allycatt98

Are you going to pay it or find another surgeon?

Sorry to hear that. I was really worried about hair loss. I have an aggressive anemia and bleeding disorder so I've had my share of hair loss. I started taking Biotin months before the surgery and then switched to the chewable form after surgery. Are you taking vitamins right now?

Meat, especially chicken was a problem for me at first. I'm glad to have made it thru the awkward stage. Now I'm struggling with fluids. When I'm on the road it's hard to get them down because my stomach is a social butterfly.... sing, sing, sing. Then my nutritionist says I need 90 grams of protein a day! And this is going to happen how? I'll be honest, they're more days than I'm proud to admit that I only get in a liter of fluids. I'm pushing myself to get better, but it's easier said done. Heck I'm just happy to still have hair.

Having the surgery was the best decision I've made in years. My surgery was on July 10th and I'm tolerating all textures with no dumping issues. I'm so blessed. The biggest problem for me is that my stomach likes to "sing" sometimes when I'm drinking fluids. Not a problem when I'm alone, but in a client meeting, it presents a problem.

I did not pay any fees other than office visit co-pays to the surgeon. He suggested BariActiv Vitamins and the whole box of various vitamins is only $25 per month. ...and it's a lot (iron, Calcium, Vitamin C, B12, etc.). They bill my insurance and send them to me via FedEx every month. Nutritional counseling isn't covered (even though it was a requirement) so my six visits cost me $250. I also had a copay for the Psychological evaluation. I can't imagine paying for anything else. Well except the actual surgery. The program fees are not uncommon but they're still good doctors out there that aren't charging them. So please do your research, make sure there's value in the fees. You'll need your money for new clothes. Don't waste it on these fees.

I'm a bit unclear. Why would your PCP be initiating anything? From what you advised, you have not met any criteria and do not have a surgeon. Submission of an auth request just doesn't make sense. You can find a surgeon by going to the WellCare of GA website. If you still have trouble finding a doc willing to accept you, then I would contact Member Services and get them working on your behalf. I regards to the auth request, I don't believe it will be approved. You haven't met any of the criteria including the all important psych eval.

I think you misunderstood my post. It had nothing to do with swiping the card, but about exploring options with coverage. When it comes to the world of healthcare, nothing is black and white. For example, Bariatric Surgery is considered cosmetic (and therefore not covered) unless it is medically necessary. Sometimes it takes more than just good receipts in order to justify "medical" expenses hence my comment about exploring some of the expenses listed. The difference between an approval and denial often is determined by supporting medical documentation. For the record, I just switched to a HSA this year. For the past six years I've had a FSA account which was strictly audited. I had to provide supporting medical documentation for everything except prescriptions, OTC medications (when they were allowed) and first aid at the Pharmacy. So I'm familiar with the IRS allowables.

I would explore some of the expenses you listed as not being covered. I've gotten them covered before in the past.

I would use my HSA debit card preferably.

You look skinny already lol Thanks! I don't feel it though. Maybe in six months or so things will be different.

Hi! Are there any previous or current patients of Drs. Marema and Koppleman (US Bariatrics) in St Augustine, FL? I really wanted my surgery to be performed by either Tiffany Jesse or Robin Ache (Suncoast Bariatrics) but Palms of Pasadena Hospital is no longer a United Healthcare Bariatrics Center of Excellence. They said this is currently affecting about 30% of their patients. I don't like Tampa General so I opted to go to Dr. Marema at Flagler. I have five more NUT visits (including one this month) so I'm looking forward to a July surgery date. I'm currently waiting on the office to complete the insurance verification process so I can schedule a consultation. I was advised that this takes 7-10 days. I would love to hear from any current or new patients. I'm a bit worried about the 2.5 hour car ride home after the surgery. Ally

I'm scheduled for surgery tomorrow (7/9) at 9:30. My mom is going with me and we have to hit the road at 4:30 am bc I have to be there by 7:30 and the hospital is about three hours away. Since I'm staying locally in a hotel for a few days after I get discharged, I decided to cut back on expenses and just drive down the morning of surgery. Fortunately UHC will reimburse travel and lodging so I'm looking forward to getting some of this money back. I can't believe that my surgery is right around the corner! I thought that day would never come. My biggest concern is my anemia and bleeding during the surgery. Anyone else scheduled for tomorrow?

No advice bc my date is also 7/10. Im on day nine of my liquid diet. I moaned about donuts on the phone with my mom today. But the finish line is in sight. Then we begin a totally new battle. Looking forward to seeing you on the finish line Soto!

Lol. Just be sure to pursue using your benefits as much as possible to avoid out-of-pocket fees. The Psych eval is covered. However, sometimes the Psychologists you are referred to by the surgeon are out-of-network and you end up paying out of pocket. I would call member services in order to maximize your benefits as much as possible. I worked in the WC PreAuth dept for six years and reviewed Bariatric surgeries so I'm used to the shuffle.

Mommychuchi, I'm confused.... Is your surgery approved or just a covered benefit? I ask this bc the psych eval and nutritional counseling visits are all required in order to obtain approval. So if you haven't completed them how was your surgery approved? In regards to nutritional counseling, some centers/physicians prefer for you to visit their NUT in order to ensure you're provided the most accurate information regarding their specific requirements. If I were you, I would confer with Member Services bc your Psych Eval is a covered benefit so I'm not sure why you would have OOP fees associated with that.

Hi Rella, Your should be able to use HSA funds for the surgery in addition to claiming the expenses above and beyond HSA on your taxes. I would prepare a packet similar to what would be submitted for regular insurance approval: BMI, history of weight loss attempts, nutritional counseling and any documentation you've received from the surgeon. I've also used FSA funds in the past for physician directed weight loss programs. I hope this helps.

Thank you for all this knowledge, I am exicted but so scared. The whole removing most of yur stomach keeps freaking me out. Would love to chat more please stay in touch / How are you doing on your pre-op diet? I'm also scheduled for July 10th.

I'm also scheduled for July 10th and start my preop diet on the 26th too! I'm scheduled July 10th as well in St Augustine, FL. I'm on the dreaded liquid diet. Down six pounds in five days

I agree! I ordered 4 of their sample packets: Birthday Cake (blech!), strawberry (good), Vanilla (okay) and banana (really tasty). The best part was that the balance of Stevia was perfect and I didn't need to add anything else. I buy mine off of Amazon because it's much less than buying directly from SDC.

Hi Awas! I hope my responses to some of your questions are helpful. Let me know if you have any questions. 2. I heard all about the diet today and all I could do was die. Yes I'm fat but believe it or not fruits, veggies and nuts are my favorite foods. The thought of having to center my eating around a piece of meat or fish with none of the above for a long time (my center recommends until you hit maintenance) is making me cringe. I'm not a big meat fan...but at the same time I don't want to end up malnourished... Once your surgeon gives you clearance, why would you have to avoid a balanced diet that includes additional Protein sources such as the ones you listed above; i.e., fruit, veggies, nuts, etc.? Are you sure that you're not confusing one of the diet phases? I'm sure someone will correct me if I'm wrong, but I thought the major limitations were imposed during the pre and post-op periods. You might want to speak with your surgeon's office again for clarification. Things can be really confusing in the beginning and its easy to become overwhelmed..... And for the record, I'm not giving up my mangoes. 4. I am already battling anemia...will this surgery make that battle even harder? Okay I can speak to this one. I have Iron deficiency anemia. At times my Ferritin is less than 6 and my iron saturation has even been less than 3%. So this one is close to home for me. There are different forms of anemia and you didn't really provide any details. Do you suffer from anemia due to dysfunctional uterine bleeding? Is there an inherited bleeding disorder? Is this a Pernicious Anemia? The surgery itself (because of the inherent bleeding risks) may be a concern. The post-op diet could cause additional complications depending on your health situation. Are you currently under the care of a Hematologist? If so, I would consult with your Hema/Onc. Additionally, I would have this conversation with your surgeon and nutritionist. Anemia often requires more than just a discussion about diet, it may also affect your pre and post surgical treatment.

I'm in Tampa and will be sleeved at Flagler on the 11th. I'm interested in joining.

Hello, I worked in the Utilization Review dept at WellCare for years. Their Clinical Coverage Guidelines are available online. Just click on the "Providers" link, then select Provider Resources. The process isn't difficult, but I would allot at least a week for review time. Their volume is really high. In regards to process: The Nurse Reviewers will review the request for medical necessity based upon the guidelines. If everything has been submitted by your doc and criteria met, then the nurse can approve the request. Notification of the approval is faxed to the surgeon and hospital. If criteria is not met, the request is sent to the Medical Director for determination.

I'm in Tampa, but my surgeon is in St. Augustine.

I can see why! I'm so impressed and inspired. How long did it take you to achieve this? Ally

I'm going to have my sleeve done by Dr. Koppman -- Dr. Marema's former partner. His office is at Flagler. He's three hours away, but it was worth it. Marema is touted as the bariatric expert of the state. There is a long wait for appointments and he charges a $600 non-refundable program fee that does not include the insurance required NUT classes. Reviews on his bedside manner vary. Don't know much about Kim. He's well respected by other docs and patients.