Brianna_Nicole

Hello all! This is my first time posting here on the sleeve forums. I started this whole process on January 8th, and after 4 months of evaluations, tests and screenings, dietician visits and a sponsored diet and exercise program, I have a surgery date set for May 19th and got approved within 24 hours of my request for precertification from Cigna! I am so happy that everything went smoothly and can't wait. Now that it's so close and real, I am very nervous however! I've never stayed in the hospital overnight or had any surgery so I have no idea what to expect. I start my pre op diet in 2 days and have my pre op visit on Wednesday! any and all advice on what to do to prepare in the next 2 weeks would be greatly appreciated! Thanks so much

Hello everyone! :-) This is my first post here. I was recommended to check out this site after posting on OH. Some info about me: I'm 25 years old, female, 5 feet tall and 263 pounds. I want the DS surgery. So far I've had my surgeon consultation and first dietitian appointment. I have all my other evaluations scheduled in the next month. My first issue I'm hoping for advice with: I went to my consult adamant that I want the DS surgery. Unfortunately I am NOT good at standing up for myself or disagreeing with doctors. When the surgeon asked what surgery I want, I said DS and he basically said that I do qualify at my BMI, but he would recommend I do the sleeve because I'm young and have a long time ahead of me to deal with the side effects and deficiencies that come with the DS. He said that if I'm not successful I can always have the 2nd part done and convert to a DS. He asked me what I thought about that and because of my shyness I said okay to the sleeve. After coming home and doing even more research, I'm even more adamant that I want the DS for many reasons: 1. I want to lose 120 pounds and KEEP IT OFF. The DS has the best results and least chances of regain, which I have a long history of. It looks like the average weight I can expect to lose with the DS is at least 90-100 pounds, while with the gastric sleeve I would probably only lose about 60. While losing 60 pounds would of course be wonderful, I would rather have the surgery that can take me to my total goal. 2. I have heard that the DS lets you eat the most normally. 3. I want to have the best possible surgery now, one time. I don't want to have to go through surgery again. 4. On the same note, getting a second surgery approved will be extremely difficult and probably denied, so if I don't lose enough weight or if I gain a lot back, I will have to self pay which I cannot afford. 5. Taking Vitamins and committing to blood work and follow-ups is not a problem to me. I look at it this way - I can have this surgery, take daily vitamins and go to the doctor regularly to check levels; OR, I can not have the surgery and continue to have weight issues, take daily medicines for co-morbidities and go to the doctor regularly for my health problems. So, I plan to call the office today and let them know I have changed my mind and want the DS. I'm worried that my Dr. will be offended or something, because I have known a lot of doctors that can be arrogant and hate being questioned. At my consultation he was extremely nice and didn't give me any indication that he was that type of person, but I'm still nervous! So my question is: what do you recommend I say to the doctor to support why I disagree and want the DS? If for some reason he refuses to do it for me, can I transfer the evaluations I've done to another practice/surgeon without having to start all over? Next issue: I had my first dietitian appointment on Monday and I'm very worried that he doesn't know and understand my insurance requirements. My Cigna plan requires 3 months (so 4 consecutive monthly appointments) of a physician or dietitian supervised weight loss program. When he mentioned I would be seeing him one more time, I told him that my insurance requires 3 months of visits. He went and got a packet with a description of the requirements for all the different insurance companies and said I was right about that. He then said that I could just see my PCP for some of the appointments. I said I want to do the 4 appointments all with him because it is supposed to be with the same doctor and I do not want to do ANYTHING that could get me denied. He said that was fine and we could meet monthly. Another concern of mine is that my monthly weight loss program requires documentation of my weight, dietary program and physical activity. He recorded my weight and taught me about the 1200 calorie diet plan he is prescribing for me and gave me papers with all the details and recommendations, and he taught me about the Protein and other diet requirements for after my surgery. The appointment was very informative and helpful, but we never touched on a physical activity plan at all. Maybe I am being paranoid, but I'm very worried about problems with insurance after the horror stories I've seen in the forums. I want to make sure every detail is perfectly followed. So what I was thinking of doing is seeing my PCP every month on top of the dietitian appointments, just in case it's not done correctly by the dietitian. My PCP is great and strongly supports my surgery. I'm positive he would do the weight loss program with me and follow all my requirements. Do you guys think this is a good idea? Could seeing both the doctor and dietitian at the same time for the weight loss program possibly be a problem for any reason you can think of? Okay, now one more topic! I am really sorry for this incredibly long post, I just have so many questions and concerns. I have checked and confirmed my bariatric surgery coverage in a few ways. I call the Cigna customer service line twice to confirm that my specific plan covers weight loss surgery and both times was told yes, it is covered. But I just don't trust the people on the phone to always be correct. I also signed into my account on the Cigna website and used the cost estimator for my plan, and it said that I can expect to pay a $300 co-pay for bariatric surgery. Lastly I read the coverage booklet posted by the employer providing the plan. The only mention of bariatric surgery is in the exclusions section, but this is what it says: "Payment for the following is specifically excluded from this plan: .... • for medical and surgical services intended primarily for the treatment or control of obesity. 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 if the services are demonstrated, through peer-reviewed medical literature and scientifically based guidelines, to be safe and effective for treatment of the condition." Is it just me or is that a bit confusing? I'm thinking this means that the plan does not cover any obesity treatment for those who do not have "clinically severe obesity". A BMI over 40 or between 35-39.9 with co-morbidities is defined as clinically severe obesity. So I definitely meet this requirement with a BMI of about 52. I'm also thinking that the last part about treatments that are peer reviewed and scientifically shown to be safe and effective means that the 5 procedures covered in the Cigna bariatric surgery coverage policy are all covered (gastric Bypass, gastric banding, RNY, vertical banded gastroplasty and BPD/DS for those with BMI over 50). I just find it odd that weight loss surgery is ONLY mentioned in the exclusions section. This booklet may be outdated - the "effective date" in the beginning is February 2009. Well, if you made it through this post, I appreciate it and applaud your patience! :-) Thanks so much for any advice or insights you can provide.

My surgeon didn't say I would only lose 60 pounds, that was me estimating based on the statistics I've seen. That is amazing that you lost over 160 pounds, wow!! That is a huge inspiration for me. Congrats and thank you!

Oh okay, that does make sense. So your case was reviewed by doctors at the insurance company? Or you have to provide documentation of a review by your own doctors? Thanks for the reply

Wow, that is amazing!!! What an inspiration... Thank you, your post was very helpful and encouraging Congratulations on being so successful.

I have researched this topic too, because I'm only 25 and definitely plan to have kids with my fiance in a few years. You can have babies after having DS surgery. I believe they say to wait 2 years before getting pregnant with all of the surgeries. I understand that the nutrition deficiencies are a big concern for getting pregnant after DS though. How soon do you plan to get pregnant? I'm thinking maybe if it is very very soon, you might want to have the baby before surgery? Good luck to you!

Thanks! Thats good to know about the dietitian. He started me on a 1200 calorie diet and gave me a bunch of recommendations for Protein shakes and 0 calorie drinks for after surgery (high calorie drinks are a huge problem for me!), so I actually did find him very helpful and knowledgeable. Its purely insurance that was worrying me. How has your experience been with the sleeve so far? I see that you've lost 55 pounds already? That is incredible! Congrats!!! :-)

That is very true that my experience could be very different from the average; I'm just using the statistics to make an estimate for myself. I'm very worried about regain with the purely restrictive procedure because I've been losing and gaining, up and down, back and forth, for years. I definitely plan to make the changes I have to make and work for the best results, regardless of the surgery. Thank you for the advice, and congrats on your 71 pounds lost since September, thats amazing!!! :-)

Yes the dietitian was especially focused on protein when we talked! Did you find it hard to get in all the protein you needed at first? I'm really curious how your diet and typical day is now, 10 years later? I've heard that about the 2 step DS being safer as well. I've also seen a lot of posts and discussions in the forums about doctors recommending the 2 step simply to make more money. I have no idea which is more accurate! I want the one step because I know getting insurance to cover another surgery will be a nightmare... If I do go with the sleeve I'm going to make sure I document EVERYTHING so that if it fails and I need a revision, I have plenty of evidence that I followed the rules. I could come to NYC. Do you have a recommendation? I don't mind travel if it means the best care. Thanks so much!! :-)

Thanks for the reply When I said I could expect a loss of about 60 pounds, I was referencing the average weight loss statistics I've been reading about. I realize that my experience can be much better or much worse than this, but the average is the best predictor I have to go on. I also have to consider that I have a long history of losing a good amount of weight and gaining it all back. This is a big reason I'm inclined to pick a malabsorptive procedure that has better statistics about regain. I just want to make the best choice for me.

Thanks for the advice! I think you're right, it would be best to make an appointment and discuss it with him and show him my research. Ultimately I think I should present him with my concerns and see what he thinks. I highly respect him as an expert so if he strongly advises against the DS I would listen. I have heard so many different experiences with Cigna! Either they say it was a breeze or it was horrible. How has your experience been so far with the DS? Are you glad you chose it?

Wow, thank you all so much for your replies! Its really helpful. I have to go back and respond to everybody now