Ladiec2

I too have a low BMI. For that reason, I intend to only tell a couple of family members and that's it. I don't want to here any critics asking me why I did it or that I don't look like I need it. I am considered morbidly obese and have severe sleep apnea, RA, and back pain. I choose not to have to explain these conditions because, quite frankly, my health issue is none of their business.

Ok...so I had my 1st appt Thurs with the Surgeon..We went over the procedures, met with the insurance person and was given a list of what was required by my insurance and what's required by the surgeon. Discussed my thyroid issues...everything ok there. I have AETNA and am going with the 3 month cycle, therefore my surgery date should be some time in Feb. 2015 or late Jan. I am so excited!!! I hope all of my tests go well. I also need to make sure that my PCP has 2 years of overweight history. I could be on the borderline as some point, but I hope to find out today. My BMI is 35.6 with comorbities.

Wow that was fast. What ins. do you have?

Today is my first appt with the surgeon. While walking in the building I get a call from my PCP telling me that my thyroid level is still very high. I had discussed the sleeve surgery with him over a year ago and he told me that we need to get my thyroid in check. When I saw him Saturday, he said ok since I practically beg him every time I see him. He took blood work while I was there and now I'm getting this news while going into this appointment. My meds have to get increased again. I'm so afraid the surgeon is going to tell me to wait. Mind you my meds have been increasing over a 5 year period little at a time from 50 mg to now 275 mg. Does anyone have thyroid issues? What was your outcome?

I do have another appt on the 22nd with a different doctor. I was going to cancel but now I think I will go. He may have less out of pocket fees and not require his patients to purchase his products.

OMG! I feel your pain. I hope it all works out. Thanks for posting this because its comments like this that will help us newbies to prepare and stay on top of the docs, nuts, insurance company. I hope I don't hit a stumbling block. Best of luck to you! Stay positive!

Also, I can't gain any weight during the 3 months of weigh ins...no fluctuations. One thing I didn't like is that I have to use my doctors Protein shakes and Vitamins...bummer. The cost is $219. Does anyone have to pay approximately $1300 out of pocket costs for the Nutrition class, educational materials, Diet assessment, etc.? I thought all of this was covered by my insurance, but apparently not.

Marfar7... I use the same meds. Well surgeon didn't seem to think my hypothyroidism would be a problem. A lot of stuff to read and look at these out of pocket costs.

Welcome, I'm a newbie as well. I had the seminar and have my 1st appt. with the surgeon and the insurance coordinator tomorrow. I also have an appointment in a couple of weeks with another surgeon (totally different office) and from their I'll decide who I'm going with. I want to have the sleeve too, but I'll wait to hear what they have to say. My insurance requires a 6 month and a 3 month program. I want to try to make it happen in 3 months. Good luck!

Sounds like you got the right answer from your insurance. Maybe you need to discuss what you found from your ins. company with the surgeon. I think the nurse may have been frustrated that they gave you 12 months to lose the weight, but you gained and she's trying to help you out by not submitting your paperwork. I would discuss it with them and then move forward with the 6 months and lose the weight each month. Good luck!

Don't compare yourself in losing lbs with someone who is much heavier than you are. They're going to lose in lbs a lot more and quicker because they have more to lose. Use the percentage of your body weight and see who then loses the most percentage. It's the same way the Biggest Loser calculates their weight loss. For example: If a 300 lb person lost 30 lbs. that's 10% of their body weight lost. If a 200 lb person lost only 20 lbs., that too is 10% of body weight lost. Even though the heaver person lost more weight, they both lost the same amount of Here is a website that calculates in weight lost percentage. http://www.fitwatch.com/qkcalc/calculate-weight-loss-percentage.html

OK....soooo what kind of mindset should I be in when I have my psych eval? And does it really take more than 1 appt. with them?

Thanks for the info. Just got my appt. changed to 10/9 so I'm now even more excited. Last week I contacted my RA/PCP and my SA and requested my medical records, printed out a copy of my insurance brochure, wrote my questions down and went to see my PCP Saturday and got him to recommend it. The ball is rolling. I am going with the Sleeve. How did you get to do the 3 months instead of the 6 months?

I participated in a webinar last night and decided to go with that Dr. He was very informative. I've gone to others before, but just kept putting it off. I really wished I had done this last year, but I kept telling myself that I didn't want to wait 6 months and I figured I could get the weight off during that time. Well I haven't made any progress on my own so now and its been a year so now it's on. No more procrastinating...its time to put my foot to the metal and complete the requirements. I'm a very impatient person. I have AETNA and they have a 3 month or 6 month program. I want to see if I qualify for the 3 month program...not sure of the difference. Just made my first appt. with the surgeron for Oct. 22. and we'll go from there. If anyone has any advice as to what I need to be doing in the meantime, please let me know. I am right at the borderline of my BMI beging 35.2. I have sleep apnea and rheumatoid arthritis. Thanks in advance for any advice!

Jessiquoi: what did you do or say to be able to get the surgery in the 3 month period. I too have AETNA and they listed the 3 or 6 month plan. I didn't understand the difference. I want to see if I qualify for the 3 months so I can get it done in Jan. 2015.

I have my first appt. in a couple of weeks. I know my insurance covers the procedure so that's fine. I know I want the sleeve. What are questions I need to ask the surgeon when I meet with him, questions for nutritionist....

What can I do before my appointment to speed up the process? Speak to your insurance company. Ask them to specify if bariatric surgery is a covered benefit in your policy. You will need to provide them the surgical code CPT-43644 for gastric bypassor CPT-43775 for sleeve gastrectomy and to receive this information. Not only insurance companies vary in their coverage of weight loss procedures, individual policies may also vary in their nature. Some policies may have “exclusion clauses” and may not cover bariatric surgery. It is very important that you ask your insurance company to be very specific about their company’s policy and your own policy as they pertain to bariatric surgery. Gather all of the information your insurance company may require. This may include diet records, medical records, medical tests going back at least 2-5 years depending on the insurance company. This reduces the chance of being turned down because you failed to provide necessary information. Letters from your personal physician and professionals supporting the medical necessity of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery. Choose a primary care physician if you don’t have one already, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. Results of diagnostic and routine screening for co-morbid conditions such as type 2 diabetes and high cholesterol can be necessary for documentation of medical necessity. Make a list of all the diets you have tried (a diet history) and take it to your doctor. Bring any relevant medical data to your first office visit, including reports of special tests (echocardiogram, sleep study, etc.), or a hospital discharge summary if you have been in the hospital for weight-related health problems. Bring a list of your medications, including dosage and schedule. Quit smoking. Surgical patients who use tobacco products are at a greater surgical risk. Talk to a doctor for help with this. When you send your letter, call your insurance carrier regularly to ask about the status of your request. Your employer or human relations office also may be able to help you work through any issues. Be sure to write down dates and the names of people you speak with and keep notes about the conversations. When possible, get them to fax you copies of the policies they are quoting. Make sure your primary care physician is documenting your weight loss efforts and your weight in your medical records at every visit.

Ok thanks Beni. Maybe I will try to make an appt with the nut since I have to wait several weeks for my Bariatric dr.

I requested copies of my medical records from my pulmonary dr (sleep apnea) and my rheumatologist. I want to be prepared like you when I visit the surgeon in a couple of weeks...so excited!

Hi Fab@Forty: I'm at the beginning stage. I participated in a webinar last night with Dr. Elariny at INOVA Fair Oaks. I really enjoyed his presentation. I've done several. I've been putting this off for over a year and now its TIME! I have an appt. with him in a couple of weeks. So I hope all goes well. What stage are you at? Have you already submitted your paperwork...who is your insur. carrier?

I live about 20 min. from Tappahannock, VA. Who was your doctor. I'm in the beginning stages. Have a drs appt. in couple of weeks.

CALL ASAP. If they see anything on the schedule right now before that date, make sure to ask to be put on a waiting list. Hopefully you can get it done before that date and then Medicare can take care of your post-op follow up appts. GOOD LUCK and keep us posted!

OK...hello. I too have AETNA and they have a 3 month and a 6 month program. I've been wanting to do this for a long time and finally decided to buckle down and get it done. I'm very impatient therefore I want to go the 3 month route and have it done around the beginning of the year. What did you do to go thru the 3 month route?

Hello: I too have AETNA and am about to begin the process. I went to a seminar last year In Richmond, VA (Oct 16) and only have a couple of weeks to make an appt. with that Dr. so I won't have to sit thru the seminar again. I participated in 2 Webinars this week and I actually like one of those Drs. better. So I think I'm gonna make an appt with the one at INOVA Hosp. in Fairfax. I am very excited and I hope AETNA approves my surgery. My BMI is 35.2 (borderline) withSleep Apnea and Rheumatoid Arthritis. I've tried everything over the past years and I just keep gaining it all back and then some. So good luck to you with AETNA!

Meme1171...you can do this. Have faith and treat it as if you're going to win a million bucks if you do this right and you'll lose everything if you don't. Sometimes you have to have a different mindset. Last year I tried to lose the weight by doing the 2 week Protein diet and pretending that I had to lose the weight in order to get the surgery done. It worked! I did lose some weight during those 2 weeks, but no surgery. I'm hoping to have it done before the end of the year. You are lucky to be getting it done now. So hang in there and do the right thing! Good luck! By the way, Oct. 14 is my mother's Birthday too.