Sharon1964

Am I the only one that thought the OP must have dozed off in the middle of posting?

You might want to ask the surgeon what he is going to do about the damage to your vagus nerve that he caused. If he says he didn't cause damage to your vagus nerve, insist he explain why he is of that opinion. I'm not a doctor and I don't play one on tv, but a lot of your symptoms including gastroparesis can occur after abdominal surgery if the surgeon damages the vagus nerve. Just a thought.

I have a number of friends in very successful marriages that are open to one degree or another. I also have a number of friends that believe you can love more than one person at a time. I don't think this guy's marriage state has any bearing on the real issue. Personally, I think having this coffee would only muddy the waters. You need to decide what you can live with and what you cannot, and then act accordingly. An attraction to someone else should not be a part of this decision.

Sorry to disappoint, but no, having the EGD and spending money doesn't mean you are approved. Call your insurance company (look for the member services number on your insurance card) and ask them what their requirements are for weight loss surgery. One thing I didn't see on your list which is a requirement for many insurances (or your surgeon if your insurance doesn't require it) is a psych eval.

I cannot believe that no one has said, "what this thread needs is pictures." Sigh. I am so disappointed in you all.

Please, please double-check this with your insurance company. In all my years in the medical support field, I have NEVER seen it work this way. Perhaps your insurance DOES work this way. In my experience though, if the primary denies, the secondary will ALSO deny because the primary denied. Your insurance MIGHT have a clause that says if your primary denies for not being covered on the plan, they will pay as if they were primary. I would not only call my secondary, but I would probably record the call.

Here is your answer, "thank you for your concern, my doctor has it covered." Then change the subject.

Beware, I can be blunt. As I read your story, my impression was that YOU were the one who was trying to control him. Don't get me wrong, the man has a boatload of issues, but that was my impression.

I would be surprised if the list was not available online. There should be no reason to wait.

I agree with the others, there's a whole lot going on here and you need professional help. The one thing I would NOT do is to get married with things the way they are now.

Congrats!

Would you consider making the group public so we don't have to join to see what you have?

I can help you with this part. Payment for the following is specifically excluded from this plan: .... • for medical and surgical services intended primarily for the treatment or control of obesity. This means that plain old obesity isn't covered. However, treatment of clinically severe obesity, as defined by the body mass index (BMI) classifications of the National Heart, Lung and Blood Institute guideline is covered You are covered with a BMI of > 40 or BMI of >35 with coexisting conditions if the services are demonstrated, through peer-reviewed medical literature and scientifically based guidelines, to be safe and effective for treatment of the condition." This just means all of the current surgical options you discussed. They have all been demonstrated to be safe and effective, through published studies in medical journals such as the Journal of the American Medical Association. These journals do not publish just any study they receive; they must be reviewed by a panel of peers. So if some quack says he thinks he can help you by wrapping your stomach with pipe cleaners, that surgery would not be covered because it has not been proven effective in medical journals. Your documents don't mention who will be approving your surgery (and they usually don't). It may be a doctor at the insurance company, it may be a nurse, or it may be a clerk who checks to make sure you have completed all the steps. In some cases, a clerk can approve it, but only a medical professional can deny it. So if the clerk thinks it should be denied, it would be passed along to a medical professional for review.

After three rounds of antibiotics, I think I would ask for a referral to an infectious disease specialist.

Somewhere I still have an old cassette tape with Steve Miller Band Live! on one side and Rolling Stones (best of, or greatest hits or something), which I used to power-walk to. Steve Miller Band: Gangster Of Love Rock 'N Me Living In The USA Fly Like An Eagle Jungle Love The Joker Mercury Blues Take The Money And Run Abracadabra Jet Airliner I don't remember all of the Rolling Stones songs, but I know some were: Mother's Little Helper 19th Nervous Breakdown Paint it Black

Maybe it's a state difference. Here in California, our company has zero liability for medical claims. We pay the premiums only. If I were you, I would speak to another insurance broker to make sure (one that handles more than one insurance company). The only time I am aware of that a company has any liability is when they are "self-insured", which means they basically hire an insurance company who is called a TPA, or Third Party Administrator, to process the claims. Often the big name companies (like the Blues) do handle TPA duties.

It depends. First, the vast majority of psych visits are paid with no notes to the insurance company whatsoever. Kind of like your odds of an IRS audit. Second, should they request the notes, and the notes say, "Pinkbunnies is here today to discuss weight loss surgery" the visit will be denied. If the notes say, "Pinkbunnies is distressed by his health and is considering his options to help resolve those issues", then the visit will be paid. Psych docs don't have to be very specific in their notes. Your psych can discuss all sorts of emotional issues related to weight without actually saying it's related to weight. Further, your doc can keep a separate set of notes called "process notes" (versus "progress notes") which are his/her own private thoughts about you, and in there they can make notes about weight. Those notes are protected by law and do NOT have to be released to the insurance company. The key is that they must be separate from their official progress notes. I'm sure if you tell your psych these things, they will most likely keep your information safe.

You don't need a period to get pregnant, you just need to ovulate. Hormones are stored in fat, so you are releasing enough hormones to have a period. The question is, are you releasing enough hormones to ovulate? I would make an appointment with my doctor.

What's wrong with it? Because your surgeon doesn't allow it, that's what's wrong with it. I'm a "rules" girl. If there's a rule, there's a reason for the rule. Your surgeon said "no solid food", not "so solid food until you lose XX pounds." Give yourself the best chance you can to be successful, by following your surgeon's rules.

I went and answered your original topic.

Your best bet is to call the customer service (or member services) number on your insurance card. Ask them what their requirements are for approval for weight loss surgery. Write down the date, the time, the number you called, and the name of the person you spoke to. Write down your questions and their answers. Some of your questions should be: 1. Does my policy cover weight loss surgery of any kind? 2. Are there certain types of weight loss surgery that are covered and if so what are they? 3. Are there any types of WLS that are specifically excluded? 4. Do I need a psych clearance? 5. Do I need a period of time of medically supervised weight loss appointments, and if so, how long? 6. Do I need any other clearances? 7. What are the BMI requirements? 8. Do I need to have any comorbidities for it to be covered? 9. What is my deductible? (amount you pay before insurance pays a cent) 10. What is my copay? 11. What is my maximum out of pocket? (the total amount you will spend in a year on medical care and then insurance will cover ALL of the rest) 12. Is the psych clearance (if you need one) covered by my insurance? 13. Is my surgeon in my network? And if not, what does that mean to me financially? 14. Is my hospital in my network? And if not, what does that mean to me financially? 15. Is my anesthesiology group in my network? And if not, what does that mean to me financially? Good luck.

Most, but not all, people who have double coverage have zero out of pocket costs. Whatever the primary doesn't pay, the secondary will. Some secondaries only cover deductible, or only cover copays. I always encourage people to become educated on how their insurance plan works. You cannot always trust the person at the doctor's office to know what they are talking about. At my office, my staff is forbidden from discussing costs with patients; only I am allowed to do that. I start the discussion by saying, "this is what your insurance is telling me, I HIGHLY encourage you to call them and ask them the same questions that I'm going to write down for you." I used to be on a panel of experts answering questions on a website about all aspects of the business side of medicine. I would shake my head at the number of people with screennames like "InsuranceExpert" who would ask such basic questions that it would seem that they had no training or experience at all. And I would wonder how on earth they were still employed at a doctors office. /end of rant/hijack Educate thyself!

My psych told me that he had WLS about four years ago, so the dude has some street cred, not just "book learnin". I've never really trusted skinny-minny doctors or nutritionists, because I figured that they learned everything they knew in school and had never really been there. Of course, some of them could have had WLS too and I didn't know it.

My surgeon requires a colonoscopy if you're over 50. Today was mine. I also had an upper endoscopy. Yesterday, I only got 3/4 of the prep material down before I starting vomiting. I had to stop and finish with Water, so I was worried they were going to say that I didn't do enough prep and make me do it again. My plan was to drink only Clear liquids until the next procedure date because there was no way I could do that again! I did tell them that Versed doesn't work on me. Versed is a drug that is supposed to make you forget things, but I always remember. They take me to the procedure room where the nurse said, "I'm going to start giving you medication", she sees my red wristband and asks, "what are you allergic to?" I'm allergic to Demerol, which is what was in her syringe! Close call!! So she just gave me fentanyl and versed, and I drifted off. I came awake very suddenly, halfway through the colonoscopy. There was no pain, and no fear or anything negative like that, but I could definitely feel things happening, so I opened my eyes, looked right at the nurse, and said, "Why am I awake? I don't want to be awake!" and I heard the doctor tell her to give me more fentanyl. Thank goodness I didn't wake up during the endoscopy, when you have a tube down your throat. It was during the colonoscopy portion, when you have a tube up your... wazoo. My next memory is waking up in recovery. When the surgeon came in to give me the results (one polyp), I told him I remembered waking up in the middle of things. He said, "you took ALOT of anesthesia, you'll need propofol next time - make sure you tell your surgeon." Propofol is the sedative that Michael Jackson was so fond of. I came home and had some sprite and slept for most of the afternoon. Phew! Glad that's over!

OPM - out of pocket max - is exactly that. It's the maximum you will pay out of pocket for your plan year (usually calendar year but not always). Once you've met your max out of pocket everything will be covered at 100% no matter if they're usual coverage is a smaller percentage. I doubt that the term will be defined on the webpage where she is looking up your policy info. You can ask your insurance for a plan coverage booklet if you don't have one; they almost always have definitions. Or you can do a three way call with her and your insurance company. You can also ask to speak to the office manager and discuss this person's need for more training. As someone who works in the business of medicine, including teaching people how to bill and understand insurance, it strongly annoys me when people in these positions (surg coordinator) don't know what they're doing.