Mistie

First, I want to thank everyone for your replies and support. It means SO much to me. I am generally not a weepy person - as a professor and counselor I've learned to keep pretty tight control of my emotions. Yesterday, however, I was crying at the drop of a hat! All day long. Even until I went to bed. Every time I would get a new response here in my email, I started all over again. What most people would not understand (except you guys!) is that the appointment itself was shocking and a disappointment, and I left feeling defeated - in ways I never would have imagined. I really felt like I got shafted yesterday. Not only with what I expressed earlier regarding the weight loss and Crohn's, but I went in expecting to be setup to see the nutritionist to start the supervised weight loss (ie. as required by insurance), to talk with someone about insurance and how much the total would be, etc. Instead, he seemed to just be going through the motions without any real plans to see me - just shuffled me out the door. To respond to everyone's questions/comments. The center IS one of the Center's of Excellence. My insurance company requires it - so they do have the full team of nutritionists, psychologists, etc. My insurance requires three months of supervision by one of the centers, as well. The doctor did not require the weight loss specific of me - the nurses told me before I ever saw him - he requires everyone to have a BMI below 55 before he will operate. The diet they gave me - their pre-op diet, IS a low-carb/high-Protein diet - unfortunately, many of the foods they are telling me to eat on it are foods I cannot eat due to my blood, for example. As for the surgery - I told them I was interested in the Sleeve. Although it is irreversible, which makes me more nervous, I did my research. Research says that it is better for patients with a higher weight, it is better for patients with Crohn's and Anemia (due to absorption issues, I am guessing), etc. Although some of the stats say RNY has a higher overall weight loss, the sleeve seemed a better option due to my own health issues - which I took into consideration before ever meeting with the doctor. In regards to the green stuff + blood thinners: It's not the blood thinners with which the green stuff is incompatible with, it's blood in general. Whenever you have blood clotting issues, you are suppose to eat a VERY limited amount of green, leafy items. Ie. cabbage, lettuce, broccoli, etc. Last year, they said that included other 'green' veggies, as well, as I was eating a lot of asparagus (it was my go-to veggie when losing weight) - it was messing up my blood. The 'green stuff' thickens your blood, in the same way alcohol thins it (it's the reason you are not suppose to take aspirin for a hangover - they both thin your blood). I mean, I guess I COULD eat a salad and then drink some alcohol, but that might be defeating the purpose As far as what I do now - I cut out salt years ago. If I DO ever drink soda, it's diet - I drink Water almost exclusively. I eat minimal carbs - I am simply not a bread, rice, Pasta type person. I use a Fitbit and walk a set number per day. I have been using LoseIt! for a couple of years and log every bite of food I eat and every minute of exercise I do. I go to water aerobics several times a week. So, in a lot of ways, I feel that I was somewhat ahead of the game in preparing. I acknowledge I've had a lot of health problems. Oddly, none of them are weight related! I have perfect BP, low cholesterol, etc. I would like to KEEP it that way! I have already called a clinic I went to several years ago which said they did NOT see any signs of the Crohn's. I have asked for my records. This can be 'proof' for him, with or without additional testing. As well, I have looked at another center. As I said, there are three in my state. He's about an hour away. The second I have seen mixed reviews. The third is about three hours away, but my general MD likes it. I looked on their website, and they require a weight below 400 lbs. That I can manage. I THINK I got everyone's questions...! Again, I appreciate all of the support. I have never opened up about my weight to anyone, and although I have a beyond supportive family, they simply do not understand. My mom keeps saying she has struggled with weight all of her life, and this is true, but not to the same extent. To everyone on here - keep doing what you do for everyone else on here. Your words of encouragement, no matter how strong the support system of others, are so much more meaningful than you can ever know...

Thank you, LipstickLady. Logically, I know he has my best interest in mind. He wants to ensure a safe procedure. I just quickly got my heart set on it, and it seems so unattainable. In my entire state, there are only three clinics. I'm going to go ahead and do the testing, to see the results. If he does not/will not proceed, I will see another clinic, as my general practitioner is actually three hours away, so therefore was actually more familiar with another clinic (my OB had referred me to this specific clinic, as it is closer to my home - sounds confusing, but I live between two places, as I have a home home, but a secondary home, because I teach at a University). As far as a plan for losing the weight at the moment, they simply printed off the 10 day preop diet they use. That does not really work for me, however, as it incorporates a lot of 'green' foods, which I cannot eat (on blood thinners, so I cannot eat green veggies). I also asked him for suggestions for controlling hunger, as I am on Depo Provera shots, which his nurse practitioner said was more than likely increasing my appetite (I asked her how it influenced weight, as I was told by a doctor it does, and that was the reason I had regained the 74 pounds I lost last year, with friends). He had no recommendations.

Dandylion- what about calling and speaking to the insurance coordinator at the bariatric center? Just explain your situation. You have an appointment, and have been trying to find out insurance requirements but can't get a straight answer. S/he may not be able to give you an exact answer, because each plan is different, but s/he should have an idea.

Heather, The specific info is on pages 20-22, under covered services. On pages 21 and 22 is where it talks about the requirement for a supervised diet. As I said, their bullets are really mixed up! The levels are screwy, so it's hard to tell what's a requirement, and what's an 'option.' I'll post it below for you! Number 1: two programs which have been supervised by other doctors, takes a total of 6 months. Number 3: Supervised by Active Health - takes 6 months - just phone calls. Number 2 can be completed through your bariatric center. Takes 3 months. Includes visits with the physician and a nutritionist. The center said our insurance will NOT cover the nutritionist, however. The exact wording is below! *Member must meet 1 or more of the following criteria (1) physician-supervised nutrition and exercise program; or (2) multidisciplinary surgical preparatory regimen, or (3) Participation in the Weight Management Enhancement Program. (1) Physician-supervised nutrition and exercise program (it's just listed as a sub-bullet, not numbered, so hard to tell the difference) - Member has participated in two (2) or more physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavior modification, Weight Watchers, the Atkins Diet, the South Beach Diet, or Sugar Busters), documented in the medical record at each visit. The physician-supervised nutrition and exercise program must meet ALL of the following criteria: (IE. This is two, three month programs at least - so this requires at least 6 months to complete). (2) Multidisciplinary surgical preparatory regimen: Within 6 months prior to surgery, the participant must participate In organized multidisciplinary surgical preparatory regimen of at least three months (90 days) duration meeting ALL of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the participants ability to comply with post-operative care and dietary restrictions: Behavior modification program supervised by qualified professional Consultation with a dietician or nutritionist Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen). Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to the surgery, supervised by exercise therapist or other qualified professional. Program must have a substantial face-to-face component (and must not be entirely delivered remotely). Reduced-calorie diet program supervised by dietician or nutritionist. (3) Participation in the Weight Management Enhancement Program for 6 months (This is the Active Health program - monthly phone calls). Active Health administers our weight management and smoking cessation programs. The telephone number for more information from them directly is 866-939-4721. They were very helpful when I called!

Greetings! I'm BCBS MS (state employee) and just starting. I found out our insurance now pays (started in fall 2013), completed the online educational seminar the same day (I was going to book the in-person, when I found they added the online portion), and attended the in-person support group the same week. The next week I scheduled the appointment - the earliest they could get me in is May 27th. I called today to see if there had been any cancellations, and I was moved up to May 4th - VERY EXCITED! I have spoken with BCBS, as well as Active Health - who manages that portion of our insurance. I wanted to know specifics of our requirements for approval. According to Active Health we have the three options (and it's in our manual we can find online) - 6 months of a distance supervised program through them, two three-month physician supervised programs, or a three month supervised program through our bariatric center (this is not the wording in the program, rather, layman's terms for it!). They do not have a requirement that we lose weight, rather, that we show we participated in the program. If you go to MyAccessBlue, you can find your 2015 manual under publications - the info on bariatric procedures is on page 20 something. Be forewarned - the formatting is REALLY off, so it took me awhile to make sense of it, that it was ONE of the options, not all! Ha.

If you have any doubt, call your doctor! No one can give you a yay or nay without medical testing. Almost three years ago, I went through a two-month period of having trouble breathing, and it was getting worse and worse. I went to the doctor 5 times, and no one could figure out what was wrong, because the only symptom I actually complained about was my breathing - they said asthma, pneumonia, allergies, bronchitis, and everything in between. Finally, in the ER, someone figured it out. I had blood clots. I was admitted to the hospital and stayed there in ICU and had to go through surgery, etc. I had had so many blood clots, my lungs (both right and left) were collectively over 50% filled with dime and nickel sized blood clots (so of COURSE I could not breathe!), and I still had three in my legs when I was admitted to the hospital. I never had ANY symptoms of swelling or heat in my legs. Perhaps some tenderness, but if so, I would have just thought that was from having to walk and being so heavy. That said - again, if you question it, call your doctor! As others have said - better to be safe than sorry.

Thanks for the info, John! I'm an avid cruiser (28ish), and that's one thing I have worried about. I'm actually trying to figure out how to schedule surgery given my cruising schedule It's nice to know that you were cruising comfortably so soon after surgery, however!

The risk of dvt is high for anyone who is immobile, and according to my hematologist, 1 in 7 women get blood clots when flying overseas-we have a higher chance than men. In other words, do some walking! And when you're in your seat, do some leg lifts every so often-keep your circulation going. Even without a history, lack of movement makes one susceptible.

I just found out my insurance will cover, so I'm steamrolling ahead. I made a comment to my mom over the weekend, after having spent time exploring this site, about how expensive it will be post-op. She put it in perspective. Not only will I not be buying regular food (and I tend to buy pricey organics and fresh food to be healthy), you won't be buying fast food, either. So, I will be SAVING money, now that I think about it!