wildflowergirl

After four years fighting with the insurance company to get approval, my surgery is in the morning! Woooohooo ???? Anyone else having surgery 11-23-15?? Can't wait to be on the Loosers bench.

Monday the 23rd in Charlottesville VA at 10:15. Pre-op weight 228.4 See you on the loosers bench ????

Surgery scheduled for November 23rd at Martha Jefferson Hospital with Dr. Stokes. Anybody else in the Charlottesville area?

I don't know of a facebook group either (maybe you could start one)???? My surgery is scheduled for November 23rd in Charlottesville Virginia.

I'm a Preschool Teacher with 2 1/2 year olds and I am planing on taking 6 weeks just to be safe. If I decided to go back earlier it will be a bonus for my employer. My surgery is scheduled November 23rd and I'm scheduled to come back January 4th.

I went to see the doctor November 4th 2014. The doctor thinks I'm a perfect canidate for the sleeve. But even though I am 5 foot 3 and weigh 230 pounds now, my insurance won't approve me because I have not been diagnosed with any co-morbidities. (I am pre-diabetic, my blood pressure is a little high but no medication, and my cholesterol is a little high again no medication) I have been doing Weight Watchers for 3 years and have been loosing and gaining to same 15-20 pounds. My BMI has been over 35 for those 3 years but has only been over 40 for a few months. So I either have to stay at this weight for 2 years or I just went for sleep apnea test and if thats positive then I have to stay above 35 BMI and have sleep apnea for 2 years to get approved. It's just so frustrating because I obviously can't loose this weight and keeep it off on my own. So it looks like I may qualify for surgery by October 2016 . OK I'm done complaining

Just got the call today APPROVED ???? Surgery November 23rd. Wooooohooooo!!!!!!!!????????????

just to update I have finished the 6 month supervised and all paper work for approval got submitted October 6, 2015 ???? so I'm Just waiting to hear from Aetna. Surgeons office said it's been taking about 15 buisness days. Everyone keep your fingers crossed for me!!!!

@@Inner Surfer Girl I was but I started this process almost four years ago and I did the supervised back then. Aetna says the 6 months supervised has to be within 2 years of submitting for approval. I was a little bummed but the six months have gone by fast.

Just a quick update. Aetna changed their policy as of November 2014 (No longer says you need a two year documented history) So I started my 6 month supervised WL with Doctor in April 2015 and will be done October 5th. The surgeons office will be submitting that first week of October (Woooohoooo I've spent these 6 months collecting copies of all my medical records and labs. I have a notebook full to include when everything is sent to Aetna. I have a copy of their policy and have been following it to the letter. (I even had to inform the surgeons office of some changes in the policy they didn't know about) So keep your fingers crossed that I get approved and with luck will have my surgery before the end of 2015!! Oh and I'm still smiling

Can you just do another month and then resubmit? I was denied when I tried before because I had no co-morbidities with a 35 BMI My Doctor would not do a peer to peer review. So now 3 years later my BMI is 40 and I have Co-morbidities so I started the process over in April (in the process of doing the 6 months supervised weight loss that insurance requires) I will be done October 5th and (fingers crossed) will get approved.

I have bulging disk between L5-S1 I am hoping to get approved for surgery October or November 2015. I have 100 pounds to loose and am hoping I'll have no back pain when I get to goal.

I will be finishing my 6 months supervised October 5th and if Insurance approves I will get sleeved end of October or first of November. I am in Palmyra Virginia and will have surgery at Martha Jefferson Hospital with Dr. Stokes. (fingers crossed)

How Much time did you take off work or are you planing to take off??? I have 3-5 year olds and am trying to decide how much time I'll need off. If all goes well I'll be having surgery around the end of October 2015. I'll have about four weeks saved up that I can take if I need it. Thoughts????

Thanks for the reply I'm full days (8hours a day 5 days a week) I'm thinking 3 weeks would give me time to adjust.

my insurance states that you can not have any net gain from the first weight. My doctors office said even .2 of a gain and insurance would not approve! I have Aetna insurance.

Found out that Aetna changed the Policy they no longer say "two years" As long as doctor records show consistent on going obesity and the policy now says that during the 6 month supervised you can not have a net gain of weight- so you have to weigh the same or less at the last appointment as the first appointment. I am so excited I have been at a 40 BMI since November have had sleep apnea since January and have been over 35 BMI for over five years(probably longer) So I just started my 6 months this month (April) and if all goes well I'll get surgery the end of the year!!!!

Aetna and the coordinator at the surgeons office told me that Aetna's new (just redone 11/04/2014) Clinical Policy Bulletin: Obesity Surgery states that during the 6 month Physician supervised diet that you can not have a net gain. So I was told as long as you weigh the same or less at the last appointment as the first appointment you are ok. If you want to see the policy look up Aetna's Clinical Policy Bulletin: Obesity Surgery Number 0157. Good luck I'm doing my 6 month now!

Hi Lauren I just saw your post and was wondering how much time you took off work?? I am in the begining stages hopefully I will get my surgery(gastric sleeve) October 2015. I am a preschool teacher also. I have 4 and 5 year olds.

I spoke with Aetna yesterday and was told as long as my BMI is over 40 NOW and I have two years of weight history being in the obese category then thats all I need. (I have been over a 35 BMI for years with no co-morbidities) I have doctor records showing my weight over 35 BMI for the last 5 plus years.

I have to have a BMI of 40 for two years (in dr records) before my insurance will pay (I have Aetna) or 35 BMI with co-morbidities for two years. I was just under 40 BMI with no co-morbidities for the last 3 years and was denied ( and yes I did appeal and was denied) . Now I am at 40 BMI and have sleep apnea since November 2014 so in two years I can apply again.

I have Aetna also and had BMI over 35 with no co-morbidities did everything NUT visits, PSY visit, six months PCP supervised weight loss). I was denied. Now my BMI is over 40 (since November 2014) still no no co-morbidities. Denied. I have to have documented BMI over 35 with co-morbidities or over 40 with no co-morbidities for 2 years before I will be approved!! I was just diagnosed with sleep apnea in January (so I now have a co-morbidity). If my BMI stays over 40 I can reapply October 2016 if it drops below 40 I can reapply January 2017. This whole process has frustrated me so much I am 5'3" and currently weigh 231. I know I can't do this without the help of the VGS. I have done WW for the last 3 years and the lowest I got was 206. I just loose and gain the same 25 pounds over and over. My goal is to try to keep from gaining until I can apply again next year

Just to keep you posted on whats happening with me Still over 40 BMI (40.92 -231 pounds) and into 4th month of 24 months of having 40+ BMI to be able to apply again to insurance. I also had sleep test and have sleep apnea so even if I did manage to loose some weight on my own I would still qualify (according to insurance) 24 months from January 2015 (when i was diagnosed with apnea) if my BMI is over 35 (198 pounds or above) with comorbidity (sleep apnea) (that would be 33 pound loss and the most I've ever been able to loose is 20 pounds. The bariatric doctor said he would be happy if I could just keep my weight where it is until we can get the surgery approved. He said usually people that are 100+ pounds over weight (me) would be lucky to loose 25 pounds on my their own and keep it off. I make sure that every time I go to my PCP I talk to him about my weight and how it relates to my health and I make sure he documents what we talk about. When I am able to apply again I am going to be sure to have everything in order! Still have borderline high blood pressure (no meds) pre diabetic (no meds) and borderline high cholesterol (no meds) the bariatric doctor said I am just a fairly healthy obese person (which keeps me from surgery- thanks insurance) but eventually it will all catch up to me and he would like me to have surgery and loose the weight before I have several health issues to deal with. So I'm just keeping a smile and waiting until I can apply to insurance again. October 2016 if I don't loose any weight (40+ BMI) or January 2017 if I loose more than 5 pounds (35+ BMI with sleep apnea)

The weight loss doctor wanted my primary doctor to do just that but my primary doctor said he would not because weight loss surgery is not his area of knowledge. But he thinks this is a great idea for me to have the surgery. I am just going along with life and keeping my own records of weight and doctor appointments and making the doctor make notes when I see him of his concerns for my health as related to my weight. (If he talks about my sugar, blood pressure or Cholesterol being high but not high enough for medication yet) I ask him to write that in his notes (and I watch him write it) and I ask him to note that its related to my weight. I discuss my weight at every appointment and the things I've tried and how I always gain weight back plus some. (I ask him to make notes of that too!) October 4th 2016 will be two years and I will be ready for the insurance company this time. I have copies of what they require and I keep in touch with the nurse at the weight loss surgeons office to make sure all t's are crossed and I's are dotted! I plan on starting my 6 month supervised weight loss plan in April 2016 and getting psych evaluation and nutrition done by September 2016 so on October 4th 2016 I will be at the surgeons office with everything ready to be submitted to insurance! Two years seems like forever but when I think of how many years I've been overweight and know that this will make a difference I know I can do it!!! I made a count down calendar and each month I cross off I know I'm that much closer!! It will happen!

I know how you feel I have had 35+ BMI for years now with no co-morbidities and insurance denied me Now I am at 40+ BMI still no co-morbidities and I have to stay at this weight for 2 years for the insurance to pay! If I loose even 5 pounds during that 2 years and it is in doctors records they will not approve. I am so frustrated because I know I need this surgery as a tool to be successful .On my own I seem to gain and loose the same 15-20 pounds over and over.