kmorri

Before you go that route you'd probably be better off to go self-pay.....You should for sure do what someone else suggested and check out Obesity Action Coalition website they have information that can help you submit your own appeal.....you really don't need a lawyer for that..... I retired from BCBS of Florida. An appeal is not difficult but you do have to have all your ducks in a row. You have to focus on providing them information that proves you meet their criteria......and remember the fact that someone at the doctor's office didn't tell you about a requirement won't matter to the insurance company.....just focus on providing information showing them you do (Use their denial letter as an outline of the requirements you need to prove)......if there's a requirement they have that you don't qualify for write a very compelling letting outlining the reasons you need this surgery so badly........if there are requirements you absolutely don't meet the chances of you being approved are not very good and a lawyer won't make a difference.....But if I were in your shoes I certainly wouldn't give up without doing the appeal myself. Good luck to you!!!

@@OBXhappy How about a GYN....do you have 5 years of history with recorded weights with your GYN?......If you have the history with your GYN then provide that info to the surgeon and ask if he would do the peer to peer with that.

@@mmazzo Yes there seems to be a big difference in pre-op requirements between surgeons. With most any diet after the first 4 days it gets easier. Good luck!

This might date me, but that's what Barney Fife did! He had to pass a weigh in so he wore a heavy metal link chain under his shirt lol!! Scuba diving weights in your pockets...LOL

If you can't get any information from the surgeon's office you can google "bariatric pre op diet" and probably get "general" guidelines. Good luck to you. @@lupita19

wow that's crazy if you're scheduled for surgery on 5/9 but they haven't given you any information regarding what you should do during your pre-op phase.......just wow.

Pre-op guidelines are totally based on your surgeon. You will need to get their specific guidelines directly from them.

How exciting!!!.......wonder what my hubby will think about me dating again...hahaha Just kidding!

Have you tried checking in the Self pay and Mexico forum on this site? You'll probably have better luck there. Good luck! http://www.bariatricpal.com/forum/486-mexico-self-pay-gastric-sleeve-surgery/

@@hijynx yes same for me regarding Vitamins......just not the Protein drinks. My doc doesn't want me to be on protein drinks once I get to the real food stage. He wants me to get my protein from real food....but like I said that's a ways off and I plan on just taking it a day at a time.

Like kmorri I use unjury and nectre brands bought in the dr. office. My doc seems very strict compared to some of the post I read here. We weren't given an outside option, even told us how much money we'd need prior to this stage. Honestly took the guesswork out of it Sent from my SM-N900T using the BariatricPal App I ordered mine online and I didn't find Unjury to be anymore expensive then any other brand that met my surgeon's requirements......Also, my surgeon wants you to get off Protein drinks once you get into the "real" food stage. ....that may be difficult but we shall see. one step at a time!!

What I've heard is if when they first start the surgery, and get the first look at your liver and if it's too big, the surgeon may decide that surgery is too risky and may decide to not take the risk and cancel the surgery. I don't know how often that happens but that is surely not a risk I want to take. After all the time and effort I have in preparing for this surgery I'm going to be doing everything my surgeon tells me to do regarding pre-op....... Luckily my 2 week pre-op diet sounds pretty simple to me (I haven't started it yet)....Mine is one Protein drink and two small "lean and green" meals per day.... the lean and green meal will consist of a lean meat like chicken or fish and a non-starchy veggie. So at least I'll be able to have some real food.

I'm a 57 year old grandma of 6!!! My surgery will be in May and I can't wait!

I like equal best.....I've used Stevia before and it doesn't seem sweet enough for me....I had to use more of it. Funny how everyone's tastes are different.

@@tiffanymarie6997 Glad to hear you're starting to feel a little better. I haven't had my surgery yet, but from what I've seen on this site from folks who have, it gets better each day.......Hang in there and walk as much as you can..,,,,and when you can't rest. Keep us updated.

My Protein shake guidelines also said to make sure it doesn't say "protein concentrate, hydrolyzed Gelatin, or collagen protein" anywhere on the list of ingredients. ....this requirement is what keeps me from being able to use the Premier brand. I use the unjury brand

My suggestion is to contact your insurance company and ask what the medical criteria for coverage is.....you can sometimes even find the information on their website. But rather than not knowing you should call them. You don't want to jump through a bunch of hoops and spend a lot of money only to find out in the end you don't qualify...Good Luck

I don't understand and I'm a little confused.....you said they say you're approved in this post.....approved by your insurance? But here you say you're worried your bmi isn't high enough.....so are you not approved? The normal process is you see the surgeon.....they do an initial evaluation. If they believe you'll meet the insurance requirements they coordinate all the the required testing and educational classes required.....and when all that's completed then they submit all your paperwork to the insurance for approval. Has any of that been done?

Congrats!!! My auth request will be sent to my insurance next Tuesday. ....I can't wait to get a real date so I can start my count down!

@@tiffanymarie6997 I'm glad you called them. I'm sure being able to keep your pain meds down will make you feel a little better.....at this stage focus more on Water than Protein.....once you can keep the water down then worry about the protein. Take care!!!

@@tiffanymarie6997 I'm so glad to hear from you! I was getting worried. I'm so sorry you're having a hard time it sounds awful. If you're not able to keep anything down you probably need to call your doc. I'll keep you in my thoughts.

Has anyone heard from Tiffany? Her surgery was Monday and I haven't seen here online since then....I'm just wondering how she is doing.

If I were you I would drive over there and stand and watch someone send what needs to be sent.... You're paying them a lot of money.....they work for you!!

I'm not post surgery yet and don't use a cpap....but my husband does. My guess would be dehydration maybe? are you getting all your fluids in?

So I found this statement on the IL department of insurance website...each state has different rules so since you live in IL this would be for you....Your "exchange" policy is an individual policy and your work policy is a group policy, so the way I read this is they don't have to coordinate with each other.....(COB means Coordination of Benefits) NOTE: Individual health insurance policies do not have to comply with the COB rules. Those policies may have special provisions in place if you have more than one policy. You should review your individual health insurance policy to see how it pays if other insurance is involved. Here's a link to the document as well. http://insurance2.illinois.gov/healthinsurance/coord_benefits.asp for some reason the link isn't working....if you copy and past the link in your browser rather than just clicking on it it should work...