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GADeltaDawn

Gastric Bypass Patients
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Everything posted by GADeltaDawn

  1. I'm moving right along and only have 3 more hurdles to clear. I could actually be scheduled for surgery as early as the end of the month! So my question is...does anyone know what the negotiated rates are that Anthem BcBs have established in Georgia for the gastric bypass? My surgeon is Dr. Rashid in Decatur. I'm just curious because the self pay rate is $5900 and my coordinator says that the negotiated rate could be as little as half of that. So I'll only have to come out of pocket for 25% of the negotiated rate. Curious to hear from others on this.
  2. GADeltaDawn

    Anthem BCBS Missouri req's?

    OK, so I had my appointment with the surgeon today and have no supervised diet with Anthem BcBs. I've gotten clearance from my PCP, pulmonologist, and my labs are done. Next week I have my psychological exam and the following week I have the nutrition class. Once everything is completed I'll have another appointment with the surgeon, dietician and an upper GI. I'll sign my paperwork at that visit. 5-10 days later my insurance approval will come in then I get a surgery date. What a whirlwind the past two weeks have been! In all actuality I may have my surgery sometime in March! So excited to have my hope back!
  3. GADeltaDawn

    Anyone have PCOS?

    I have pcos and was told I was most likely insulin resistant. I was also told that if I lost the weight it would most likely resolve on its own. I did see a list of comorbidities in my research for the surgery that included pcos as a valid one for weight loss surgery. I just can't remember where. I'm talking to my surgeon about it to see if it would be a plus to include even though I met the bmi requirement. I have noticed in my past weight loss that my symptoms to get better the lighter I am. Good luck and keep us posted!
  4. GADeltaDawn

    Anthem BCBS Missouri req's?

    Oh good! I've tracked my weight in LiveStrong and followed their program so I have 2 years of weight tracking along with my laundry list of other attempts during that time. All my doctor weights correspond to my records so I was hoping this would be enough. My doctor did prescribe me wellbutrin for stress at work in hopes it would also work for weightloss and I've been on that for a year and a half. This med is used for that and my dad actually did lose a lot of weight with it. I only lost like 10 pounds when I first started it though. I'm still taking it but only because it works so good for stress. Trying to make sure I have all my records in order so I'm not having to guess and estimate at my surgeon visit. I go on Thursday. I've already scheduled my pulmonary, psychology and nutritionist and will have all those completed by the 19th. I'm hoping I can get the surgery sometime in march. I'll update after my appointment too. I'm told this insurance is actually one of the easiest to work with
  5. GADeltaDawn

    Substitute sugers

    I use Truvia in my coffee. Tastes very close to sugar. No chemical taste.
  6. So I just got notified that my insurance requirements were updated last week to the following: "The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery." The prior wording was this: "The individual must have actively participated in non0-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery." The requirements were pretty vague before but I'm trying to figure out if this is going to require a doctor supervised diet for 6 months or do they just want my personal journal of attempts over the past 2 years? Anyone else have this kind of requirement that can help shed some light on what they want? If they will accept my own journals, I want to have time to compile them before my appointment so my doctor can actually read them. But getting a straight answer from the insurance company is proving to be a challenge. They only want to tell the surgeon what my coverage is (not sure why, this is a battle I'm in the process of picking). I have Anthem BcBs. Also, my PCP had prescribed me Wellbutrin in hopes that it would help with weightloss on top of managing my work stress level at the time. It did wonders for my stress so I have continued taking it but nothing for the weightloss. Do you think the insurance would recognize this as a medical weightloss attempt? I know I'm probably stretching here but I really don't want to wait another 6 months to do yet another diet that will fail. I have my first appointment with my surgeon on Feb. 5th and I'm trying to get all my paperwork and records in order. Please help me to make sense of this! Many thanks in advance!
  7. Hi y'all! I started out wanting the sleeve but the more I learned about it, the more I'm considering the bypass instead. Did anyone else change their minds and if so, what were the driving factors behind you're decision? The main thing that I like about the sleeve is the hunger hormone being gone but I have horrible reflux and heartburn already and don't want it to get worse. On the bypass side, the dumping would probably be a good thing for me because of my sweet tooth. I need that accountability. I think I like the longer history of the bypass too, seems to be the gold standard. I really don't want to risk a revision later. You're thoughts?
  8. GADeltaDawn

    Anthem BCBS Missouri req's?

    I've been trying to find out the same thing! This wording just changed a couple of weeks ago. I also have this same insurance and have called 3 times, spoken with 3 different people, and none of them will tell me exactly what this means including the precert rep. I'm told the surgeon will have to request the guidelines. My appointment with the surgeon is February 5 so I'm hoping to get clarity on this. I also have personal records with LiveStrong and weights from my PCP but no kind of doctor supervised diet. I'll post whatever I find out after my appointment.
  9. GADeltaDawn

    Insurance

    Amanda729, I'm in GA also with Anthem. What type of diet documentation did they require? I'm told I don't need a supervised diet but they want me to have a documented and appraised attempt for 6 months in the past 2 years. Just wondering if they will take my own journals or does it have to be something "official".
  10. I think it's important to look at your surgeon's statistics and compare them to national averages. My surgeon makes their stats available to whoever asks as part of their education of patients. Turns out the complication rates for the one I chose are less than half the national average which is why I chose them. I wanted the best. Also take a look at how many of these surgeries they do every week. The more, the better because you are getting a surgeon with finetuned skills. Just do your research and find someone that you are confident in. Best of luck in your journey!
  11. Hi y'all! I started out wanting the sleeve but the more I learned about it, the more I'm considering the bypass instead. Did anyone else change their minds and if so, what were the driving factors behind you're decision? The main thing that I like about the sleeve is the hunger hormone being gone but I have horrible reflux and heartburn already and don't want it to get worse. On the bypass side, the dumping would probably be a good thing for me because of my sweet tooth. I need that accountability. I think I like the longer history of the bypass too, seems to be the gold standard. I really don't want to risk a revision later. Your thoughts?
  12. GADeltaDawn

    Trying to decide...

    I don't have diabetes but my dad does so I know that raises my risk to it. I'd be interested to know if the bypass will also lower your potential genetic risk to diabetes a well as a lot of the other diseases that can be reversed. My parents and brother all have some major health issues that I've been lucky to dodge so far including heart disease. I'm seriously thinking the bypass is going to be the best route for me.
  13. GADeltaDawn

    Trying to decide...

    That has been my thoughts too, quality of life is the driving force behind me doing this and I'm trying to keep that focus. I'm not so worried about the speed of weight loss, I just want to get on track to be healthier. It so hard to do that when I'm always hungry though. I make pretty good food choices like ground turkey, no fried food, and lots of veggies but that durn sweet craving gets me every time! One thing that I think will work in my favor with the dumping is that I hate feeling sick and will steer clear of any food that makes me feel bad. Good luck to you in your journey!
  14. GADeltaDawn

    And my journey begins....

    I'm told my insurance is one of the easiest to deal with, no waiting period or diet. I'm hoping to have the surgery in March or April at the latest. I will be the type to try and cram all my testing into a couple of days if possible just to get done. I have a 43 BMI all I met the criteria. Just hoping for a seamless approval. Good luck to both of you!
  15. I went for the seminar with my surgeon of choice this week and left with my first appointment on Feb. 5th. The amazing thing is I went in 100% sure that this is what I wanted and left 200% sure. I think mostly because I love the surgeon I've chosen and know she will be a good fit for my personality and needs. I've also made an appointment for the same day with my PCP for medical clearance. I'm so excited but I'm also finding that this is very emotional for me. I finally feel like I have hope to get healthy and to live my life. I was turned away by several doctors when I asked for help and was just told to stop eating so much so I was at my end when I started researching surgery as an option. Does anyone else find themselves being emotional like this or is it just me? I'd love to hear your stories! Sure would help me to stop feeling like a big mushball!
  16. Hi y'all, I'm looking for a preop/early postop support group close to me. Anyone know of any good ones near Barnesville GA? I'm about an hour south of Atlanta.
  17. Hi all, I'm just getting started in the process for VSG surgery and need some advice. I'm attending an informational session sponsored by my preferred surgeon on Jan. 21. I have a 43 BMI and Anthem BcBs in Georgia. Can anyone offer any advice on questions to ask at the session? Does anyone have experience in the approval process with this insurance? What about the presurgery diet? I have tried every diet out there through the years but have no documentation because my PCP refused to help me lose the weight. I was always told to stop eating so much and sent away like I was a bother. Did you have to do a doctor supervised diet with Anthem for approval? Please, any other pearls of wisdom you can share about your own journey to approval would be greatly appreciated! I'm thrilled to have found this site and looking forward to getting to know others. Thank you in advance!
  18. GADeltaDawn

    Just getting started...need advice

    Thanks so much for your advice! I'm excited to get going in this process. How quick did you all go back to work? I'm only telling my manager that I'm having a procedure done but will have the opportunity to work at home for a few days if I need to. I have a desk job with very little stress but it can be demanding on the old brain cells at times. My main concern is being clear headed enough to perform. How long did you depend on the pain meds for comfort and to function?
  19. For those post-surgery, what about Truvia? I've been using it in my coffee forever and it's the only sugar free sweetener I care for. Will I be able to use it after my surgery?

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