AquariusDiva

I'm slso a recent transplant from MD, now living in NJ. But I'm having surgery at Lenox Hill Dr. Roslin in NYC. We chose him BC DH is having the SIPS WLS being studied there (similar to a bypass but with milder malabsorption and less intrusive). It just so happens I'm going first.

It appears to me that they go off your weight at the surgeons office. I was in a similar boat border line 38.5-39 most if my adult life. But I manAged to gain 10 lbs to make it over the 40 bmi. From my experience with the 6 months NUT- I ended up gaining (but I also had a knee injury during that time). My husband has gone both up and down during his visits. For him the problem was that his PCP did not write very good notes about diet/exercise during his visits (just looked like normal co morbidity visits). We are still waiting on his approval.

UHC wanted 6 months of dr supervised diet - Cigna my new insurance wanted three. The visits counted as my patient notes had my bio stats, weight loss plan - including diet (discussed with patient 1200 calorie diet, discussed limiting g carbs, etc) and exercise (discussed with patient to walk 3x a week, patient knee injury preventing from conducting traditional cardio- suggested swimming) etc. those type of notes are what Cigna and United ended up both approving

Keep your surgery date !

My doctor didn't request any diet from me except the 24 hrs before follow a clear liquid diet ...

Argh - that would figure that UHC dropped it this year!

I had UHC last year and went through the whole process but was denied bc they required a 5 year med history of obesity. I was missing a year and one year was deemed too low. Dr appealed and got it overturned (probably bc they had 8 year history with me being overweight. But it came through at the end of the year and my dr was on vacay. So did another submission to my new insurance in January Cigna- they denied it bc the surgeon, Nut and psych were over a year old 12/13. Appealed with new visit to the 3 of them and they overturned it. So I'm now scheduled for 3/16. I did gain a few lbs during the 6 mom supervised program ... But that wasn't why they denied it ...

Gratefu Love -How about going this weekend for a visit ...

My surgeons office has a nut and psychologist as part of their office. The insurance picked up the surgeon consult and that included the nut, but the psych was $150 in cash. Would going into NYC work out for you? Dr. Roslin with lenox hill hospital - and it's a center of excellence

Me too - set for March 16. Still have to elegy my pre surgery stuff done, including bloodwork, EKG, upper GI and chest X-ray.

Another reason some choose to go to MX seems to be that they are on the low end of BMI- like being 39 Bmi with no co morbidity or under 35 bmi. I know a low bmi person who got the lap band in MX. As far as insurance denial - I was denied by UHC due to missing one year of recorded weight by my doctor and one low weight year (part of the five year medical history). But we appealed based on high weight records dating back more than 5 years ... And that appeal worked. I was then later denied by cigna based on the 12 month rule for surgeon, Nut, and psych evals. That was reversed once I did another visit to all three. It's been a long process for me. ... Started back in dec 13. Just got the last insurance approval. Surgery set for 3/16.

I am lucky that DH is also planning to have the surgery (gastric bypass). So the goal is for both if us to be thinner and more active. But I think it is great that your DH is talking to you about his fears. It sounds like part of it stems from his previous experience .... The best thing is to keep the lines open so that you can address his concerns. Not validating his fear ... But seething for you to talk through. I do think that WLS is not just about you, but also does closest to you .

I think is important to know what the pre op requirements are, if you are on medication how to handle those (ie if diabetic do you take your med the day of surgery) etc.

I'm not telling my boss what I am having done. He only knows that I'm having surgery ... I have told my co worker that I'm having gall bladder removal (yes, I lied). My company will pay short term disability starting the first day of surgery at 100% of my salary, which is a rare benefit- and one I am grateful for. DH will end up using 5 days of sick leave before short disability kicks in, and once it does it is for 66% of his salary.

March 16th is my new date. I started this process in dec 2013. After a long 6 month supervised diet and all- my insurances at the time UHC, denied it. My doctor appealed it and won. But it was towards the end of the year, so I wasn't able to schedule it. Then the new insurance denied me bc they felt the WLS surgeon, NUT, and psychologist stuff was too old ... So then I had to redo all of those. After all is said and done, with two insurance denials and two won appeals/resubmission. I'm slated for March.

UHC is the insurance I had last year, did everything, submitted and was denied. The doctors office appealed it and was approved. But bc of timing and new insurance, here I am a year layer - jumping through hoops. I will say that I have learned much from this site during that time.

Your regular doctor

Update: my new insurance thought the surgery doctor report, the nutritionist eval and the psychologist was too outdated for them. So I had to reschedule all of those (for today). I'm hoping that the 6 month supervised diet from last year won't be a problem now and resubmit everything (again).

Hey Larry, maybe it's not such a bad thing as long as the plan covers the surgery. With united you need a 5 year weight history, 6 months supervised diet, PCP letter .etc. so if you already had that completed, your coordinator can just submit it for approval come feb. 1st. Skipping the 9 weeks of phone calls...

I had a similar issue, including a low bmi one year and a missing bmi for another year. My insurance denied the WLS. So my surgeons office filed an appeal, and it was approved on 12/15. Unfortunately my surgeon was on vacation for the last two weeks of dec. and as of today, 1/1/15, we have a new insurance. So now I'm waiting for the new insurance to approve it again.

costco has the Premier ones on sale - case of 18 for $20. So far I like the taste of the chocolate and strawberry. The vanilla seems bland to me. My doctor has not said I need to be on a diet pre op ... Except for one day of Clear liquids the day before. But since everything I have read, many do. I thought I would do it anyway. So I'm doing 3 shakes during the day and a small carb free dinner. Is that what most pre op diets follow?

The only person that knows is my husband. I will not be telling any other family members or coworkers. They just would not get it and I don't want to hear it. My sister or mother have never had a weight problem and I am pretty sure I know they would not understand.

I'm tentatively scheduled for the 1/12 too. So far my instructions only say 1 day of clear liquids the day before. I do have a bunch of test to do before then, including a preop paper from my PCP, bloodworm, EKG, chest X-ray and upper GI. I need to set up an apt tomorrow with PCP, but not sure how/where/when I'm going to get all of the tests done ...

Something similar to mine. I have approval from my current insurance that came through last week after the six month diet, and a denial and appeal. but doc was off for the last two weeks of December and come January we will have a new insurance . So I will have to wait and see if the approval transfers.

Tentatively scheduled for the 12th. I got approved by my current insurance toward the end of dec. but come January we have a new insurance. So here is hoping that the approval gets transferred easily enough.