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It?s so strange how my road to surgery played out. In the beginning, I must have had a good luck charm, everything fell into place. Then I received the insurance denial that the Sleeve was not the ?Standard? procedure for someone with my BMI. It has been 5 weeks of stress and anxiety with appeals, denials, thoughts of Mexico, family concerns, yadda, yadda, yadda. After long discussions with my surgeon, I gave in to RNY. For myself, I needed to start my weight loss journey now. After I made that decision, I was able to focus on the pre-op, and have lost 5 lbs (only did one week, cause my head was not at the right place with all the drama going on). Anyway, I spent the day yesterday getting all the necessary items that I would need after surgery. My list includes: Pill box for Vitamins Centrum ?silver? chewable vitamins Caltrate Plus D chewables B12 Gas ?X thin strips Pearls (probiotics) liquid Benadryl (for any mucus issues) New Heating Pad Baby spoons My pantry is stocked up for 2 weeks on full liquid diet, so I guess all I need to do is pack my bag for the hospital. Thanks to all for your support and allowing me to be your ?step? sister! Hugs, JoAnne

Congrats to both! Just think, you will have one item that you won't have to put on your New Years List! WhooHoo! Hugs, JoAnne

Congratulations Judy! I'm so happy you were able to get your BP under control! Now keep taking deep breaths and leave all stress behind! December 1st will be here before you know it! Hugs, JoAnne

Hi my dear friends, I am doing well! I will admit the first 30 hours after surgery were hard. I felt much better once I was able to take oral pain meds. I got home last night from the hospital, took a pain pill, and passed out. It's amazing what a day does make. I felt 95% better today, and it's only going to get better from here. I love my "sippie" cups, baby spoons and bowls. (TMI section) Also, I need to watch out for any lower gas. I can't trust any! Thank goodness for "always with wings". They are lining the rear of all my undies. I'm not weighing myself, since I was pumped full of fluids. However, I did loose 10 pounds during the pre-op. I was pretty happy with that! Well, it's time to start walking around the house again. My family is on a mission to make sure I get my 10 minutes an hour in! Thanks all for your thoughts, prayers and concerns. I will update more tomorrow. Hugs, JoAnne

I just had RNY on Tuesday only because my insurance denied me for the Sleeve, and I couldn't deal with any more stress at this time. If you have a choice, I would choose the Sleeve. The biggest thing is to do the research. I had a great surgeon who eased my fears for the bypass, but my heart belonged the Sleeve. Best of luck in what ever decision you make. Hugs, JoAnne

Got this from unjury news letter. Sounds yummy! pumpkin Spice Latte Ingredients: 1 scoop or 1 packet vanilla UNJURY 1 tablespoon Canned Pumpkin (not pumpkin pie filling) ? teaspoon Apple Pie Spice (cinnamon, nutmeg, allspice) ? cup Skim Milk2, Lactose Free Milk, Soy Milk3, Rice Milk4 2 teaspoons Splenda or Equal (add more or less to adjust sweetness) ? cup Water 1 teaspoon Instant coffee (regular or decaf) Directions: -Heat water in microwave (below 130 degrees) then mix in instant coffee Add: -Coffee (as prepared above), milk, canned pumpkin, Vanilla UNJURY, apple pie spice and sweetener in blender -Blend until combined (about 30 seconds) -Heat in microwave until warm or serve over ice Fun Extras -Serve with a cinnamon stick -Top with 1 tablespoon of cool-whip (sugar free or regular) and sprinkle with Apple Pie Spice Nutrition Facts per Serving: 150 calories, 24 grams Protein, 11 grams carbohydrate and 9.5 grams sugar UNJURY Protein Pumpkin pudding Ingredients: 1 Package (1.4 oz) sugar-free Vanilla Jell-O Instant Pudding Mix * 3/4 Cup water 2 scoops or 2 packets Vanilla UNJURY? 2 tablespoons canned pumpkin (not pumpkin pie mix) ? - ? teaspoon pumpkin pie spice5 (Mix of Cinnamon, Ginger, Nutmeg and Allspice) Directions: - Measure 3/4 cup cold water (ignore package directions which call for 2 cups milk) - Add two scoops of Vanilla UNJURY to the 3/4 cup of water - Mix the UNJURY in water by thoroughly shaking or stirring Next, follow pudding package directions... - Empty the Jell-O sugar free Instant (Not Cooked) Dry Pudding Mix into a bowl. - Add pumpkin pie spice to dry pudding mix - Blend spice and dry pudding mix thoroughly with a fork - Pour in the previously-mixed UNJURY-and-water. - Add 2 tablespoons canned pumpkin - Stir/Beat until thoroughly mixed (a wire whisk or mixer works best) Place in small container and chill in the fridge. Top with Fat-Free Cool Whip1. Enjoy! Makes about 3 servings. Nutrition Facts per serving: 107 calories, 14 g protein, 12 g carbohydrates, 3 g sugar *For higher calories use regular Vanilla Instant Pudding mix Comments: Because this IS a high-protein low-carbohydrate recipe, it isn't comparable in taste to a classic pumpkin pie, but we think you'll enjoy it!

Thanks for the good thoughts and prayers. Getting ready to turn in. I need to be at the hospital at 7:30 am. Surgery at 10:30. Night All! JoAnne

Good Luck Chandra! I'll be saying a prayer and sending good energy! Hugs, JoAnne

Hang in there. The pre-op diet is hard, and your head has to be in the right place. I was suppose to do 2 weeks, but only made one fully successful week. I started out surviving on Atkins Advantage shakes, crystal lite green tea with raspberry, and Water. By day 3 the only Atkins Advantage that I could tolerate was the dark chocolate. I ended up buying Lipton chicken noodle Soup. I know I should not have the noodles, but the soup is only 60 calories a serving. I fished out most of the noodles drank that in the evening mixed with unjury Protein powder. I found having something hot/warm to drink was very satisfying. This has gotten me to Day 7 of the liquid diet. Put the cheesecake down, take a deep breath, and give it another try! You can do it! Hugs, JoAnne

Hi Mountain_Lover, I started my pre-op diet on Tuesday. Was suppose to start a week before, but was too stressed due to the appeal. Anyway, I am on day 5. You really have to have your head in the right place. I was using Atkins Advantage shakes. By day 5, I can only tolorate the dark chocolate. I have Lipton chicken Noodle Soup (yes, I know we're not suppose to have the noodles), but it's only 60 calories a serving. I add unjury unflavored Protien to it (soup must be warm, not hot). That has been my saving grace, along with crystal light green raspberry tea. I'm still hoping my surgery is Tuesday. I've been calling all week, and the assistant that takes care of scheduling has been out sick. I finally got a hold of another person from the office. She said she had my file on her desk and would call me back. Never got a call. This makes me very nervous since I usually receive a letter in the mail for any appointments or pre-op procedures that I had. To date, I've received nothing. Trying to keep my stress levels down and hoping that everything is ok. Anyway, give the soup a try if you get to the point of "Not another shake!". Hugs, JoAnne

OK.....I work for CareFirst BlueCross BlueShield. I was told by our member services that the Sleeve was covered. I also looked at a copy of our Medical Policy, which states: 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 So, assumed that since I was just having a stand-alone restrictive procedure, there was no BMI associated with that. However, it appears that CF will only cover the sleeve for patients exceeding 50. This makes no sense to me. I'm ready to throw-up and cry! I do not want the bypass. If I appeal, my date of 11/10 is out the window. :confused:

What an AWESOME accomplishment Tiffy! Way To Go! :thumbup: Hugs, JoAnne

Thanks Mountain_Lover, Tiffy and Vegas! I appreciate your kind words and encouragement. The support everyone has provided helped me through this past month. Congrats Mountain_Lover on your approved surgery date. I am truely happy for you! :thumbup: Although my surgery will be different, I'm still excited to be able to share my journey with everyone. Hugs to All, JoAnne

I am so happy for you Mountain_Lover! :thumbup: Your wonderful new life will be starting before you know it! Hugs, JoAnne

Thank you so much my dear friends! Having your support makes this process so much easier for me. I started my pre-op diet yesterday (a week late, but I was too stressed before to stick with it). Two days down on Atkins Advantage, Water and crystal light. It's not that bad when your head is in the right place. This time next week I will be on my way to a new me! Hugs to all, JoAnne

Hi Mayflo, Sending you positive energy and will keep you in my prayers. Can't wait to read your updates! Hugs, JoAnne

Well it appears that I will still be denied for the sleeve. The Medical Director has stated that Sleeve Gastrectomy is not standard procedure. They are asking for my surgeon to provide in writing why He is choosing this procedure for me. Well, the problem here is that my surgeon is a RNY guy. He does perform the sleeve on patients that request it, but RNY is his surgery of choice. The sleeve is my surgery of choice. What I'm pissed off the most is that all the 2009 studies that have been published, and submitted with my appeal, do not seem to be taken into consideration. Next steps.....This has been an agonizing process. Last week I decided that I would re-schedule my surgery date for 11/17 (was suppose to be today). I put the appeal decision in the hands of God and would have whatever procedure (sleeve or bypass) based on the outcome of the appeal. So, it looks like bypass it is. Yeah, I know I'm selling myself out, but I really don't have the energy to deal with this anymore. I have an excellent surgeon and know that I will be in good hands. I have spoken to several of his patients who had the bypass (1 - 4 years out), and they have nothing but good things to say about the procedure. The saddest thing is "leaving" all my friends on this forum. I still will be checking on you and wish you all the best! You are the Greatest! Hugs, JoAnne

I still may have a shot for approval! OK, after I regrouped yesterday, I spent several hours digesting the content of my denial. To my surprise I found two major flaws in their decision. 1) As I had referenced in my appeal, our medical policy on Sleeve Gastrectomy was extracted from a 2007 position paper from the ASMBS. The ASMBS "Executive Council has removed that outdated statement and has charged the Clinical Issues Commitee to review current data and revise the position statement". http://www.asmbs.org/Newsite07/resources/sleeve_statement.pdf I questioned, "How a denial could be made based on our Medical Policy where the source of the information can no longer be referenced?" 2) In my appeal, I also referenced "A systematic review of the literature covering Sleeve Gastrectomy through January 2009 which was published in June this year." This literature contained 36 studies with over 2500 patients. I knew for a fact that this study was never reviewed as part of my appeal, since I had to pay for a copy of this paper. (if anyone would like a copy of this literature for your own investigation, please PM me with your email address). I emailed Central Appeals with my above concerns (along with the soft copy of these documents), and requested a re-review based on the above. I received notification late this afternoon that the Medical Director has agreed to review the 2009 literature I provided, and will render his decision by next Tuesday. I feel my odds of approval are 50 - 50, since the Medical Director could have refused to reconsider my appeal after the denial was rendered. Please keep your good thoughts and prayers coming! Hugs, JoAnne

Now that the only alternative is to go to Mexico, I'm getting a lot of opposition. 1. Should something go wrong with the surgery, finding a local surgeon will be next to impossible. (got this from my surgeons office) 2. After Care follow-up will be next to impossible to find. 2. Husband is against me going to Mexico due to the above. I feel so screwed over. Even If I cave in to RNY, my surgeon knows how dead set I am against it, and may not do it since my head is not in the best state for a surgery that I don't want.

Decision on my appeal has been denied. I am told it is not Medically Necessary. Enough said. I have no recourse. I will focus on next steps. Thanks all for your support during this trying time! Hugs to All, JoAnne

Thanks Mountain_Lover! I was told that I would have a decision by tomorrow (Monday). If my appeal is denied, then that will be it, with no other options of appeals, since I am in a self-insured account. I already have been in contact with a coordinator for Dr. Almanza, and scoped out airfare (just in case.....for my own sanity, I need to have a backup plan in place to immediately act on). So tomorrow you will be reading YaaaaHooo, I'm been approved, or Ole going to Mexico! Mountain_Lover, I wish you a speedy approval on your insurance. I know how hard this waiting game is. Thanks to everyone on this forum for your support. It has made these last 3 weeks much easier on me! Hugs to All, JoAnne

Hi Judy, My thoughts and prayers are with you. Take deep breathes and keep the positive energy around yourself. Hugs, JoAnne

Good thoughts and prayers will be with you Ruby. Can't wait to read about you success! Hugs, JoAnne

Hi Mountain_Lover, I totally agree that our medical policy makes no sense and that I also interpret the policy as approved for standalone with no BMI restrictions. However, according to the Director of Pre-Cert, VSG is only approved for those with BMI > 50. I have tried to get a status on my appeal, but was told it was in review and that a decision would be made by 11/1. I have no idea if my surgeon has done a peer to peer appeal yet, since the assistant that tracks that is out of his office until tomorrow. I have also called several Dr's in Mexico. Southwest is having an airfare sale till Thursday. I have found air for around $100 each way. Amazing for coast to coast! At any rate, I started my 2 week Pre-Op diet today (as far as I know my surgery date is still 11/10, just in case. So, I'm still in a wait and see mode, trying to stay positive that this will all work out. :thumbup1: I really hope I don't cave in to RNY since self-pay would not be easy for me at this time. Hugs, JoAnne