Michelle Tarver

I know my NUT approved them for me... But can't recall it off the top of my head.. Hold on I'll look Sent from my E6782 using Tapatalk

Duh yeah that also lol sorry! Sent from my E6782 using Tapatalk

It is a Military Hospital NOT a VA hospital. Good luck with your procured

I have quit cold turkey about 5 years ago. Well actually over the past 25 years I have quit cold turkey 3 times total. It is not impossible. And it won;t kill you. Just go..I won;t have a smoke for this 5 mins or this new 10 or this 30... and keep stretching that time, pop a hard candy when you should have had a smoke, dance to a song when you should have had a smoke, fold some laundry, ect ect ect eventually you will forget to smoke. Good Luck!

Me,ME,ME... Late Jan or Early Feb even. I Could have been a late Oct Early Nov..But due to personal/work reasons I have to wait.

Yep, I am 5'7" and BMI is RIGGHTTT there at 40.sumthing..no co morbidity So I was told not to go below 262, so I could lose 5 more lbs between now and my anticipated date in Feb. ( For my reasons not the surgeons I have to put it off) . For MY (Atena) I have to be at a qualifying BMI ON surgery day. It's stupid. the INSURANCE requires a 90 day diet and exercise Doctor super vied program.. Bangs head on the table...

Oh boy...so looking forward to this:eye roll: Sent from my E6782 using Tapatalk

Google You are your on gym. A complete work out at home. No equipment needed. It is a $5.00 app and a $10.00 book. My husband had great results while he did it for 2 years. He fell off after an injury and stop me if you have heard this before... He never restarted... He says its all self paced and self modifying

you can ask the Y about a scholarship.

Fwiw...my wls scheduled me for an endoscopy. The information they sent clearly says I need a responsible friend or relative to drive me home as I will be sedated for the procedure. They will not allow me to go home with a can driver. You may be able to hire a medical transport company, but you probably will have to pay out of pocket for it. Sent from my E6782 using Tapatalk Can driver not can driver lol... Sent from my E6782 using Tapatalk

So, I met with the Surgeon last Friday, she suggested to double check with the insurance company about coverages,co-pays,ect. And the Surgeon told me NOT to lose any more weight. That I would go below 40 BMI and not qualify for the surgery. So Wednesday I called them. gave them the procedure code. Was told yes we cover the surgery.There are some conditions you need to meet. here let me send you the Clinical Policy Bulletin to read. So I read it. It does say the BMI has to be 40,but it also says you must do EITHER a 90 day multidisciplinary approach ( NUT, Behavioral,exercise ) OR a 6 month weight loss plan BOTH be mainly face to face. I am doing the 90 day one. However I can not have the Surgery until late Jan/early Feb. So I asked about the BMI..at what point do they look at it ? On surgery day? At the start of the program? Was told to re read the policy builtin and ask my doctor. They should know. So I called the doctor. They were like well we don;t know until we put in for pre authorization what your insurance really requires. We have a general idea. But if you want policy specifics call the insurance company. So I call BACK the insurance company. I am again told to read the policy bulletin. I said I have it DOES say 40 BMI..BUT NOT when, The woman on the phone says" we can't answer clinical questions you have to ask your Doctor.."( ok getting frustrated here!) "But IN MY experience They looked for the past 2 years of BMI above 40 before they would approve me for a LAP band" but that was all she cold tell me. So I called the insurance company BACK AGAIN. I ask.. I read the Policy Bulletin, I know the BMI has to be 40, but at what point and for how long? I get told.. read the bulletin I said I have It does say 40 BMI but not anything about time period or length of time prior to surgery. Can you please answer this question? Ins co: We do not answer clinical question." me: This is not clinical it is about MY policy. NO it is clinical. The policy Bulletin says nothing about the time period to be at 40 BMI. Ins co says: It is not for you to read it is for your doctor, I reply : You sent it to me. They reply it is for your Doctor. I reply.. it is in English? INs Co says yes. I reply that I am educated enough to read English. She again says its for my Doctor. I asked her, Do you think I am unable to read English? The information I am looking for is not in the bulletin. So if these are the guidelines and it is not in the guidelines then they do not apply to my policy I asked? Ins Co says: That is not the case. So I said... Where do I find these guidelines? Ins co says ask your doctor it is a clinical question, I said it is a POLICY question I am not asking you how to do the surgery or WHY to do the surgery. I am asking what my policy says about the surgery. Ins co : it is in the clinical policy bulletin. I reply I read it it did not answer my question. Ins co says it is not for you it is for your Doctor. gain I say I can read English. I now ask for a supervisor. Of course the supervisor is "not available, I can leave a voice mail and they will get back to me in 24-48 business hours." UM its 12 on Friday..So that is like Tues ..Not acceptable... Wee go round and round... I ask for a different Representative. I get a different Representative. I tell her I am investigating getting a vertical sleeve. I understand my BMI has to be 40, But the day I start the program or on Surgery day? And I now hear Atena will be looming for a BMI of 40 or more for 2 years prior to surgery...Is that correct? Again I am told this is a Clinical question and they can not answer. I reply that it is a POLICY question. She says I can send the policy bulletin I say I have read it and it does not answer these 2 questions. Again I ask..So if it is not in the bulletin it is not required by my plan? She said not necessarily. I explain to her I have gone back and forth with the Dr's office.and the Ins company on this. That it really seems to be a Policy issue to me as my Dr says it is. I am trying to save Atena MONEY on tests and appointments for a procedure I now may not qualify to get until Nov 2016. But we won;t know that until I have all these appointments and tests and apply for pre approval in Nov 2015. So she says we can have the doctor do a pre determination..kinda like a mortgage pre approval but not funding the loan get it? So I had to call the doctors office back and ask them to put in for the pre determination. UGH my head hurts. Looking at my medical record on line IF they do want 2 years of a BMI at 40 I have to wait until Nov 2016.....I would rather know that now before I do the Endoscopy and upper GI testing I don't wanna get my heart set on having it done THIS November and THEN find out I have to wait ..(of course Dear Hubby says to just keep loosing it myself : ...if I have to wait at 40 BMI till Nov 2016..) Soo yeah that is my day.. How is yours?!

Bwhaha... Atena sent me an email asking about my recent call to customer service. So I rated them accordingly, told my story. It was a pretty interactive one. It kept apologizing to me and asked if I wanted to be contacted to discuss it. So of course I said yes. Dying to see where this goes... Sent from my E6782 using Tapatalk

thanks that gives me hope! Sent from my E6782 using Tapatalk

Lol ...yep I can see how you would get that feeling and the bad news is this is only my primary insurance. My secondary is CHAMPVA. They do not cover the sleeve on their own but will as the secondary. However the Dr has to bill Atena first,get the EOB, and then submit to CHAMPVA Sent from my E6782 using Tapatalk

Thanks no one offered me that information. I will have to dig it up. Sent from my E6782 using Tapatalk

Oh I hope I will laugh. I don't have any co morbidity issues yet...at this rate the "pre diabetes" becoming diabetes might in a sick way be a good thing! If I had co-morbitities I could have a BMI of 35. I was 280 in May when I started I can't recall what BMI that is. I am 268 right now. I can go no lower than 263. I am 5'7". My Dr office said Atena is one of the tougher ones to work with. Sent from my E6782 using Tapatalk

I am not post op yest. My surgeon said I will get them in the hospital. Only people with a history of clot issues will get sent home with them. But every Sargon is diff rent Good Luck

Hi there,I am in southeaster MA near Taunton. I am having my surgery at Brockton Hospital with Dr.Abeles. She is booking about 90 days out from the initial consult. My insurance is notorious for being one of the harder ones to work with,they can have up to a 6 moth supervised diet/exercise requirement. Come on in here and whoo -hoo any time you like. IF you are brave I am happy to meet people in ral life that I meet online. It's how I met my best friends.. we were in a forum for 2 yrs they did a were do you live thread and it turned out we lived like 7 houses away from each other...

I was told my husband can just drop me off for surgery day and pick me up at discharge 2 days later. I am told I will be in a MINIMUM of 2 nights. I am NOT allowed to drive for 2 weeks. So yes i will absolutely need someone to pick me up from the hospital. Desk job people usual go back at 2-3 weeks. I will take a lot longer..I lift 50 lb boxes at work. Best of luck to you!

I have Atean choice ll from my employer costco. After the 1st group info session we were given the procedure codes and told to go look them up with our insurance company. http://www.aetna.com/cpb/medical/data/100_199/0157.html was pretty clear on what I needed to do. Good luck to you! Maybe..if your surgeons office is not good with details dyou may want to look around at others in the area and see if they are? Or be very on guard for any more slip ups before surgery that set off alarm bells?

Could you please explain what you mean by all of this? It makes no sense. And frankly as a Christian you replies make ALL of us and Christ look bad. So either nicely explain yourself,apologize for your snarky behavior and hang around learn andd share,OR just be quiet and Go A way.

I have been told in no uncertain terms by the NUT,and the Surgeon NOT to lose anymore weight pre op or I would be denied by my insurance. I do not have any co-morbidities. So my BMI has to be above 40 It's pretty screwed up honestly. Could I continue to lose more weight with out the surgery...yes....i have lost 50 or more pound 3 or 4 times...but can I keep it off? No, no I can not. So I will play the insurance companies game.Keep my BMI in aproval range till I can hve surgery in Feb. I spoke to my brother in law who has had an R-n-Y for 15 years. His advice was " Be selfish, do this for YOU" It is the best thing I ever did for MYSELF.

South of Boston here... using Dr. Abeles at Signature Medical in Brockton. Started the process mid May. Could have had a Mid Sept date,but due to work reasons I have to postpone until late Jan early Feb.

She is great,Dr.Abeles at Signature Medical in Brockton MA. We have met in a few group settings.This was the 1st one on one. She is every bit as through and professional and nice as I was told. Since I have no co-morbitities I do not need any pre op testing except the scope for Baretts esophagus/acid reflux. She did ask due to my recent concussion that I get the neurologists to sign off on going under the general anesthesia. Just as a precaution. I was not given a pre surgery weight loss goal. I am at 267. Was again told not to go under 262,or I would not qualify due to my BMI being to low. But the bummer is she would have given me a late Sept early Oct date for surgery. And I can't. I have been out of work since March due to the concussion and I go back part time next week. I need to work a few months before I go out again. My job involves lifting 50 lb boxes..so I may be out 8-12 weeks after surgery. So I am just bummed I can't get this sleeve done sooner!