elforman

Just because the surgeon is in network does not automatically imply that your new coverage will include bariatric surgery. I strongly suggest that you consult your HR/benefits team to ensure that bariatric surgery and weight loss services are not excluded in the new policy. On the right side, there are times when one company will continue to cover you for a procedure like this that is already underway so that you do not experience an interruption in treatment. This may not qualify because those arrangements are usually reserved for treatment of severe injuries or pregnancy, but it never hurts to ask.

That's a standard term to mean that the insurance company believes you're worth spending the money on. Mostly they want to make sure that your risk of recidivism is low, that you know what you're getting into and how to take care of yourself post-op. That's why there's a psychiatric exam requirement before you can be approved. Most people do just fine with that, though in some cases the psychiatrist may feel there is some previously undiagnosed or untreated depression that could affect your health. There are also other factors, such as if you have other severe medical conditions like advanced cancer, are you likely to actually benefit from WLS? They balance that against the cost of leaving you untreated and instead paying for all of the complications that could arise, such as diabetes. Bottom line is unless you have an extreme situation either physically or mentally, you'll be fine.

Do not go by the billed amount. That's like the sticker price on a car: Nobody ever pays it. You go by what your insurance company says is the allowable amount for the procedure. you need to consider the surgeon, the assistant surgeon (if any), the anesthesiologist, the hospital/surgical center fees, nutritionist, pre-op visit and other things that may pop up. Costs and insurance contract vary throughout the country so the usual total allowable amount at the contracted rate can vary anywhere from $15,000 to $30,000. Use that range to figure out what your share of the coverage will be. If you have an *** it's likely only a one-time flat fee for the surgery and co-pays for each doctor and other visits. If you have a PPO then you're going to be responsible for your deductible amount in full then likely 20% of the allowable amount until you've reached your out of pocket maximum.

@NikaChicky I'm not sure what you mean by MediCal/Partnership. Do you mean one of the situations where a private insurance company like Health Net administers the plan on behalf of the state? Most MediCal recipients are in either a plan like that or what's called a "COH" (County Operated Healthplan). In both cases they are run like any other H-M-O, but because they are the stewards of the public's money, and the members' eligibility can change from month to month, the restrictions and hoops you have to jump through are likely to be a tougher than the standard insurance company protocols. They know that from a financial standpoint it makes more sense to pay for the surgery since it will likely cost less to do that than to treat the diabetes, heart disease and knee replacements that are likely to follow if left untreated. But because the MediCal population is can be transient and unreliable, they will also take extra care to ensure that the member will have a good support system and be able to follow the post-op requirements. And it just so happens that I work for one of the COHs, so if you have any specific questions I'd be happy to help. If it's something I can't answer I've got resources throughout the company who can answer policy questions.

I used to LOVE the children's cherry cough syrup. Then again, it was the early 70's and the children's cough syrup had alcohol back then. I think we also had lawn darts... That was also when we learned I was allergic to alcohol. I'd have a cough and take the cough syrup. Then I'd stop coughing but I'd start sneezing. That never stopped me from drinking as an adult, I just don't drink much, and just as I'll be doing with food after my sleeve, I go for quality over quantity. When you can only have two beers, you don't waste your time with Budweiser...

Now I don’t want to make anyone else jealous, but I just finished my psychiatric evaluation over the phone and it took all of 15 minutes. That’s it. No paperwork. No questionnaires. Done over the phone. No sweat. Granted, this did cost me $400 and it is not covered by my PPO. There was also the option of doing it via skype but since I'd have to do it during work hours and i can't use my company laptop for personal use, so I opted for phone. We arranged for a time for me to call her last week so I called her right on time as planned. She first asked why I was pursuing the surgery. I explained that while my eating has not gotten out of control, my various ailments including a bad back that may require surgery, arthritis in my shoulders and bone spurs in both big toes have made it difficult if not impossible to exercise without pain. I have not been increasing my portion sizes over the last few years as my weight climbed, but without the ability to burn off the excess calories I just kept getting bigger. Next, she asked some medical history questions (I never drink to excess because I’m allergic to alcohol and I’ve never smoked or taken illegal drugs) then asked if I was an emotional eater, a binge eater, a habitual eater or a miscellaneous eater, i.e. problems like portion control, which we’d already covered and I’d already identified myself as being. We went into a little detail about my current eating habits and previous weight loss attempts, which had mostly been successful when I could exercise freely. She asked about the kind of support I’ll have for the surgery and during my recovery at home. I explained that my daughter (who graduates from college this Friday with a BS in psych and a 3.7 GPA, thank you very much) will be taking me to and from the surgery. That’s because when I have it in late May/early June, my wife will still be recovering from knee replacement surgery. So, my kids (my freshman son was nominated by a professor for membership in an honors society that only admits 15 kids from each graduating class at his school, again, thank you very much) will be taking care of both of us. We consider it only a tiny portion of the payback they owe us for putting them through a private college. Finally, she went into a little detail about the required post-surgical changes in habits, such as measuring and logging food and sticking to the prescribed post-surgical plans, and asked if I thought I’d be able to handle. Having read through this board, some FB groups and all the literature I got from the surgeon’s office at my initial consult, I repeated everything back to her chapter and verse to confirm I know exactly what’s expected of me. I also told her that I’m far too cheap to spend all the money on the surgery only to throw it all away with bad habits. She asked if I knew about the types of complications that could arise, so again I referenced this board and the FB groups, explaining I’ve learned a lot about the types of problems that come up most frequently. She asked if I had any fear of the surgery and I said I’ve had many surgeries in my life, so I’m not afraid of it, plus I know that for each person who complains about a post-surgical ailment, there are probably fifty who do not have that problem so the odds are clearly in favor of not having complications. That was pretty much it. She said the approval will be on its way to my surgeon by the end of the day. I gave her my email address so she could send me some literature she likes to send all of her patients and her contact information in case I had any further questions. I am not kidding when I say it took me twice as long to write this as the phone call itself. With this and my endoscopy both out of the way, all I’ve got left before submitting for approval is my final visit with the nutritionist and the pre-op visit with my PCP who’ll also take care of my chest x-ray and EKG. The only real problem between now and the surgery is avoiding the temptation of pigging out at my daughter's graduation party...

I'm relieved to see this. I was beginning to think it was just me.

This is a Powerade sale status update alert!!! They're $0.49 for the 32oz bottles starting today at Ralphs markets when you buy eight or more. (For those outside of Ralphs' territory in California, Ralphs is part of the Kroger chain but I don't know if the price will be good at all stores in the chain.) Also, I went to Stater Bros yesterday to get it there while it was $0.49 and of course they were sold out, so I got a rain check for 25 bottles.

So what are the options here? Your co-workers are either blind, oblivious, don't care or they're just messing with you. In any event, you should have some fun with it because there will reach a point where somebody will notice and ask if you're lost weight, then you should just deny it. Tell them it's a new haircut or new clothes. Just mess with them.

The bottom line is that they don't have to understand, you just need them accept it. You're a grown woman who can make her own decisions. You can also assure them that the surgeons and insurance companies both have multiple safeguards in place, most notably the psychiatric exam requirement, that are designed to ensure that you are a good candidate for the surgery and that you understand what the surgery entails and how it will change your life. I've got two college age kids and on more than a few occasions I've not understood their thinking on some of their decision. So I'll voice my concerns, then tell them that I trust them to consider my advice and that I trust them to make the proper decision for themselves even if I disagree with them. As a parent, the way I know that I'm getting through to them and they're realizing they're in the wrong is that they get emotional. When they stay calm I know they've thought it through. So my advice is that if you find yourself in a disagreement or faced with a lack of support, stay calm and resolute. Go in prepared with all of your facts and research, but also listen to what they have to say and if what they say doesn't sound fact-based, ask them for proof of their claim.

Remember that taste is very subjective. Personally I find the grape flavor, well, to be honest, vomit inducing. And unfortunately I haven't been able to find the strawberry in my area, so my rankings would be: 1. Fruit punch 2. Orange 3. Mixed berry 4. Strawberry (even not having tasted it I'm assuming it's better than the grape) 6,342,198. Grape

If mine had gone like that I'd demand $390 of my $400 back.

I wish i could get my triglycerides down to 343. They're usually over 400 and have, at times, been so high the machine can't calculate it properly. In my case it's not related to a particular condition, it's just genetic. Admittedly, as a guy I'm not worried about my chances of getting pregnant. I take statins every day and haven't spoken to my doctor yet about what to do about them before and after surgery,, but we'll cover that soon. The worst part is that they normally prescribe large doses of niacin in addition to the statins, but I'm allergic to niacin, so that's out.

This is one of those times where I'm happy to have both a very small family and live in a big area full of strangers. I'm not in regular contact with anyone on my side of the family and there's no need to tell anyone on my wife's side, so it's only my wife and two college age kids plus two close friends who'll know. My wife may tell some of her friends and co-workers but their opinions and input mean absolutely nothing to me. If she puts it on Facebook though, there will be consequences. The actual fun I'm going to have is trying to keep it from my co-workers, not because I don't want them to know but just to see how long it'll take until they figure it out on their own. They're a smart bunch and since I won't be having the surgery until late May or early June, I've just been telling them that I'm on a medically supervised diet due to stomach issues, which is technically accurate. When I have the surgery I'll just say that I'm having a surgical procedure to fix some stomach issue but I'd rather not go into specifics so as not to disgust anyone.

Thanks for the heads-up. I never think of SB because I live in the San Fernando Valley and I don't think there's ever been one with ten miles of me. But they opened one in Simi a couple of years ago that's on my way home from work that I always forget about. I like their store except for when I don't have half an hour to wait at the meat counter for service. I presume you live in the greater SoCal area as well, so if SB doesn't have a good price on the Zero, check Smart & Final. They have frequently it on sale for $0.49 or $0.59.

I'm still pre-op, but I used to get muscle cramps in random places head to toe so six months ago so I started drinking a 32oz bottle of powerade zero each morning on my drive into work, replacing my first cup of coffee. Once I get to work I have one cup of coffee, so I've halved my caffeine intake. Then I fill the empty powerade bottle twice with water to drink throughout the day so I get 96oz of liquid before I even get home and I hardly ever cramp up any more. Now if only I could convince my boss to move my desk closer to the restroom... (FYI, I also started taking potassium supplements to help with the cramps.)

You can rest assured that any product that would hire Gilbert Gottfried as a commercial spokesman is going to be of the highest quality. (Actually, on his podcast this week, Gottfried and his co-host admitted that neither had actually tried it yet.)

@evgirlYou'll need to refer back to your policy or call UHC's customer service center and ask them. Each insurance company sells many different plans with different coverage levels, deductible and out-of-pocket maximums. And more importantly, presuming you get your insurance through an employer, it's the employer the decides what is covered by your plan and what your share of cost is. Many employers omit bariatric surgery coverage from their policies to save money, so at least that doesn't seem to be the case with you. A lot of people start the process only to find out that weight loss services are excluded from their policies in the small print. So if you discover you've got a high deductible and high out of pocket, remember it's your employer's fault, not the insurance company.

I suppose I'm lucky in that I haven't thrown away clothes in about seven years so I still have everything from when I was at my thinnest then through my heaviest two months ago. Then again, I'm a guy so we're not talking about that many clothes. However, once I get under 200 I will buy myself a new suit.

If you're a Costco member, the Kirkland brand protein bars are great nutritionally, they taste great and you can't beat the price. Online shows 19.99 for 20 but they're cheaper in the stores by a few bucks. Under 200 calories, 3g or 4g net carbs, 21g protein. https://www.costco.com/Kirkland-Signature-Protein-Bars-Variety-Pack-2.12-Oz,-20-count.product.100296198.html

Sorry, I'm not a "community" kind of guy. I'm the kind of guy who makes a decision and sticks with it, I don't need cheerleaders or support from anyone but my wife, nor am I the type to go into detail about my "journey". I value my privacy which is why you'll never see a before or after picture of me either. I'm happy to come here to learn a few things and offer common sense advice, which often runs counter to the advice offered my many here. Think Ron Swanson but with a doctorate in sarcasm and without the outdoor and survival skills...

Sounds like a laudable goal. However, bear in mind the most common reason so many more women have WLS than men is that so many men have the "I don't need anyone's help" mindset. It is hard for a lot of men to admit they need help in the first place and even harder to accept it. It's the same reason more women seek help from mental health professionals. Once you can get more men to accept that there's no shame in asking for help, half your battle will be won.

Just call your primary care doctor. There are so many things that could be causing mood swings that any advice you get here is just going to be wild guesswork based solely on bits of information you provide. It could be some body chemistry issue like a hormonal imbalance or it could be a purely psychological issue, but only your doctor is going to be able to do a complete assessment.

When things like this would happen, my mother used to say "Everything happens for a reason" or "That must be how god wanted it." She died 22 years ago and while I still miss her, I do not miss her saying stupid **** like that. She dealt with everything on an emotional and spiritual level. But you know what? Sometimes **** happens, and it can hurt, but you just have to deal with it and move on. After being raised with stuff like that I taught my kids that when something bad happens, go ahead and let yourself experience the emotions you're feeling, but do it quickly then put them aside and address the problem immediately and with a clear head. There's always plenty of time to get emotional later.

Serious question: Is your husband too incompetent to cook himself? Or is it machismo crap? It's 2018, not 1954, and he should be able to cook for the family, not just order take out. Send him to a cooking class, or have him watch youtube videos. It's not rocket science.