the end of next week to do those. I need to make sure they are not done too soon since I do not have a surgery date yet. I am literally on my way. The surgeon will not schedule my surgery until these things are done. So I am being my own best advocate to get it done asap. I thought waiting for the insurance approval was nerve racking. I am quickly finding out that trying to get all of this other stuff done is just as time consuming and nerve racking! Keep me posted on your journey! :seeya:

hang in there!

also check out this link http://www.obesityhelp.com/forums/mental-health/Head-Hunger-Coping-with-Your-Triggers-for-Overeating.html