TX2NC

My request was sent to Anthem on 7/25 and my approval was received on Friday 8/9. I actually think it came in the day before, based on the fact that my surgeon’s office called early in the day. Best of luck!

Hello All, I should be the 1st or 2nd week of September. My surgeon's office called me today to let me know that my insurance approved my revision from lapband to RNY. I go in next week for my "results visit," basically just going over pre and post op instructions and getting my official date. Incredibly, even in my excitement/relief, I managed to remember to ask my case manager how far out the surgeon is booked for surgery since he only operates twice a week. She said that they just booked the last two spots for August, so she would mention to the doc to hold me a spot for the 1st week of September. Fingers crossed for September 6th. Happy to be on the train with everyone.

Hi Revision buddies! Just a bit of backstory: I had a lapband placed back in fall of 2007, so almost 12 years ago. Unfortunately, I have always struggled with my band when it had fluid in it (vomited frequently, inability to eat most proteins, GERD, could not drink anything that wasn't warm or at minimum room temperature.) My band and I officially "broke up" in 2015. All of the difficulties I had been struggling with had gotten so bad that I had developed acute gastritis, and esophageal spasms due to the GERD and persistent vomiting, which resulted in me having to have all of the fluid removed. While the vomiting every time I ate and esophageal spams stopped, the GERD remained and the last 60 pounds I had managed to keep off after my initial loss, rapidly returned. So here we are in 2019, through an unfortunate incident my husband had earlier in the year, our deductible and out of pocket maximum have been met for the year. The window of opportunity for me to finally end 12 years of GERD and struggle with this band is finally open. I found a surgeon I really am confident in and have had an EGD to check for Barret's and see what kind of shape my stomach was in. I was lucky in that my hernia had not returned and I didn't have any ulcers, but he did notice that even with no fluid in my band, that it seems tight, I'm not really sure what that means, but it would explain why I still struggle with most proteins. At my last appointment, we reviewed my EGD and he was sending the letter to the insurance company. Because my revision would be due to band complications, my insurance doesn't require the 6 months of dieting, psyh visit, etc, just a letter from the surgeon showing medical necessity for the revision. Since I have a history of GERD, we have decided that RnY is the best option. The paperwork was probably sent in sometime after July 3rd, my appointment was late afternoon on the 2nd and I can't imagine that they would be able to get the letter done and submitted the same day. And now I wait. UGH! It's the worst. I don't have any idea how long it should take. I've read the boards and for some people, it's taken as little as a single day for approval. and some waited for weeks only to be denied. It's maddening!! Thanks for the vent! TX2NC

Approved! I go in next Thursday to get my official pre/post diet instructions and schedule surgery. We are aiming for the 1st week of September if we can't squeeze me in the last week of August. My DH is going with me to the appointment since he'll be the one helping me post-op. He's excellent at being a caregiver, so I'm not terribly worried on that end. So here we go.😁

So I just got off the phone with Anthem. They did receive the prior-authorization request on 7/25 and they have something like 14 days to review. So it looks like they have until about 8/13 to decide. But at least I know where I am in the process.

You’re right SeattleLady! It’s amazing to me that insurance companies basically bet that we’ll give up. That we won’t continue to fight for our health. I think that’s why I get so peeved when they try to push their “healthy lifestyle alternatives,” plans. They don’t care if we’re healthy, they just want us to pay our premiums and not file claims! Thanks GreenTealael! I have tendencies to have very high expectations of my self regarding follow through. I can be a little hard line with it. Because I can be so stringent with myself, I somehow manage to convince myself that my expectations are probably too high when it comes to others. But you’re absolutely right. I feel like the lack of follow through has wasted the whole month of July. It’s been a week since she called me to get the phone number. I haven’t heard anything, but again I’m worried about calling because in theory they are waiting in the insurance company. Maybe I’ll call the insurance company to make sure they’ve received the prior authorization request. Ahhh! It’s also that whole thing of not wanting to bother people if I’m honest. It’s hard to explain. It’s like as a plus size woman, it’s been sort of constantly in my face that my size is a bother to everyone, airplanes, small office chairs, attribution of every medical problem I’ve had for 25 years being because of my weight, even if it’s completely not related. Almost like because I’m big, I should just stay happy and not raise a fuss because everyone is already being accommodating about my size. Fortunately, I have a therapist to help me work on reprogramming myself and learning to find my healthy voice. In the meantime though, I can at least make a phone call. I know this will all be worth it!

Hi All, So in due diligence, I've been researching protein shakes and drinks. I haven't had surgery yet, but I'm trying to start training myself to drink consistently throughout the day and to start steering away from not eating most days until 2 PM or later. While at Target this weekend, I noticed that they had the Protein 2o in mixed berry and picked some up. They're not half bad actually. They do seem to make my mouth dry when I first take a sip, but I think that's just a matter of getting used to it and I actually enjoy the overall flavor. Back when I had my lapband sx in 2007 pretty much all I had available to me were the milky, overly sweet type of protein shakes and I loathed them after being on liquids for so many weeks pre/post-surgery. So, I am quite encouraged by the juice type drinks. Which leads me to my question. Given that the protein shake market has gotten so much more expansive in the past 12 years, I'm confused by what seems to be 2 different labeled shakes. Some say Protein "meal replacement" like the Bariatricpal protein One and others like Genepro and Syntrax just say protein powder. I've tried reading the labels and I don't see much difference in the two types. Although I will say that I thought it was rather shady of Syntrax to advertise that their protein individual pack will provide 23 grams of protein, only to read the label and see that a serving size is 1/4 of a packet, so you have to multiply everything by 4 to get to 1. the amount of protein they advertise and 2. the actual calories in each pack. So that's my questions Bariatricpal world: is there a difference in meal replacement shakes and the ones just labeled protein powder Which do you use? Also, since you're here, if you've had bypass and you're greater than say 5 months out, how many of you are still drinking protein shakes as a regular part of your diet, even if just one meal, say breakfast. Thanks for your help!

Thanks for getting back with me. It seems like I’ll just have to wait and see what my new stomach will allow me to do. I had a hard time getting my protein in back when I first had my band. They used to make these protein bullets that packed a bunch of protein in about 2oz, and I’ve seen something similar in the store so I can grab a few of those if I get worried. I think I would really like to be able to eat just normally. I mean, not like what normal is now, but just regular, healthy food. Ultimately though, I’ll do whatever I need to to get back into control and make the most of this second chance. Fingers crossed!

Thanks for the clarifications. I’m really not very good at eating during the day. But I know I’ll need the protein to heal and be successful.

Hello All! I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? 😠 So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!