2goldengirl

NO. they can't. First, there is no six months. If you're speaking of my particular situation, it depends on my BMI when I saw the surgeon or when I first saw my PCP about it (they're less than a point different) There is nothing in the selection criteria about weight lost or gained - simply weight to meet or not the BMI requirement.

No, I wouldn't bother. You've spent too much time already. They ought to have a call log for your account that shows each call anyhow.

Fantastic work! Celebrate! (throws confetti).

I've only told a handful of people. Two of them who don't believe I'm "big enough" are in different camps. One is a dear friend who herself has lost 150# with her sleeve. She's nearly a head taller than I am with a much larger frame, so I see where her perspective comes from. To her, I'm tiny. The other is my boss, who is herself tiny. I didn't tell her my weight, I told her my BMI. She was actually very complimentary; she just said "I just can't see where that extra weight is on you". Both of them have been totally supportive of my decision.

A bit of both, actually. I didn't find out about the change until Late September, otherwise I'd have told my PCP on our first appointment. Then I had to change surgeons because the first had an office staff that, ahem, doesn't work and play well with others. I WAS able to determine that my medical group knew of the change. But I filed a grievance anyhow, because Blue Shield did a crummy job of educating their own staff and their medical groups about the change. How to find out who your medical group is? Easy. Look on the back of your insurance card. There is the name of your PCP AND your medical group. They're also referred to as IPAs. Here's how it works in a nutshell: Your employer purchases insurance coverage from an insurance carrier (in this case, Blue Shield of CA). They agree to a health plan for their employees and the premium, part of which is paid by the employer, part of which is paid by the employees. Blue Shield contracts with medical groups throughout the state, who process authorizations and pay the majority of claims and provide other services for members. Primary care and specialty physicans contract with those same medical groups to get paid for the services they provide at an agreed upon rate. You go to your PCP. She/he submits a claim to, for instance, Healthcare Partners (an IPA). Healthcare Partners pays the claim. Your PCP wants you to see a cardiologist. She/he sends you to a cardiologist who is also a participating physician in the same medical group. The cardiologist wants you to have testing done. They submit a request for authorization for this to be done at a facility contracted with your health plan. Healthcare Partners processes the authorization and pays the claim afterward. In CA, in most cases, the day to day of managing authorizations is the responsibility of your medical group/IPA. This is why Blue Shield doesn't actually authorize your surgery - your IPA does. Blue Shield writes the policies, the IPAs carry them out.

You don't mention purees in the food choices you're so tired of. Throw some cooked chicken in the blender with some chicken broth and unflavored Protein powder. Throw canned tuna in the blender with broth and plain yogurt. And of course you can stand it for a couple more days. You worked hard to earn the privilege of all these liquids, and they're the means to an end. You've got this.

I'm salaried, not hourly, and my supervisor and manager know I'm having the surgery and are totally supportive. They know I work extra time when there is extra work to be done (like tonight), and they don't insist I make up the time for medical appointments. Your surgery and follow up visits should be covered under FMLA leave, unless you've already had your surgery and maybe even then. FMLA leave doesn't have to be taken in full-day increments if you're hourly, and can be taken a day at a time for things like medical appointments. If you haven't talked with your HR department already, do so now. they aren't allowed to share any information about why you are taking leave without your permission. FMLA protects your job for up to 12 weeks total for care for a medical condition or illness. I don't know what state you're in, but in my state, state disability insurance covers you for the period of time your surgeon says you are unable to work due to medical illness, which includes recovery from surgery. In my state, SDI only covers about a third of my income. I have Extended Sick leave as a benefit from my employer that picks up the other two-thirds. I hope this helps!

The grounds for your grievance is that their people on the phone are giving outdated and inaccurate information to their providers - in this case, to your surgeon's office. I can't understand why MD offices insist on calling when the information they need is right there on the internet, except that they also want to verify that the policy doesn't exclude bariatric surgery. I've yet to have a Blue Shield policy exclusion in more than five years of working with their members. Thanks so much 2goldengirl! Here goes the update and not a pretty one. The surgeons office called Blue Shield to verify the policy information. Btw my patient navigator was so upset with Blue Shield...she said she was on hold forEVER and that when she finally got someone, they didnt sound very knowledgable.....funny because I felt the same way when i called....They were told that the requirement is 6 months, no less. The surgeons office said if I wanted to I could do the 3 months and they can submit all of my paperwork to Blue Shield however, they will probably decline it and request me to do more or I have to appeal it and they would take "an even longer time". So how can I file a grievance if Blue Shield/CA is telling them the policy states 6 months pre-op.... So here you go: Call Blue Shield Member Services (the number on your card). Say "I want to file a grievance" They will ask you to state in general terms the nature of your grievance. You tell them: "Blue Shield changed their medical policy concerning bariatric surgery on July 31, 2015. Both my surgeon (surgeon's name) and I were told over the phone information that was contradictory to the new policy. My surgeon's office won't proceed with submitting their request for my surgery based on this misinformation." If you have the dates you called yourself (I know you called more than once) and the names of the people you spoke to and the answers you got, you can fax this information to them. Also write down what your surgeon's office told you (and who told you that at the surgeon's office). Fax it to 916-841-0999. Then call your medical group (sorry, I don't know which group you're with). Ask to speak to whomever handles requests for bariatric surgery. Ask that person whether they are aware of the change in policy. If they are, let them know that your surgeon's office isn't following the new policy, and that you have filed a grievance with Blue Shield over it. Good luck. And yes, I do this for a living. And a lot of other things as well. If it's any consolation, I had my first visit with my PCP about this in September. It was December before I could see a surgeon for an initial consult, and it will be late Feb. to mid-March before my surgery date. That's just about six months.

No, it doesn't necessarily mean that. It depends on both your surgeon and the degree of reflux you have - if you have reflux. Try to relax, getting anxious won't do anything but make you miserable. Nobody needs that.

It may be that her view of "normal" has gotten so distorted over the years that she's having trouble adjusting to the "during" you. With so many people we interact with every day anywhere from obese to superobese, it can be hard to view someone differently. It's hard enough for us to see ourselves accurately - imagine what it must be like for those around us!

Attention, especially from the opposite sex can be very unsettling if you aren't used to it. We get so used to feeling "invisible" before WLS - or worse, the object of the wrong kind of attention (judging, shaming, and all that). It takes work on the inside to unprogram a lot of those old messages and negative self-talk. As far as "letting them all down", you aren't doing this for anybody else. You're doing this for you. Your health and well being. it truly doesn't matter at all what anybody else thinks. They don't define your success or lack of it - that's strictly up to you. If you aren't getting counseling about these issues, I'd really, really recommend it. It's just like working out at the gym; the gym works the physical body, counseling is your personal trainer for the inside of your head. Good luck!

Well, my OD'ing on a food and never wanting to be in the same room with it again was...fruitcake. I was five. I thought it was amazing. And I was five. And - don't even get me in the same room with candied fruit. I have no interest in testing changes in taste with fruitcake postop, thankyouverymuch. I DO think it would be really interesting to see a study done about postop changes in taste/texture preferences, though. I'd especially like to see if different surgeries led do different taste/texture changes; or whether typical preop preferences influenced postop preferences in any way.

As I understand it, you do your appointments via Skype and telephone, so don't let that be a barrier. There is a forum here for folks who are planning to, or have gone, to Mexico.

What you don't know is the rest of the story. Was she off for two weeks for the holidays? Was the office closed during the holidays? Was another key person in the office out sick and everyone doing double duty? Put yourself in this person's shoes. Would you want someone getting angry despite you doing the best you could? Does your surgeon also do other kinds of surgery, some of which may have been urgent? I'd probably call and ask to speak to the office manager and ask why it's taking three weeks for elective surgery requests. You may find out that the person who is doing the submitting is not doing her job as expected - but you may find otherwise.

Just think about this a minute: You have lost 17-20 lbs. in three weeks. Do you not see that this is awesome? Hide the scale or give it to your next door neighbor for a month or two. Keep following your program. You're doing great!

Congratulations on your loss, and remember - nobody can make you feel like a failure unless you allow them to. Success can't be judged two weeks postop. Period.

London. Be still my beating heart. I absolutely adore London. and absolutely more walking everywhere. When I was there, I invariably needed to use a tube station with a nonworking escalator. This was nearly fifteen years ago, and I remember only having the time for two meals a day because I was trying to see a month's worth of London in just over a week. I ate anything I wanted to, enjoyed it immensely, and came home 5 lbs. lighter. If you enjoy architecture, both St. Martin in the Field and St. Paul's church have cafe's in the crypts. I actually had a meal in both, I thought t was a gas to have a meal in a crypt. St. Martin in the Field does a lot of concerts and jazz on Wednesday evenings in the crypt itself.

Paris. Seriously. Paris! Stop worrying, and prepare to enjoy a glorious trip. Stop obsessing about every bite that goes in your mouth, or you will miss out on SO much of this wonderful experience. You will be busy every moment. Enjoy knowing that your pouch limits you to not overindulging, but enjoy every sip and bite you take while you're there. You will probably find that you continue to lose while you're gone - I always have in Europe, partly because of walking absolutely everywhere. Your senses will be completely filled with all that is Paris, and you likely won't even think much about food. You've lost 190 lbs. Think of this trip as a lovely reward for yourself. You will doubtless have the joy of fitting MUCH more comfortably in the airplane seat! Plan to buy yourself something - a scarf, a pair of leather gloves, something that makes you feel special and absolutely Parisian. It can be your anchor for shedding the pounds that remain until maintenance. Bonne chance!

Broadly speaking, insurance doesn't cover drugs or supplements available without a prescription. A lot of deals can be found online. I use the Flintstones Chewables vites and they're very reasonably priced. I found a sublingual B12 at CVS that does the trick, also reasonable. Since I'm preop, I'm taking Calcium from costco, I have to figure out what to do postop. I hate the taste and texture of the chews. I spend less than $20 a month on Vitamins. It's worth it to protect my health.

You wouldn't talk to the pre-auth department at Blue Shield - that department only handles things that Blue Shield directly authorizes (like clinical trials, certain transplants, that kind of thing. Have you called your medical group? Your medical group ought to be able to intervene. Remember in the pst where I told you that if you got any pushback from your surgeon to contact Blue Shield and file a grievance? That's what you need to do. Call Member Services and say "I have a grievance". "Grievance" is a magic word, make sure you use it. And when they ask you what the nature of your grievance is, you tell them that your surgeon's office is not following Blue Shield's medical policy for bariatric surgery. Tell them that you are aware that Blue Shield's policy changed effective 7/31/15, but that because Blue Shield has not effectively educated their medical groups, you are being held hostage to a policy no longer in force. Good luck!

I really appreciate this post. I'm preop, but have several friends who are postop. One of them had a tummy tuck late last year after losing 150 lbs with her sleeve. She was SO unhappy with the extra skin around her abdomen. I rather expect that when the time comes I'll have something done - I've wanted a boob reduction/lift anyhow. I love the comment of wanting not to look like a deflated fat girl. I think there is something about taking the leap to get plastics done that can be the final acceptance that the "fat life" is over, and that the "thin and fit life" is a permanent change. And permanent change is what we all want when we start this journey, isn't it?

@@RileyBear, in CA, Blue Shield delegates review of authorizations to delegated medical groups. Blue Shield's policy is used, but there are more than 200 medical groups in the state. It works differently here than in other states with other insurance products. Letters of medical necessity aren't used in H M O products in CA. The medical groups contract with specific bariatric surgeons who prform surgeries at specific hospitals contracted with each of the health plans. If the surgeon's office can't get the surgery approved, the surgeon can't get paid, so they are very motivated to get surgeries approved the first time their request is submitted. A decision has to be made within five business days in CA so long as the required documentation is provided at the time of the request.

Welcome! Did your surgeon say you would need some time after your baby is born to have your surgery? I'm just curious. Kaiser should have a support group for bariatric patients. I really recommend you start attending, it's a big help.

@@sjrn16, you may have different forms of Aetna. You have H M O, which limits your out of pocket to copays.

Please don't worry about the numer of days. The important thisg is - your insurance approved your surgery. How many days you stay depends on your surgeon. All this means is that the hospital would have to justify for medical reasons a stay longer than the number of days on the letter.