2goldengirl

Call the surgeon's office - they are the ones who submit everything to Aetna for approval. They know the process better than anyone.

@@TnT123, you have lost 31 lbs. in four weeks. That's a LOT! Think about it. Your body needs to catch up. Relax. Keep doing what you're doing.

The first culprit I would suspect are those shoes. The midsole in athletic shoes doesn't last forever, and if you've had to glue to soles, chances are the midsoles are shot and aren't absorbing any shock. Back off for a a day or two. Get some new shoes. Then see how you feel. Yes, there definitely could be something else going on, but start with the simple fix first and see how you do.

It's a narrow-network product, and I believe it's only offered in northern CA. here in the bay area, which means your two sites for surgery ought to be either Valleycare or Summit in the east bay, UCSF in SF, or Mercy Methodist in Sacramento. The same criteria apply for approval of surgery; here is a link to the policy: https://www.healthnet.com/static/general/unprotected/pdfs/national/policies/BariatricSurgery.pdf They do NOT require six months waiting period, nor have they since this policy was updated in May 2015, however "Patient has made a reasonable effort to lose weight and there is documentation that these attempts at dietary control have been ineffective in achieving a medically significant long-term weight loss.". A psychological evaluation is required. Their criteria for individuals with a BMI between 35 and 40 are pretty stringent. All of these details are on pages 3 and 4 of the policy. Health Net requires that its delegated medical groups (Brown & Toland, Hill, Mercy, etc.) follow Health Net's criteria. This means that if your medical group says that you need to anything beyond what is mentioned in the criteria, they are incorrect. Your surgeon will have specific requirements for preop diagnostic testing, such as an EGD and/or upper GI X-ray, a sleep study, or an EKG, and that's fine, those are diagnostics your surgeon needs and not subject to the health plan or medical group's policies. I hope this helps!

@@needtorecover, G to H here. I think my shoulders & sleeve length will be just fine in a size 6-8. We'll see!

Yes, they count. I'd done so many over the years that I'd forgotten the names of some of them. I just made a list and gave it to both my PCP and my surgeon. I did it as a table, and I added which year, how much I'd lost, and how long the loss lasted. And don't forget this - completing the form is your surgeon's job; properly documenting how you meet the criteria for surgery is their job as well. They will need information from you, but they've gotten many, many patients authorized for surgery - whereas the only experience you personally have is your own.

I'm actually researching this right now. I have to do something while I get all my preop work done, right? Pinterest has been a great help, along with a book I got recently about style for women > 40. I've realized that my personal style has been a bit unfocused, which has led me to some choices I've been very happy with, and some unfortunate ones. I've realize that simple lines, classic cuts, and timeless fashion are what have always appealed to me. It will be a LOT easier to find things worth investing in when I'm not in that Twilight Zone of "sometimes a plus size, sometimes a standard size". One of my treats to myself at goal will be to sew a tweed Chanel jacket with all the couture details. Did you know you can buy tweeds from the same mill that Chanel buys from? What a want is to buy a shirt or a sweater where the shoulders don't droop down my arms so that it fits over my boobs. Right now I just can't do a classic white button-up shirt. Anything that fits over the front has sleeves that are too long and shoulders too wide. I don't have very narrow shoulders, and once I get to where my circumference is more in keeping with my bone structure, it will be SO much easier to get things that fit. Right now I wear knits almost exclusively, because they have give and drape. I'd love to explore wovens again. I'd love to wear jeans that were both comfortable and flattering, just now they're just not a good look for me, and they're beastly uncomfortable, especially all day at my desk. I have a friend who is an absolute genius at consignment shopping. She's on board to replenish my wardrobe as I shrink. I have things stored in the attic that will do me for the first 20-30 lbs. loss, maybe further with the addition of something like a belt for the cardigan sweaters, that kind of thing. And in the meantime (thanks to a year-end bonus), I bought myself a lovely new handbag and tote for work, and did a bit of shopping on eBay over the weekend; I'm wearing my first-ever statement necklace today, and it's drawn raves. I think it cost about $15 on eBay. I've got unfortunate feet from past injuries, so time will tell if the weight loss will enable me to wear some kind of heels again.

You've gotten a lot of tough love here, and while I may wonder at the manner in which your psychologist delivered the message, there are some hard truths to face before you make your decision. But here's the most telling from my POV. You are 34 years old. You say you have been fighting obesity since you were a teenager. That's roughly half your life. if you decide that WLS surgery is a good option for you, what you then have to look forward to is having a healthier life for many, many decades. I say this because I'm in my 60's. I have been fighting the notion of surgery for more than five years while at the same time working with individuals who are on the surgical journey. I've read countless reports from Registered Dieticians, Psychologists, primary physicians, and surgeons. Only a very few of those clients had any kind of complications after surgery. All would do it again. All had tried over and over again to lose weight without surgery. All failed to maintain their weight loss without having surgery, despite multiple and very sincere efforts on their part. Having made the decision to have surgery myself, I wish so badly that there had been a way to treat my obesity successfully and definitively when I was your age. I don't know necessarily that I would have been happier or had a better life (I'm well and truly blessed), but I'm now staring down the last third of my life knowing the damage that decades of obesity have done to the only body I have. I won't ever get those healthier years back. One final note for you, and that's about your "I'm a rebel" comment. I get it, I'm kind of a rebel myself. Tell me I can't do something, and I tend to see that as a challenge. One thing that is absolute where surgery is concerned: rebellion needs to be able to come off the table in terms of pre and postop directives. I only mention this because it's something that is part of my preop self-reeducation. Good luck with whatever you decide.

The policy change is for H M O, and does not apply to P P O so far as I know.

Sigh. People who answer 800 numbers aren't paid to think. And Bariatric Pal asterisks out "***", which is why I spelled it out in my post. Let me say this again: Blue Shield of CA for Health Maintenance Organization members follows the policy I linked above. period, no matter WHAT anyone answering an 800# says. I don't blame you for being confused, since Blue Shield's member services staff are. Here is how you do this. You make an appointment with your PCP. Take a copy of the Blue Shield policy (not the whole 48 pages, just the first four will do). Talk to your PCP about a referral to a bariatric surgeon. make sure the surgeon gets a copy of the policy (though mine didn't believe me when I sent it to them, hence my Grievance with Blue Shield). You have to get a referral to see the surgeon. Make an appointment with the surgeon. Some surgeon's offices want you to see an RD and a psychologist first before they will see you. this is where you explain again that your health plan criteria don't require these before consulting with a surgeon (surgeon may want you to have them, but you can certainly see the surgeon first) IF surgeon's office won't see you without these two visits despite Blue Shield's policy, call Blue Shield and file a Grievance. Blue Shield will overturn the decision not to see you first, because Blue Shield requires their delegated medical groups to follow Blue Shield's policy. Work with your surgeon's office to complete any required preop testing and diagnostic work. My surgeon wants the RD and Psych visits, a sleep study (which means a referral to a pulmonologist) , an upper GI (for which I just needed an MD order from the surgeon) and an EGD (which means referral to a GI specialist from the surgeon). Expect to wait for all this to be accomplished. I had to wait nearly a month just for an initial appointment with the GI doc, for example. I don't know how long it will take after I see her to get the EGD done. I hope this helps!

Contact your health plan and request a copy of their criteria for revision of bariatric surgery - this is key, because most health plans have different criteria for revision than initial surgery. Hope this helps!

Blue Shield does NOT require six months any longer for their Health Maintenance Organization members. They changed their policy effective 7/31/15. Here is a link to their medical policy index. own to the "B's and you see bariatric surgery. https://www.blueshieldca.com/provider/authorizations/clinical-policies/medical-procedures/policy.sp Link to the policy itself: https://www.blueshieldca.com/provider/content_assets/documents/download/public/bscpolicy/Bariatric_Surgery.pdf And the section concerning patient selection criteria: Patients should have documented failure to respond to conservative measures for weight reduction prior to consideration of bariatric surgery, and these attempts should be reviewed by the practitioner prior to seeking approval for the surgical procedure (e.g., Weight Watchers, Jenny Craig, Optifast, MediFast). The timing, intensity and duration of the preoperative timeframe should be individualized and left to the discretion of the patient and provider. However, given the elective and life changing nature of these procedures, and the necessity of proper education and instruction in the lifestyle changes inherent in both the immediate and long term postoperative management, it is recommended that three months elapse between the initial bariatric consultation and the date of surgery. You need to meet BMI criteria as well, that information is earlier in the policy.

No, it isn't just because of the dumping. Sugar can cause you to crave carbs, and, in addition, your primary need three weeks postop is for enough protein for you to continue to heal.

But you didn't answer what sort of plan you have. Usually CalPERS offers Health Maintenance Organization coverage. If that's what you had, and will continue to have, then so long as you remain with the same medical group, you should be fine. Your insurance company pays for the hospital, your medical group pays your surgeon. So long as Dr. Higa is contracted with your medical group, you shouldn't have a problem. Addtionally, if you have written authorization for your surgery from Blue Shield, you may be able to get Anthem Blue Cross to honor that authorization. Don't panic. This may all work out just fine.

You mentioned CalPERS. What sort of plan were you with, and what sort are you with now? If this is PPO, that's one thing, but if it's HMO, staying with the same medical group ought to work.

I am between my initial and pre-op surgeon visits. Not on a preop diet yet, though the surgeon would like me to lose 5# between the two appts, which are a little over a month apart. I'm not trying to diet, I decided that I was going to allow myself to relax and enjoy the holidays and the foods we usually have at this time of year. I know that's it's likely that I won't enjoy eating some of these foods in the future. So you want to know what happened? I just threw out almost half of a pie I made for Christmas dinner. I didn't have any. Not on Christmas, and not after. I'm not interested. Huz bought my favorite chips for New Year's. I haven't had any. I'm not interested. I have tins of Christmas goodies I made for when the kids were here for Christmas. I haven't had any. I'm not interested. I was completely unaware that somehow I've gotten a brain transplant

Is the NUT at your surgeon's office a Registered Dietician? If not, it's worth spending the $ to find one and meet with them. An RD has a Master's Degree and ceetainly will have better advice than simply "eat 1000 calories". Good heavens, that's appalling.

I think so long as you hit your Protein goals, and meet your Vitamin requirements, you can use whatever products work for you. Premier Protein is often recommended because it's easy to find and many people find they like the taste and texture. Remember that any bariatric center is working with individuals who may not have much education about food and nutrition. They can often be very precriptive for just this reason. Your situation is quite different, you have digestive issues that have meant lots of trial and error for you. You know what works, and what doesn't. Your RD or NUT will certainly work with you on making sure that you don't exacerbate any of your digestive issues. Good luck!

First of all, why would your doc prescribe anything that would impede your weight loss? Second, your body has had major surgery, and it needs to heal. You actually have an increased need for protein while you heal because protein is the stuff that new cells are made of. You can't make protein in your body, and the only stored form is your muscles. Later on, when you have healed enough to eat solid food, you won't get all your protein in the form of shakes. But in the immediate postop period, you can't eat enough food to meet your body's needs.

Your staples will show up on X-ray.

It sounds as though he is resistant to change. You having surgery will mean changes in your life and he doesn't like it, either because he plain doesn't like change, or he doesn't like that you took the initiative and made a decision that will change his life as well as yours. And the notion that sleep apnea is a government conspiracy is just way, way out there. You need to do what is right for your life and your health, whether he likes it or not. And I do not agree that you owe him an apology. Given his reaction, I can understand why you didn't want to put up with this kind of attempted sabotage for the past four months. When two people in a relationship have unhealthy habits in common, once one of them decides to change, it unbalances the relationship. Your husband will either get on board (with time) or he won't. I'm guessing that he overall isn't the supportive type - which is a shame for both of you.

People forget that not so very long ago, people used to smoke everywhere, including in hospitals. I took care of many, many smokers over the years. Many of them did just fine. Others didn't. However, smoking does have a significant negative effect on healing. I really encourage you to continue to work on quitting entirely before your surgery. Use Patches or pills or whatever you have to. Choosing surgery is a significant investment in your health. Quitting smoking will only help your success. Good luck!

Congratulations! Your smile says it all.

Well, first I suggest you start tracking your food and Fluid intake. And I mean track - measure, don't guess. It sounds as though you don't have a clear idea of what you should eat or how much. You should have gotten that preop from your surgeon, NUT, or RD. Second, are you exercising? How much? Third, stop trying to set your bar for success based on this many lbs in that amount of time. Focus on goals you have control over, like whether you exercise a certain number of minutes each week or track your intake X days out of seven.

Go to the Fitbit website, there are help forums there. You did mean "Fitbit", not "Misfit", didn't you? I have a Fitbit Flex, and I sometimes put in in my pocket or inside my bra when I don't want to wear the band.