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Sending you good thoughts and prayers for a quick approval from your insurance carrier! Hugs, JoAnne

Thanks Mountain_Lover! I am on pins and needles! I'm so nervous not knowing what the outcome of the appeal will be. I thought I would have an answer by last Friday from my surgeon's office on his peer to peer appeal. Apparently that has not happened yet. I left a message late Friday and just a little while ago. I probably have gone from a PITA (pain in the arss) to a full blown Hemmorrhoid calling his office so often. I'm also afraid to bug my insurance company, since I know my surgeon will be doing the peer to peer appeal. I'm about 2 weeks away from my scheduled surgery date, and should be starting my liquid diet on Wednesday. Again, thanks for your thoughts, prayers and good energy. I will post as soon as I hear anything. Hugs, JoAnne

WhooHooo Judy! Congratulations! Can't wait to read about your journey! Hugs, JoAnne

Hi Kirasoma, Saying an extra prayer for a clearance report tomorrow. Best of luck, we are all behind you! Hugs, JoAnne

Thanks Chancie, Susan, Sandy and to all that have replied or just feel my frustration. This is why I love this forum. Everyone is so caring and supportive. I feel like everyone is part of my family. Your good thoughts and energy keep me going. Hugs, JoAnne

Well, my appeal has been received, and they have 15 days to respond. I do know that my surgeon will be doing a peer to peer appeal for me too. I have already started my pre-op testing (sonagram, chest x-ray, barium swallow and 15 tubes of blood yesterday). I just wish I had the final decision so I could plan my next steps. I could probably swing $5,000, but $9,500 plus air would be out of the question right now. The sad thing is my surgeon is supportive of the sleeve surgery. I'm still trying to keep that positive energy flowing. :drool5: Has anyone had their surgeon go to battle for them with the insurance company? If so, what was the outcome? Hugs, JoAnne

CareFirst BlueCross BlueShield of MD approves the following: Adjustable gastric banding (e.g. Lap BAND?) Gastric bypass Gastric stapling 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 Since my BMI is 41, I don't meet the VSG qualifications, but I do qualify for gastric banding or bypass. It truly makes no sense that VGS will be approved as standalone for BMI > 50. If my BMI was > 50, I would be approved for Gastric Band, Gastric Bypass or VSG, I have submitted my appeal with tons of documentation on the latest VSG studies, and my surgeon has request a peer to peer review with the Medical Director of Appeals. Hopefully they will get the message. I do not know what the outcome will be, but I will not go down without a fight. With that said, I'm afraid I will be forced to cave in to RNY. I need to start my weight loss process asap. I can barely fit into any of my clothes, and I refuse to go out and purchase larger sizes. I am still trying to keep my positive attitude, but I feel myself wearing down. I'm so thankful for all the support everyone has provided. Hugs to All, JoAnne

Carolyn, will keep you in my thoughts and prays for a safe surgery and speedy recovery. Can't wait to read your updates! Steph, I totally agree with you about the health care hoops. I work for CareFirst BlueCross BlueShield. I am very familiar with the pre-cert process, and was so careful to make sure all my I's were dotted and T's crossed. Well, in my appeal, I have pointed out that the Position Study referenced in our Medical Policy for Obesity, is no longer available on the WWW. I'm hoping that in itself will be a factor for approval. I have provided many references of recent VSG studies. Additionally UHC, our competitor has reversed their Medical Policy this month stating that VSG is proven in adults for the treatment of clinically severe obesity (35-39.9 kg/m2 - Obesity Class II (Severely Obese)). My CareFirst Medical Policy will only approve if BMI > 50. I truly believe that the tide is slowly turning with physicians, specialists and Health Care Insurers, seeing the benefits of WLS. Recent studies for VSG can only help to get this procedure approved with the same criteria as RNY and Gastric Banding. Should my appeal is denied, I will have to regroup and reconsider RNY or self pay in Mexico. However, I'm still not giving up hope for approval! Hugs to All, JoAnne

To my dear sleevers who went to Dr. Aceves, do you have a direct phone number to his center? Is the (888) 344-3916 number through an agent or his own center? What price were you quoted and pay? Did the price include air, or was it all inclusive with the exclusion of air? Your help is greatly appreciated! Hugs to All, JoAnne

Thanks so much Tiffykins! I am beginning to pull research now for my appeal. I will put positive energy in this process and bless the outcome no matter what it is. The hurdles we face with insurance can only pave the way for others. Hugs, JoAnne

Thanks all for your support. I have fulfilled all the requirements PLUS, specified by my insurance company. Additionally, The UM Center for Weight Management & Wellness has additional requirements before they submit to insurance. I made sure my clinicals had every I dotted and T crossed. What I'm frustrated about is that my member services told me months ago that the sleeve was approved, but never specified the BMI requirement of > 50. I also got a copy of our Medical Policy, and it reads like it's approved as a standalone OR as a first stage with DS later for BMI >50. I sat down with one of our Medical Nurses this afternoon, to get her take on the policy. While she agreed with me, if you go further down in the fine print, you fine the AND between the two procedures. I will be approved for RNY, but NO WAY! (I'm saying this now!). I did not spend months of research on procedures that I'm not comfortable with. I'm not giving up hope yet. I will pull together whatever studies are out there and submit an appeal. I know who to go to, and will speak with them in the am. If it is not approved, then I will just need to save my $$$ to go to MX. I know Dr. Aceves is the best, but he is running no specials and the price not including air is $9500. I see there are several other "all inclusive" with Dr. Fransico Gonzalez, DR. Lisa Marie Gonzalez (LIMARP), Emmanuel Medical, The Bariatric Group. Does anyone have feedback on these practices/surgery centers, OR any other personal recommendations of MX surgeons ? Your Help is greatly appreciated! I knew it was too easy up to this point (everything fell into place like magic until today). However, this too shall pass! Hugs to all, JoAnne

Thanks Chancie. Although I've only been communicated to verbally, I've already made some internal inquiries on the best way to handle the appeal process (thank goodness I have some great connections). Anyway, I need to get some of the latest studies that have been done recently in the USA on the Sleeve. If anyone has any of this info, would you please post the url's? This is coming at the worse time for me, since I have a huge work deliverable due Friday. Any help will be greatly appreciated! I do have some information that I've compiled for my own documentation, but I did not include the links (dumb me). Thanks everyone for your support and the support you provide to the members of this forum. The information and sharing here is invaluable. Hugs, JoAnne

I will be going for my first couple of studies the week of October 19. Looking forward to the extra testing and the $$ will be a help too! Hugs, JoAnne

Just found out today that my surgery has been scheduled for November 10th. I am so, so excited and ready to become a sleeve sista! :thumbup: Now I have to go back through the posts to figure out how to setup my weight loss ticker...etc. All I can think about is this time next year I will have a brand new body (probably in need of a lot of tucks, but I will deal with that after my new body arrives)!:incazzato: Hugs, JoAnne

Thanks all! I started "freaking" out this morning when I found out my surgeon uses a tight 40 F! :confused1: My surgeon assured me that the difference between each size is about 1/10 of an inch (32 - 34, 34 - 36, etc.). This would make 4/10 of an inch difference between a 32 and 40 - less then ? inch Immediately I tried to find the actual size of a bougie. If my research is correct, then .333 mm is 1 F. .333 * 32 = 10.66 mm .333 * 40 = 13.32 mm A difference of 2.66 mm. But 2.66 mm does not equal ? inch. Do my calculations sound correct? Can anyone validate the correct size of each bougie? :huh0: Realistically, there does not seem to be much difference between these sizes, and I should not sweet the small stuff! :w00t: Thanks for any input! Hugs, JoAnne

Hi DeeDee and Jen, I'm going to the University of MD. Dr. Kligman will be doing the surgery. Would love to go to Dr. Aceves, but my insurance is picking up most of the cost, which enables me to stay local. Dr. Kligman has a wonderful program and know I will be in great hands. I have about 100 lbs to loose, and my BMI is 41. Can't wait to read and share all of our experiences through this journey! Hugs, JoAnne

My surgeon required a lot of pre-op testing: Cardiologist clearance letter, EKG, Chest X-Ray, etc. EGD (found out I had H-Pylori) Colonoscopy Mamo report Pap smear report DEXA Scan Psychological Eval SPLIT sleep Study (found out I had sleep apnea - now on a CPAP machine) There were lots more listed, but I only needed the ones above. Best of Luck, JoAnne

If we could loose weight ourselves, and keep it off, we wouldn't need surgery. WLS is not a gimmick! For most of us, it's the last hope we have after trying everything else out there. Stick to your guns Nancy! You have selected a tool that will finally help you to be successful! If your hubby won't support you, find a trusted friend who will support you through your journey. Best of Luck, JoAnne

Note to self: Don't read posts while drinking! I had just taken a swig of Water when I came to "tie dyed" undies. Needless to say that water is now sprayed all over the place!:laugh0: Congrats on your surgery Judy. So thankful everything went well. Can't wait to read about your progress!:thumbup: Hugs, JoAnne

Interesting on the H-Pylori diagnosis. I just found out yesterday that I have it too. Getting ready to pickup my prescription. I never heard of this before. Didn't have any symptoms, don't know how long I've had it, and never would have known if I wasn't having the surgery. :001_tongue: My Dr. told me that they will just check my breath to see if it's cleared up. Has anyone else been diagnosed with H-Pylori? Is it common? :thumbup: Hugs, JoAnne

Congrats on your Sleeve Day Trudy and Ivy! :001_cool: Judy, your wait is almost over too! Keeping you all in my thoughts and prayers. Can't wait for your updates! Hugs, JoAnne

WhooooHooooo! Simply AWESOME Shanda :thumbup:! Keep up the fabulous work! By the way, what is NSV :blushing:?

Suzy, don?t give up hope. Call your BCN member services in the morning and ask them what their Medical Policy is for Bariatric Surgery. Make sure you get a copy of this policy and ask where this medical policy is located on their website. I tried to find it, but in my opinion their site is very generic. I do see that BCN has several Centers of Excellence for Bariatric Surgery, but not the procedures that it covers. Take a deep breathe and keep the faith! Hugs, JoAnne

I completed my 3 month supervised diet last week (7 months of WW documented last year, but had a 4 week gap, thus the need to complete another 3 months :cool: - insurance requires one 6 month or two 3 month supervised diets, within the last 2 years). I have my: Cardiology Clearance letter, Colonoscopy report, Mamo & PAP report, Letter of Medical Necessity, DEXA scan, Psychological evaluation, Split sleep study (come to find out I have mild sleep apnea) and my EGD was done today. This afternoon I received a call informing me that my paperwork has been turned over for submission to my insurance company. YIPPIE! :lol0: I?m so excited to be one more step closer. Hopefully, I will receive approval in the next few weeks, then have a date scheduled. I would love to have the surgery in early November in order to have a jumpstart into the new year! Best of luck to all scheduled next week. I?ll be thinking about you. Can?t wait till I become a ?sleeve sista?! Hugs, JoAnne

Here’s something my dietician provided me for the pre-op diet, the basic and alternative if you can’t do all liquid. The Diet: 1. Drink at least 64 ounces of fluids per day (all must be sugar-free, calorie free, and non-carbonated) 2. One multi-Vitamin with essential minerals per day. 3. Consume 1000 - 1200 mg of Calcium per day 4. No Alcoholic beverages 5. Drink 4 - 6 no sugar added Meal Replacement shakes each day (recommends Adkins Advantage even though it has 1 gram of sugar. They taste great and have 15 grams of Protein and 24 essential nutrients plus calcium and no trans fats) Sample Day: Breakfast: 1 shake Lunch: 1 Shake 4pm: 1 Shake (optional) Dinner: 1 Shake Bedtime: 1 Shake (optional) What if you break the liquid fast or just cannot follow a liquid diet for 2 weeks? Plan B - A shake and food meal plan that will keep the fat extremely low. The goal is still to lose as much weight as possible before surgery. The Meal Plan: 2-4 8-11 ounce high Protein Shakes a day 1 meal a day, composed of 3 oz seafood, turkey or chicken (no skin) Or 1 cup Non-fat/low-fat yogurt, cottage cheese or ricotta cheese And Non-starchy vegetables - up to one cup No corn, peas, potatoes, sweet potatoes or baked Beans Fresh Fruit - 1 piece (1 cup) per day Olive oil - 1 tablespoon a day, no salad dressing, no mayonnaise Eat only 1 meal a day. Limited to 20 minutes per meal. Sample Day 1: Breakfast: 1 Shake Lunch: 1 Shake Dinner: Stir-fry 3 oz chicken ? cup broccoli ? cup mushrooms 1 tbsp Mrs. Dash 10-minute Mesquite Marinade 1 tbsp Olive oil Snack: 1 Shake Sample Day 2: Breakfast: 1 cup 2% Cottage Cheese 1 cup fresh peaches 1 cup Lettuce Lunch: 1 Shake Dinner: 1 Shake Snack: 1 Shake Sample Day 3: Breakfast: 1 Shake Lunch: 3 oz shrimp Lettuce 1 cup zucchini 1 tbsp Olive Oil Salsa 1 Pear Dinner: 1 Shake Snack: 1 Shake Hope this gives you some alternatives. Hugs, JoAnne