Nicie

RJ: Congratulations on your weight loss. I am sorry to hear about your er doctor's treatment of you. All I can say is if you ever have the misfortune of having him treat you again, I would just state, in a very calm manner (not easy when you are in pain), exactly what you are feeling about his treatment of you and ask him if he is intentionally being dismisssive to you. You don't have to like him, but he must give you the best care possible and it is reasonable to question that care. Too much of your energy has already been expended on this issue. I have been in similar situations with doctors and all I would do is recommend you never have him treat you again (if possible). You need to heal and this will block your recovery. If you were in enough pain to make you go to an emergency room, I would question if what you were told is accurate. You are in my prayers.

Sending good thoughts your way. Keep me posted please.

Did the doctor say what caused your complications? Has he/she done many sleeve surgeries? I am so sorry for your pain. You are experiencing what I fear most about this surgery. How long would you have the stint in?

Thank you. Those are wise words. When is your surgery?

TaylorJ7: Thank you for your response. And please tell your wife I am sending good thoughts her way for a very successful surgery. It takes a great deal of courage and trust to go forward with this journey. I am so happy for you! 11 days post-op and you feel wonderful. I want that for me too! May I ask you how the after surgery pain was? How long were you in the hospital? Your advice to stay busy and focused will be followed but it is so hard to think of anything else.

Yes, that does help. It is like looking into a mirror when I read your response. Your experieces are the same as my experiences. The reason I started this process IS because I wanted to have the rest of my life lived as a thin, healthy person. I am just so sad it has come to the need for this tool to get to that place.

I start my pre-op diet tomorrow. Sleeve surgery is 8/28. I am 63 and can not believe I am going to let someone remove 3/4 of my stomach and risk all the complications because I can not control my weight! I have lost 25 lbs in the last 6 months and wonder if I should just cancel the surgery and see what happens in the next 6 months. I am currently 225 and have all the obese related diseases. I am not frightened about the surgery, just everything that comes after. I think if I did not have to wait so long for the operation day, I would have gone ahead with it. I just want to run away and forget all of this.

I have bc/bs federal. My paperwork was submitted as outpatient. When I found out about this, I called the dr's office and was told bc/bs will not approve sleeve surgery for inpatient???? The dr's office told me they submit the request as outpatient and then after the surgery is done, they request approval for two nights stay. I was told it will be just fine, don't worry. That just didn't sound right so I called bc/bs and was told they approve the procedure based on what the dr says is medically necessary. If the approval is stated as outpatient, you are responsible for 15%. If the dr requests two nights for observation after the surgery, you are still responsible for 15% of the entire cost. So, if the surgery costs $50,000, I would owe $7,500 instead of just $250! Has anyone ever had this problem with the dr's office saying this is an outpatient only surgery for bc/bs and that is how they must submit the request? Does anyone know if it takes more paperwork to submit the request as inpatient? I am now really concerned that since the dr's office submitted the request as outpatient and it was approved, bc/bs will deny the inpatient request, if the dr's office resubmits. I sent an email to the director of the bariatric center and am waiting for a reply.

Dear Ramyers8679: How was the surgery? How are you dong now? How long did your surgery take? Are you in much pain? I am so happy for you! I am so grateful for this resource. It is because of this site that I pursued my inpatient approval and that will save me thousands of dollars. I can't wait until I have the inpatient approval in hand.

Great News! I just couldn't let this outpatient approval go uncontested when others have had the surgery as inpatient and bcbs customer support told me it is covered based upon medical necessity and is not an out patient only surgery. So, I had a conference call with the director of bariatrics and the people at bcbs who process the requests from the doctors office. Got this straightened out and the surgery will be approved as in patient. If the surgery was not approved as inpatient, I was ready to file an appeal with the federal employee benefit plan or with whoever handles the appeals. I was asking for a formal denial so that I would then have appeal rights. Did not have to go that route and inpatient it is! I am so excited and can't wait until I get the new approval letter.

Dear NoDramaLlama: Thank you for responding. I am so happy for you and hope you keep us posted on your surgery progress. I called bcbs again today. Was told the approval was submitted as outpatient and will be paid based upon that submittal. May I ask how you were able to get this inpatient approval? Any idea what the dr did to establish the medical necessity for inpatient stay? My doctor also keeps you in the hospital for two nights and they said the surgery can only be approved as out patient surgery?? I am so confussed.

Hi Jersrose43. Thank you for checking on me. The bariatric director contacted me yesterday and the insurance issue remains the same. I am hoping all goes well and it will be documented as inpatient after the surgery is done. Then, as you said, the doctor and hospital converse. Today I got me surgery date - 8/28/14. I appreciate your responses.

Anyone out there who has had the sleeve surgery - do you remember how your pre-certification approval was submitted? I would love to get more opinions on this. And thank you Jersrose43 for your input. 20 years insurance vet! Impressive! You certainly add an interesting perspective on this issue. I hear what you are saying and appreciate the input. However, it is in conflict with what bc/bs told me. Please be patient with me. I do have high blood pressure, diabetes, history of blood cloths and am 63 years old. Wouldn't you think that is enough to get initial certification for inpatient status? I do not want to put myself in a position where I am at the mercy of the hospital administrator. Is there anyway to get the hospital to request pre-certification for inpatient approval now?

Thank you for your response. Question - If the doctor's office knows the surgery is for inpatient care, why not just get the approval for an inpatient stay from your insurance company in the first place? BC/BS told me that if the surgery approval is for outpatient, that is how it will be paid. If there are complications, then the hospital can request inpatient status starting after the surgery. If no complications and you are there for just observation, you are responsible for 15%. So why take the chance of paying so much more for the surgery than you have to when there would be no question if the original approval is for inpatient?

I have bc/bs federal. My paperwork was submitted as outpatient. When I found out about this, I called the dr's office and was told the insurance will not approve sleeve surgery for inpatient???? So they submit the request as outpatient and then get approval for two nights stay. I told them that the difference between inpatient and outpatient is significant. I was told it will be just fine, don't worry. That just didn't sound right so I called bc/bs and was told they approve the procedure based on what the dr says is medically necessary. If the approval is stated as outpatient, you are responsible for 15%. If the dr requests two nights for observation, you are still responsible for 15% of the entire cost. Has anyone ever had this problem with billing? I believe what bc/bs is saying and think the dr's office just does the minimal paperwork to get the approval. I sent an email to the director of the bariatric center and am waiting for a reply.

I hope your appointment goes well. I am not a fan of doctor visits either. However, I would certainly go to have your issue checked out. With the sleeve surgery, the surgeon removes all but a banana sized portion of your stomach. You have no rerouting of your intestine as you would with the bypass. The sleeve surgery is less complicated; thus, less time in the operating room. Since I made the decision, I am so much more relaxed. I still have concerns about the outcome but I am committed to follow through with this procedure.

Well, I finally made a decision. I am going ahead with the sleeve surgery. I am waiting to hear from my doctor's office that the request has been submitted to my insurance company. Thank you so much for your words of wisdom. It really helped me in many ways. Nicie

Did anyone have to take the MMPI test to satisfy their insurance requirements for the psychological assessment? I can not get a straight answer from BCBS. They said the doctors office knows the rules and qualifications for the procedure to be approved.

I completed the psych exam and interview. It was truly a waste of time! All requirements are now completed. I have made a decision and I am going with the sleeve. Hopefully, by the end of June I will be scheduled for the procedure.

How come you have a one ounce stomach? Are you able to have a few bites of a McD burger? I was very surprised how easy it was for me to get off diet 7 up. That is the only thing that has been easy. Went to the doctor today, only lost a total of 22 lbs. I thought it was 24. Oh well, time to restructure my diet and exercise program. I am very concerned about gaining anything back. My past experiences have been to lose some and gain more. I am 100% committed to not have that happen this time. Nicie

Nicie your post reminds me of one not too long ago where the OP said that she was 80% sure about having the surgery and wondering how she could get to 100%. Bypass or sleeve are major surgeries. All surgeries have risks and bariatric surgeries are no exception. There simply are no guarantees. 100% implies absolute certainty. I believe that any goal you set has to meet two criteria - it must be realistic and it must be sustainable. Any goal that does not meet those two criteria should be abandoned in favor of one that does. Absolute certainty is neither realistic nor sustainable. When I was trying to make the surgery decision and subsequently the choice of which surgery to have, my goal became to do as much research as possible, learn everything I could about the potential benefits - and risks - of each option. That goal was both realistic and sustainable. The result of that effort was that I concluded that the odds were overwhelmingly in my favor of having a successful, literally life-changing outcome. And that is exactly what happened. Bariatric surgery is the most effective treatment known to medical science for the treatment of obesity and more than 30 comorbidities associated with obesity. By a huge margin. Once I had all of the facts, the decision was relatively easy. That is not to say that I wasn't frightened. There were times right up to the moment they wheeled me into the OR when it scared the bejesus out of me. But courage is not about never being frightened (unrealistic and unsustainable). Courage is about doing what you believe to be the right thing for you and your family, in spite of your fears. Today I'm a little over two and a half years post-op. Hypertension, high cholesterol, type 2 diabetes, sleep apnea and 130 pounds - gone. I hit 155 lbs about fourteen months post-op and my weight has been between 151 and 156 every since. This morning I was 152.4. I've had two complications. About six months post-op I developed an ulcer at the anastomosis that was confirmed with an endoscopy. My surgeon increased my Rx for Prevacid from one capsule a day to two. No other changes. No other treatment. Three months later a second endoscopy confirmed the ulcer was completely healed. The second complication - I'm one of about 15% of patients that experience reactive hypoglycemia aka "late stage" dumping. Definitely not comfortable but easily avoided by avoiding too much sugar or carbs. And when I make a bad choice and my blood sugar drops, I simply eat something with a little sugar, or simple carbs or just chew a glucose tablet. Without fail, the symptoms completely disappear in about 20 minutes. All in all, a very small price to pay for a life that, not that long ago, I thought would never be possible. Would I do it again? Without a moments hesitation. Am I the exception? You don't have to look any further than this forum to read countless stories similar to mine. When you have questions, there are tons of great folks here who are more than happy to offer the benefit of their experiences. Good luck in making your decision! Thank you for your response. I am so appreciate that you took the time to give me such a thorough narrative. Congratulations on your success with this challenging journey to better health. I hope to also be a success in this journey. What you wrote has made an impact on how I will move forward with this issue. You are so right in pointing out that this surgery is the most effective treatment for obesity. I think I was just kidding myself that I could lose 100 lbs without medical intervention and that was a big reason for my indecisiveness. It was also very helpful to hear that I am not alone in my fear of the unknown when you wrote about how scared you were up until surgery. I am going to write down your quote about "Courage is about doing what you believe to be the right thing for you and your family, in spite of your fears." Thanks again for your insight.

Thank you for your response. And congratulations on your weight loss. I had to laugh when you wrote "since you only have 80 lbs to go". To me, that might as well be 500 lbs! Another quote "became TOO thin". At this point in my journey, I just can not imagine that I will ever be TOO thin. You are an inspiration and I am so grateful you are able to share your knowledge. I am not going for the lap band because of the statistics out there about the long term success, the need for consistent dr. visits for filling the lap band, and the number of revisions to bypass from the lap band. The sleeve was my first choice but it can cause worsening of GERD (which I have) and it is not as effective for those who crave sweets (absolutely my downfall). Long term weight loss is also a concern with the sleeve. So, I am re-thinking that option. Gastric bypass did not appeal to me initially because of the cutting of the small intestine. However, the advantages of not being able to tolerate sweets and that this surgery is the gold standard for weight loss, I am seriously looking at the bypass. My doctor will do either operation for me. I've only just completed the pre op requirements last Thursday so I should have plenty of time to make a decision. I will keep you posted. Thanks again for your help.

Hello. I am new to this site. I will be 63 next month. I have lost 24 lbs in he last three months and still have another 80 to go. I have never been able to lose that much weight and keep it off. I keep hoping I can continue without the surgery. I went ahead and completed all the pre op testing in case I do decide on surgery. I am very concerned about long term consequences from the surgery. Sleeve or bypass. I have never had such a problem making a decision. I am back and forth on this daily. I do go to a support group and that has helped. However, I get the feeling they all have surgery fever! Not one person has anything but wonderful things to say about their experiences but that only makes me wonder if they are just painting a rosey picture. You would think that at least one of them would have had some sort of complication. I am not looking for complications, only a realistic report. I must say, though, only two others in the group are near my age. Most are 30 - 50? I take coumadin, lipitor, blood pressure medicine and metformine. I was just recently diagnosed with diabetes. I met with the surgeon and am confident in his skills. I have a strong inclination to go with the surgery but I have this nagging doubt about doing it. Any words of wisdom for me?

Thank you to all who responded! I really appreciate the info. I went to a group meeting tonight and was told they had to take the MMPI test too. Some thought it was silly and a waste of time but it is required by the doctor, so they complied. I will be eligible for the operation in June but I am getting more anxious each day. Some say the bypass is better; others say the sleeve. Right now I am so confused. I've lost 15 lbs. so far and am wondering if I should just keep up what I am doing and forget about the surgery for now.

Thank you for your reply.