CaliRey95

Unfortunately I wasn't able to be sleeved on May 1st as my insurance chose to deny the day before. They want me to do another three months, noting that I have followed the program and lost weight prior. So it looks like I'll be in July/September.

Getting so nervous, my insurance now has all of my documents for my appeal. Surgery is still scheduled for May 1st. I pre-registered at the hospital today and signed all of the forms and they walked me through the entire process when I arrive at 7 am next week. They will be starting immediately! I also have a mild hiatal hernia that the surgeon will be repairing during the surgery. Fingers crossed that everything goes through, everyone at the insurance company knows me and my situation now so when I call the already know. When I spoke to the rep yesterday they said the appals department has reviewed my paperwork and were just waiting to see the supporting documents. Which they received yesterday.

I'm guessing they're relatively new, because I hadn't seen them when I initially bought my protein shakes. I got them from Walmart in the vitamin and health section. They were actually all sold out except the two cases I bought.

Beginning to get pretty frustrated. My insurance gives two options, 3 month program or 6 months program. Both have a different set of requirements. I completed the three month program, my insurance covered most of the procedures and I chose to pay out of pocket for nutritionist and Psychologist, about 400 total. What they're telling me is that it has to be 6 months and to disregard what my policy says. Any advice? Btw, surgery is scheduled May 1, and I start the liquid diet tomorrow.

Well yes and no, my insurance says yes there is a 90 day program and if you followed everything, it depends on the doctor's notes entirely. They said it should get approved as long as my doctor outlines that I've complied and they believe the surgery is medically necessary. They said if the doctor just provides a summary, that is not sufficient evidence for medical necessity with the 90 day program. I'm currently having this argument with my doctor, she doesn't feel like typing out notes for each of our visits.

So glad things worked out hopeful! This liquid diet has been tough and it's only day 3 of 14. Doesn't help that I've gotten the flu. I'm still so grateful for the opportunity. Also, these waters are AMAZING when you need a break from protein shakes.

I definitely like the quest more than the whey powder I have at home, it's more of a light flavor. I also mixed it with water instead of almost milk, last time that combination gave me horrible bloating and stomach pain. But so far so good. Thanks for the heads up about isopure, I may be open to it post-op. I'm curious about the Syntrax as well, will definitely consider trying it.

I was also told during my upper GI that I have duodenitis. I can't really remember exact details because I had just woken up. But they did tell me they didn't want me taking medication for it as the surgeon would take care of everything and prescribe something after surgery if it's needed still. But definitely scary on the second part for you, I'd be trying to speak with the anesthesiologist. I know during my upper GI I told him I had scoliosis so I can't lay straight back and they let me sit in a 45 degree angle during that.

4 minutes ago, melmssc said: I got some individual protein powders from the GNC to see what tastes best, right now I'm drinking Quest Protein Powder; I got vanilla, strawberry, and cinnamon. And at home I have weigh powder, strawberry flavored as well as some meal replacement drinks my nutritionist recommended, I'll check the label for the name when I get home. I'm not sure if I'm going to try the isopure.

My surgeon still wants me to start the liquid diet today, he's insisting. They're saying it will most likely be approved since they're also providing every piece of documentation that was missing. And they just sent my chart over to the hospital for pre-registration next week. We'll see how this turns out!!

Good luck to all you of starting your liquid diet today! You can do it!

My BMI is 43 and I'm prediabetic. She just kept insisting that my insurance will most likely deny it and we'll just reschedule. I'm not sure why she is so negative with me.

Well my doctor's office really screwed me over. Come to find out they submitted for approval "by accident" in April and it was denied because I hadn't even completed all of the steps. Although I've spoken to insurance and they assured me they could just resubmit this week, now they've said we have to wait 40 more days. At this point I'm just going to appeal and submit all of my documents with the appeal letter. My surgical coordinator is very negative and she's insisting that we shouldn't even try to appeal and just wait until May, to resubmit. I told her that would mean I have to do 50% of the stuff all over again. She thinks that's the better idea and says she knew it would get denied regardless.

Here is a copy and paste of my policy stating the three month requirements: Multi-disciplinary surgical preparatory regimen: Proximate to the time of surgery (within 6 months prior to surgery), member must participate in organized multi-disciplinary surgical preparatory regimen of at least 3 months (90 days) duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member’s ability to comply with post-operative medical care and dietary restrictions: Behavior modification program supervised by qualified professional; and Consultation with a dietitian or nutritionist; and Documentation in the medical record of the member’s participation in the multi-disciplinary surgical preparatory regimen at each visit. (A physician’s summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician’s initial assessment of the member, and the physician’s assessment of the member’s progress at the completion of the multi-disciplinary surgical preparatory regimen.); and Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and Program must have a substantial face-to-face component (must not be entirely delivered remotely); and Reduced-calorie diet program supervised by dietitian or nutritionist

Beginning to get pretty frustrated. My insurance gives two options, 3 month program or 6 months program. Both have a different set of requirements. I completed the three month program, my insurance covered most of the procedures and I chose to pay out of pocket for nutritionist and Psychologist, about 400 total. What they're telling me is that it has to be 6 months and to disregard what my policy says. Any advice? Btw, surgery is scheduled May 1, and I start the liquid diet tomorrow.

My liquid diet starts on Tuesday, ND I've definitely had some food funerals. I've lost 16 pounds on the pre-op diet and I'm pretty sure I gained back 5 in the last week. Surprisingly I couldn't even eat most of it, my mindset is already different and ready for the new lifestyle. I'm hoping for approval, my paperwork was submitted to insurance Friday. And they want me to stick to schedule. I'll be so upset if I'm a week into the liquid diet and it's denied!

Hello everyone, I'm scheduled to have the gastric sleeve surgery May 1st. It's been a very long process. I started with my primary care physician in October. So it's been roughly 6 months, and I also saw a nutritionist the last three. I've completed every single step in the guidelines. EKG, X-RAY, LABS, Endoscopy, supervised diet 3+ months, psych eval, and weigh ins with PCP for 7 months total. I also have history of obesity since 2015. Starting weight was 256 and current weight is 248. My liquid diet starts 4/17. With that being said, I've spoken to my insurance numerous times over the last week just to get a general idea and they're pretty vague. What are your opinions on my chances of being approved? It was denied once due to lack of documentation. My PCP submitted too soon. Any May Sleevers out there?

My surgery date is May 1st, submitting for approval tomorrow!! So nervous.