Jersrose43
Gastric Sleeve Patients-
Content Count
2,583 -
Joined
-
Last visited
Content Type
Profiles
Forums
Gallery
Blogs
Store
WLS Magazine
Podcasts
Everything posted by Jersrose43
-
April 21st and Here I go!
Jersrose43 replied to seattleslew's topic in Weight Loss Surgery Success Stories
Good luck!!! -
Give your opinion to tell or not
Jersrose43 replied to New Me 787's topic in PRE-Operation Weight Loss Surgery Q&A
They can totally force you to FMLA and it's better for you because it protects your job The question is can they layer your STD with your FMLA. If yes. Then you are paid to be out of work. But if they won't later you are no pay for up to 12 weeks. I am getting two weeks STD and up to 12 of no pay FMLA. Either way she can't post my job or hire someone to take over while I am out. FMLA prevents that -
Give your opinion to tell or not
Jersrose43 replied to New Me 787's topic in PRE-Operation Weight Loss Surgery Q&A
I plan on applying for short term disability I told my boss she had a negative viewpoint. She does not control my std benefits nor does my HR dept. We all have FMLA in the us ---- USE IT! It is your right to keep to yourself or share. I have told a couple coworkers am considering 1- what? you're not that fat! 2- whatever support you need let me know I am here for you My boss - you don't need that. I am going on a diet to we can support each other. I do not approve of you doing this. That was 3 months ago. Haven't diacussed it with her since. -
I am starting to feel like I didn't get what I paid for with this post. I paid $175 It took 15 minutes. I spent more time driving to and from his office then sitting in it. I filled out paperwork for 15 minutes, including drawing pictures of self image and trees and houses. Spent 10 minutes with the shrink. Done. 45 minute drive both ways He billed my insurance for $525. They approved $375 and went to my deductible. Thank goodness I got a paid in full receipt for the $175. Because his office manager wanted the balance. As if.
-
Do u ever wonder how people here eat such a perfect diet - all the time?
Jersrose43 replied to marfar7's topic in Gastric Sleeve Surgery Forums
As a person waiting for approval and committing to this journey .... I really appreciated this post. You see I am not a food addict. I don't eat unhealthy. I consider my food choices daily optimal ones. I have tried practically every diet out there unsuccessfully. I've met with nutritionist after nutritionist. Tried diff things only to GAIN weight on a "DIET" supervised or otherwise. And then pack on the extra 10 pounds to the baseline every time. Excercise is difficult as I suffer from increasingly worse asthma every day and I run out of breath. Compounded by my weight yes. I don't eat chocolate but occasionally I don't eat burgers but occasionally Pizza maybe once a month The worst thing i do? Date night with hubby once every two weeks. We like to try new and exciting places. That's the worst I do and always overindulge. We've agreed going forward after I am back on solids it's once every other month. And no overindulging. I have 3 meals a day. I don't have multiple small meals a day - tried that gained 7 pounds No thyroid issue found but family is rampant with them so it's a matter of time. I need this tool. It is time. I plan on being as religious as possible. I have accepted that weight loss may be rapid or may be slow. That some days I will stray and it will be ok as long as the long term goal is the lifestyle acceptance and to be healthier. I do not see this as a diet. I appreciate the posters saying this because measuring everything was probably one of my biggest concerns. The mountain before me and all. -
After three days I'm still ticked at my husband!
Jersrose43 replied to katesuccess's topic in Rants & Raves
At first I read this and then thought this could be my husband writing this. We r at 20. I said I would like a 3 day trip somewhere. Vegas or AC or Quebec. Whatever go figure it out, book it and fill me in. Yep he can book it. I thought it was fine and I didn't plan anything that night. I made dinner, nothing special, we ate after kids went to bed but that's it. He brought home flowers card etc and I got pissd off. Yep u heard it. I was pissed. Yes it was nice and romantic but we agreed a 3 day trip so why the expense and waste of flowers etc. A gift. I mean I thought we communicated here. And you immediately jump to the fact it's because of your weight? Why ? I didn't read any of his actions or non action to do with that at all. His reason was because he can and he wanted to. So ok I could've also but I didn't. He wasn't overly hurt. He told me a card would've been nice. I said on the AC trip you'll get a card and then some. I think you need to talk. -
After three days I'm still ticked at my husband!
Jersrose43 replied to katesuccess's topic in Rants & Raves
At first I read this and then thought this could be my husband writing this. We r at 20. I said I would like a 3 day trip somewhere. Vegas or AC or Quebec. Whatever go figure it out, book it and fill me in. Yep he can book it. I thought it was fine and I didn't plan anything that night. I made dinner, nothing special, we ate after kids went to bed but that's it. He brought home flowers card etc and I got pissd off. Yep u heard it. I was pissed. Yes it was nice and romantic but we agreed a 3 day trip so why the expense and waste of flowers etc. A gift. I mean I thought we communicated here. And you immediately jump to the fact it's because of your weight? Why ? I didn't read any of his actions or non action to do with that at all. His reason was because he can and he wanted to. So ok I could've also but I didn't. He wasn't overly hurt. He told me a card would've been nice. I said on the AC trip you'll get a card and then some. I think you need to talk. -
After three days I'm still ticked at my husband!
Jersrose43 replied to katesuccess's topic in Rants & Raves
At first I read this and then thought this could be my husband writing this. We r at 20. I said I would like a 3 day trip somewhere. Vegas or AC or Quebec. Whatever go figure it out, book it and fill me in. Yep he can book it. I thought it was fine and I didn't plan anything that night. I made dinner, nothing special, we ate after kids went to bed but that's it. He brought home flowers card etc and I got pissd off. Yep u heard it. I was pissed. Yes it was nice and romantic but we agreed a 3 day trip so why the expense and waste of flowers etc. A gift. I mean I thought we communicated here. And you immediately jump to the fact it's because of your weight? Why ? I didn't read any of his actions or non action to do with that at all. His reason was because he can and he wanted to. So ok I could've also but I didn't. He wasn't overly hurt. He told me a card would've been nice. I said on the AC trip you'll get a card and then some. I think you need to talk. -
united healthcare- railroad employees?
Jersrose43 replied to HYCIERRA's topic in Insurance & Financing
I know my carrier required more than that They wanted to monitor my diet - so they had to send in what I ate But I don't have uhc You can try -
It's really sad when doctors offices set wrong expectations. If it's a benefit exclusion it definitely will not be paid for regardless of medical reason Call your insurance and confirm it's a benefit exclusion
-
Cigna OAP require 3 or 6 month for approval
Jersrose43 replied to JacobsMommy's topic in Insurance & Financing
That's awesome -
My insurance denies sleeve...approves RNY, I want sleeve...help
Jersrose43 replied to smokenhaze's topic in Insurance & Financing
Correct benefit exclusion is just that. No matter what code they use that procedure no matter the need will not be paid for Get on a spouse plan if at all possible If not purchase individual jnsurance that has the benefit - check and trike check Last resort you'd have to pay cash -
Cigna OAP require 3 or 6 month for approval
Jersrose43 replied to JacobsMommy's topic in Insurance & Financing
Yes you're rigt I misread. So you may need one more visit? Maybe? I can't see them being that particular but I am also on reconsideration with Cigna right now But it's because insurance coordinator messed up and did not send any documentation with the request. -
Cigna OAP require 3 or 6 month for approval
Jersrose43 replied to JacobsMommy's topic in Insurance & Financing
I read it as you have the requirements. You have 3 consecutive months (feb, March, April in less than or equal to 90 days) The only thing am not sure about is your 2nd doc. Did you get a letter from your PCP recommending surgery and medically clearing you for surgery? -
Have you thought of either joining your husbands health plan or purchasing a plan through obamacare? Just do the research and confirm it's covered first and buy the plan. The monthly expense would be less than a full out of pocket. I would consider it best to buy a plan since I am concerned about paying for pre and post care complications
-
My insurance denies sleeve...approves RNY, I want sleeve...help
Jersrose43 replied to smokenhaze's topic in Insurance & Financing
Sounds like a benefit exclusion and if that's the case no appeal for medical necessity will be useful at all. Call PBA as soon as you can and verify if it's a benefit exclusion or something else as soon as possible. This way you won't waste your time on unnecessary appeals -
Hi saw this old thread with dr bessler. Am starting the journey with him at valley in New Jersey Wonder how you ladies did post op and how you're doing today?
-
Pissed at my office insurance person
Jersrose43 replied to Jersrose43's topic in Insurance & Financing
Am going to call the appeal number tmmw and pull the files they sent over. I am so disappointed. I know that trying an appeal makes it harder. She should just have sent everything in the first time correctly. -
Pissed at my office insurance person
Jersrose43 replied to Jersrose43's topic in Insurance & Financing
I work for my insurance carrier -
United Aetna and Cigna business is mostly self funded coverages. Meaning your employer buys their plan and customizes it to fit their needs of what they want to pay for. They can customize everything including the benefit and the requirements to get the surgery. The employer pays for the actual services and an administration fee. No monthly premiums. True insurance pays a monthly premium and you get a plan of coverage.
-
Research the private plans available on healthcare.gov and pick one of those up for a year and get the surgery done. $800-1000 a month is a lot Cheaper than 18k
-
You have to apply through the affordable care act. Healthcare.gov. If you qualify for Medicaid you likely will be forced to keep that. If you can afford health insurance very month you won't be on Medicaid and likely will lose your status
-
I am still not sure I have a breaking point? All I know is I want to live longer than my own mom did. She passed at age 43. I am 43 Last 6 months I've been really sick with various diagnoses and this is the journey. Some days I feel it's not real yet. I don't have a surf date yet but all steps taken and paper work as at the insurance.
-
Always!! I stick to my guns and I explain again and again they don't know my situation. They don't know what other care my kids are getting or my husband. They don't know the cost of my prescriptions. Bottom line these insurance coordinators are great but they're not holding a crystal ball over everyone else's charges and how fast the insurance company gets a claim and pays a claim for someone else. You refuse enough times up front and pay on time when you get the bill, they'll respect your no.
-
Specific friend advice needed! Pic included
Jersrose43 replied to dreamscometrue's topic in Rants & Raves
You know shopping for dresses provides a great opportunity to just say. Hey I hope this dress still fits me when the day comes. This diet has been so awesome. Ask the shop how much you can alter etc. Make sure she's around for it. Maybe she hasn't mentioned it because she's like my neighbor. She has seen the yoyo and doesn't want to hurt my feelings or be discouraging.