ready4it

Am I freaking out too much? In June my dr's office submitted a request to my insurance for the lap band. I'd requested the RNY, but they thought I would have a better chance of approval based on my lower BMI and lack of co-morbidities. I was denied. On 11/27 my insurance approved me because my BMI was now 40. I hate to admit it, but I'd gained the weight I lost during the medical center's approval process (+ more) and was now eligible for the 3 main surgeries. The nurse coordinator asked what surgery I wanted and I said the sleeve because I thought it was the right choice for me. She said she wasn't sure because I'd had a history of gerd. I hadn't been having issues recently so I stood by my choice. I was scheduled for 12/10, then rescheduled for 1/10/13 due to conflicts in the surgeons schedule. However; in the last week and a half, my gerd has started really acting up again. I started getting nervous about it and kept going back to research the sleeve. Called the surgery coordinator this week to discuss if I should go sleeve or RNY-the nurse told me that any patient of theirs suffering with gerd only got worse after getting sleeved. They were not sure my insurance would cover the RNY, so they had to submit it back to insurance again. Now I'm super nervous that I shot myself in the foot, won't be approved for the RNY and then can't get the sleeve either because they won't do it on me. I feel like for me, the band would be a big waste of my time-but am affraid that will be the only option. Did I screw this up for myself?

I do. Once paperwork was submitted 1st time I was denied. It was quick-bmi too low for wls w/out co-morbs. Next time it took about a week for approval. Bmi is higher now, w/out qualifying co-morbs.

i am a lot like you crystal. i have never had surgery, but have lost over 70lbs with WW and am affraid no matter which i do, sleeve or RNY-i might fail. was planning on the sleeve-but am learning quickly that with my gerd, heartburn and reflux, i may need to have the RNY instead. hate being on the fence and am really affraid of getting another set back.

small world-i graduated from merced hs in 92.

gotcha-i admit, it did hurt my feelings a little at the time when i 1st met him and he said i may not qual because of my lower bmi, but that i might gain weight and later become eligible. looking back, not sure if it was a hint, fact or a jab but he didn't say it rudely. it was more matter-of-fact. still planning on the sleeve. they really didn't discuss it much throughout my classes because everyone was going RNY-so my memory is foggy on their process. how has your experience been? i asked alexis to send me some more info.

thanks! i was denied previously because my bmi was too low w/out the approved co-morbs. since then i've gained, due to stress and trying to jump through insurance's hoops i guess...and maybe a little giving up on myself. my hb had ali-he was good, but when i was going through it the 1st round i saw both ali and pierce 1x-don't recall a reason for prefering one over the other. honestly i've dealt more with other office staff than the drs. i was told the reason it was changed to pierce is that ali is out of the office a lot. i just want it done. what didn't you like about pierce?

got my new date-it's now january 10th! lord love a duck if there are any more changes i might go mad!

I received my date today-surgery is scheduled for 1/10/13. Am I excited? Well yes as a matter of fact I am. But this is the 3rd date I've been given, so I'm more scared that I'm going to get another, "I'm sorry but..." from my dr.s office. I've already heard "I'm sorry but you weren't approved" once, (at my pre-op appointment no less) and then, "I'm sorry but we need to change your date". That was the call I got last week once I finally got approved. Now I have a new date, 3rd time's a charm? I want a ticker at the bottom of my page-to do the happy dance-to be so excited-but I'm scared it's too good to be true, and it won't happen for me. 5 weeks-yikes...that's a long time to wait for the other shoe to drop. I guess I'll relax when I'm in the hospital bed right?

yes-that's what i was told this time. although i'm going to ask for a copy of the approval. the 2nd change was due to the dr.s schedule, not insurance. hoping all is good now!

thank you for the enouragement. it can be so easy to ge excited, then lose hope when disappointed. i am looking forward to being sleeved-and the day i am, i'm going to adopt your saying, i promise!

I'm in CA, but I'll be thinking lots of good thoughts for you both! While you're in surgery, I'll be doing my pre-op. Yep, I just got my date! Jan. 10th

Once upon a time, (about 2 years ago) I lost about 75lbs ....and then unfortunately, I regained most of it back. It was the 1st and only time in my life I was ever able to lose weight, I was no where near skinny-but was beginning to feel good in my own body. It didn't last, and that's what scares me most about WLS, no matter what type I have (if I ever get that far). I fear that I will lose large #'s again, and then fail with regain. My husband previously had a successful the roux en-y surgery, so I with the same office I was expedited through most of the classes and appointments, (I made myself available anytime they said they had an opening-which is key) and as a result, I quickly got approved by the dr. I chose the roux en-y when I 1st began the process because I was most familiar with it and knew the band was too much maintenance, and had been told the sleeve wasn't an option with people who had gerd. My leave was approved through work, and I was ready. The day before my surgery I had my 4 hour pre-op; I still hadn't received a final authorization from my insurance so I asked about it. The nurse went to check, and I was then taken to a private room to be told that I had been denied by insurance because my BMI was too low and I didn't have the approved co-morbidities. Even though I had a long list of health issues, history of my own and family obesity, as well as trouble with weight loss; because I was not "heavy" or "sick" enough I could not get the surgery I'd been preparing for. I was crushed. So long story longer-much stress, several hoops jumped through and pounds gained later, I was told I was approved on 11/27 and if I wanted (which of course I did!) my surgery would be the 2nd week of Dec.. So... I made arrangements with work again and got pretty excited. Imagine my surprise when I received a call from my dr.s office 2 days later to tell me that it was bumped to Jan., date unknown. I'm waiting to hear back what day my "new" pre-op is. It's supposed to be the 1st week of Jan., then surgery soon after. I'm mentally exhausted from the process and am not sure how much more of this I can endure. I just want to get it done. I've fulfilled all of my responsibilities... Despite my frustration at the process, I'm excited to be here with all of you. I've promissed myself I'm having WLS no matter what-even if I have to self pay. February is the cut-off date I'm setting for my dr.'s office/insurance to get my sleeved-or to Mexico I will go. BTW-Has anyone else gone through this? And did anyone else have trouble chosing RNY vs. VSG or change last minute (what made you decide?) Thanks all!

ANH-funny story, the dr.s office actually submitted my 1st request to insurance with the band last march. i didn't know that until they told me i had been denied. they thought i would have a better chance of approval when my bmi was lower. not so sure i'd have gone through with it even if approved at the time, as i just don't feel the band is for me. there is a lot of maintenance and too much opportunity for me to control it. not a fan of that. i was totally pro-gastric bypass up until recently when i thought i was going to have get surgery in Mexico because of my insurance issues-then i started reading A LOT of stories about the sleeve, which led to more research, youtube videos, etc. now i'm 70% sleeve, 30% bypass, and a 100% nervous

@ My350z06, I have about 90-100lbs to lose. I'm worried that being able to eat the same things I do now (eventually and in smaller portions) will be my downfall. I love sweets.

I just recently chose the vsg-but now I'm scared I might have made the wrong choice? Doubts are flying at me like the witches winged monkeys in the wizard of Oz... Now instead of the newly brained scarecrow, I'm feeling a little like the cowardly lion and a lot like lost Dorothy. Am I headed down the right path or am I leading myself into the dark forrest? I'be studied the maps but they look so muck alike... Who else had a hard time choosing between the sleeve and rny? Or how did you choose vsg? I just want to get to the yellow brick road on the corners of health and weightloss.

Thank you both for sharing. It's very helpful to hear other's stories. I am very certain that the sleeve is the better choice of the band vs. sleeve, just debating the sleeve vs. bypass right now. These are both huge commitments and I'm ready for the hard work, I just want to choose my weight loss tool wisely.

You're doing this for you-period. Don't feel guilty or greedy. Because of the size of most the others in comparison to me that I was in class with, I also felt I should be justifying myself. I was denied at 1st by my insurance for a lower BMI (36.something) with no co-morbs. I was approved just last week, months later, at what they considered "obese enough" to have the surgery without the co-morbs. When the dr told me back in March, you may not qualify now, but with your history it might be a matter of time before you do..I was hurt. But I understand why now-fighting the insurance, trying to find a work around for all these months stressed me out so much that I gained the weight I was trying to get surgery to help me take off. Now I'm "obese enough" and the insurance will pay for my surgery, I can get my hernia repaired, and hopefully eliminate several other weight related issues. Keep your head high PC! You got this :]

It's a big step for a 1st surgery but one I think you won't regret. You're making an investment in yourself, your future. I have a lot of the same fears, and I won't be telling people what I'm doing. I don't want to hear the "why's" and "it's the easy way"...We're gonna have to work at this, and what a great support sysytem we have in the VSG forum. Good luck to you in this process.

Thank you so much for sharing your story Catherine. I'm nervous about the change from rny to vsg, hoping it's the right one and that I can use it best to my advantage. I want to lose as much weight as possible with my tool, and I really worry about the fact that I love sweets. From what I've read, the sleeve appears to only affect how much I could eat of them, not prevent me from it.

How strict is your pre-op? Did you ask if you could start it the day after Christmas? Either way-you got this! I wasn't told I was required to do one; but then again my dr.s office has been a little flaky so I may not know until my pre-op apt. Where are you having surgery?

I don't have much advice to offer, but I hope everything works out quickly for you. I know how frustrating it is to be denied and have to prove yourself. I mean really-who wants to have substantiate that they deserve a surgery they're suffering from x y z issues because they're overweight; don't we pay our insurance fees every month? I got all the way to pre-op the day before surgery and my dr.s office told me I was denied by insurance for too low of BMI and that I didn't have the "approved" co-morbs. Had I not asked, they probably would have allowed me to go to the hospital and I would have found out there! I know you can imagine all the preparation I'd put into it, including getting approved for time off from work, buying liquids, protien powders, etc. In my case a supposed "slam dunk" with BSNV was promised and the ball was dropped when they got my denial. That was in June, I've just been approved because my BMI is now 40 due to weight gain (co-morbs not required). It still seems like my dr.s office is not the most organized, but it's so late in the game, it would take way too much to change. If they don't get me scheduled by the end of Jan., I'll go to Mexico. Tired of jumping through everyones hoops-I want to get on with my life already. I don't recall if you mentioned who your insurance is through, but perhaps this might be helpful to you: Members in a Health Maintenance Organization (***) and Exclusive Provider Organization (EPO) Plan The California Department of Managed Health Care (DMHC) regulates all HMOs in California. If you are an *** or EPO health plan enrollee, and you have fi led a grievance and are dissatisfi ed with your *** or EPO’s fi nal decision, you should contact the DMHC *** Consumer Help Center at (888) 466-2219 or TTY (877) 688-9891 to register your complaint. You also should request assistance through DMHC’s website at www.dmhc.ca.gov. You may contact DMHC if the matter is not resolved within 30 days from the time your grievance was received by your health plan. Contact them immediately if the matter is urgent. If you have fi led a grievance and are dissatisfi ed with your *** or EPO’s fi nal decision regarding your eligibility for health benefi ts or limits of coverage under the plan, you may contact CalPERS for assistance.

Congrats! I'm hoping to as well! Have not been given specific dates yet, but pre-op is supposed to be the 1st week of Jan. and surgery 1-2 weeks after.

The info and details everyone have given are so helpful. If something falls through with my surgery in Jan., (re. the insurance or Dr.'s office here in CA) I plan to go through Dr. Garcia as well. You guys have made me more comfortable with my backup plan, thank you!