Alisa_S
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Everything posted by Alisa_S
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Long whine alert -I'm really disappointed! I saw my primary Dr last month and told her I wanted WLS and she was all for it. Said that I had to do the 6 month supervised diet for my insurance and a boatload of other tests. Ok. I understand.She started my 6 month diet last month and sent a referral to the bariatric surgeon.MY plan was to do the supervised diet, then at the end of the 6 months in January, do all the other tests...sleep study, endoscopy, ekg, psych, nutritionist, etc. because all of that would get my insurance deductible met, then have surgery in February or March. Since my deductible would be met, I'd only be paying my 20% coinsurance by then.Got the call from the bariatric surgeon's office on Friday and was told that THEY are the ones that will do my 6 month supervised diet. I explained that my primary Dr already had me on it for a month but they said everything will go thru them. Ok. I understand.So I explain about wanting to complete the diet first, then do all the other testing (because I don't want to have to pay my deductible twice by paying for all that stuff now, & then it starts over in January) but she tells me that they do the testing while I'm doing the diet. That means that I cannot even start their bariatric program until January!
They made my first appt for Jan 9th & that's when the 6 month diet will start with them & they'll submit to insurance for approval in June & I would have surgery in July. Man!!! That's almost a year from now! 
All because I don't want to pay $4500 now, than have to pay it again in January.
I don't understand why they won't let me diet now & do the other tests at the end.
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Before you assume that the testing will take your full deductible, I would make some calls to your insurance. I have a 3k deductible and my portion of the bloodwork was nowhere close to that even though I assumed it would be. I think my copays ended up being around $1k or less for all the preliminary tests. And remember, you will have extensive bloodwork multiple times after surgery, so there may be no way to get it all into one calendar year. Also, you might look into financing options through your hospital. Mine allowed me to put the $3k I owed after the surgery (because yeah, that did max out my deductible for this year) on a 24-month no-interest payment plan. Depending on your options, it may be affordable enough that you can book your appointment sooner and get this whole thing going instead of having to wait almost a full year to have your surgery.
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I'm not talking just bloodwork tho, Sleep study, EKG, Endoscopy, Nutritionist classes. psych eval, etc. Plus the surgeon consult, monthly weigh in visits for 6 months (he's already mad that we have to drive 2 hours one way for those), & surgery.
My DED is $4500 & my OOP $9000. Hubby will flip out if I have to cover the DED twice.
I'm seriously considering going across the border into Mexico and doing it without insurance. Cash price will probably be less than my $4500 deductible, and I live right on the border in southern Arizona. There's a place in Nogales, Sonora Mexico https://bariatricmednog.com/ just 2 hours down the road.
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Saw my PCP & officially started my 6 month supervised diet 07/26/24. She just told me to eat less carbs & sugar, use the air fryer and not fry my foods in grease, and to try to walk 30 minutes 3 days a week & if I can't do that (and I cannot), to walk 10 minutes daily. Told me to walk fast enough that my heart rate is raised. She didn't give me a number as far as calories though. A year or so ago I was doing low carb/sugar free and keeping my calories at 1800 or below. She said I should up my cals to 2000 at that time, so that's what I'm shooting for now.
Hubby walked with me today. He's in pretty bad shape so I was surprised he wanted to. We walked down the gravel road at a pretty good pace (for us LOL). 10 minutes walking and my heart rate was 115bps according to my Fitbit and 125bps according to his pulsometer. Either way, it was elevated and I was breathing hard. Doesn't sound like a lot, but it's a start. We'll do it again tomorrow. 😁
I should be hearing from the surgeon soon. She said if I didn't, to call him next week. Since I HAVE to do the 6 month diet & that's going to put me into January by the time it's done, I'm hoping the surgeon will let me do all my testing in January. I don't want to do it all now and have my deductible get met, only to have to pay the deductible again in January or February for my surgery. Praying that things go the way I hope. 🙏
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I have an appointment with my PCP tomorrow to let her know that I want bariatric surgery & get a referral for my surgeon. Are there any certain things I should bring up to my Dr? I have no doubt she'll be on board with the surgery. Anything in particular I should say, or ask for? I've been told that I have sleep apnea by other Drs after having gall bladder surgery & colonoscopy, so I will ask for her to get a sleep study scheduled. I just assume I'll need one. I spoke to my insurance, United Healthcare Choice Plus, and was given their list of requirements for approval 😕 & I will provide her with that list. I don't want to forget or miss anything that I should discuss. I appreciate any tips/suggestions. Like everyone else, I just want this to go as quickly & smoothly as possible.
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What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Oh thank you! I didn't think of that and you're really talking me off of a ledge right now! That's what I'll do, knock out the 6 month diet, then have the tests done in January and hopefully surgery soon after! -
What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Nope, she thought it was cool, but that's it. And I just came to a SAD realization! I'll get all this testing done and have to shell out my full deductible for it all $4500, then IF I get scheduled for surgery in January (6 months) I'll have to pay it AGAIN because my deductible will start over. 😭😭😭 Oh my gawd! -
What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Sigh 😩I told her all that & gave her my weight chart from Dec 2022 to present and she still said "Mmmmm....I'm still going to need to see you monthly for 6 months." Then added Sleep study, EDG, and cardiac appt to the 6 month supervised diet with documented failure of weight loss. Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life." Psych eval & Nutritionist counseling that I already have to do. -
What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Sleevetobypass2023 - I've mentioned it a little & I have months and months of weight charts on my Carb Manager account. I used to track all my meals there when I was doing Keto & Low carb. I got tired of tracking all the meals and started just tracking my weight on there a couple times a month. I think I'll print that out and take it to my PCP. Can't hurt I guess. I did hCG diet back in 2010 (too long ago). In the 90's I did fenphen / phenfen - whatever it was, & dang near got a divorce because I got really mean. Tried just the phentermine about 6 years ago & it affected the same (my boss finally asked me if I wanted to work somewhere else-I quit taking it that day). Been fooling with keto or low carb off & on for the last 8 years. sigh. Through it all I just keep losing and gaining the same weight, over & over. Gosh I'm tired of it. WEIGHT LOG.pdf -
What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Thank you! -
What conversation to have with PCP?
Alisa_S replied to Alisa_S's topic in PRE-Operation Weight Loss Surgery Q&A
Yes, it's requirement. 6 month supervised diet with documented failure of weight loss. Documentation supporting the "reasonableness and necessity of a Gastric Restrictive Surgical Service being required, and significant clinical evidence that weight is affecting overall health and is a threat to life." Psych eval Nutritionist counseling sigh -
Sleevetobypass, thank you! I am relearning what I previously knew about bypass.
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Now that I've made the decision to have WLS & am waiting for my appt with my PCP my mind won't shut up! I know my insurance requires a 6 month supervised diet, but what if I lose weight on the diet and my insurance decides that I don't NEED to have WLS to lose weight since I was (theoretically) able to lose weight for this requirement? I was told after a colonoscopy that I have sleep apnea and need to have a sleep study done & that I should really be on a cpap, but what if sleep apnea is a reason to deny me the surgery? I take omeprazole for acid reflux because I have a hiatal hernia. What if that prevents me from having the surgery? What if they just say NO? After making up my mind to do this, I just don't think I could take it. I'll be 60 in Oct & I'm 5' 8" - used to be 5' 9" - & I weigh 338 lbs. On my own I have fooled with hCG diet, keto, low carb, etc, etc, etc for sooooo many years. I lose weight & gain it back. I know what I'm supposed to do, but can't stick with it. I need this. Period.
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Spinoza I really appreciate your input. I'm much more comfortable with the sleeve. I'd rather not rearrange my intestines.
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Oh wow! That sucks! Guess I'll start researching bypass again. I first learned a lot about it probably 15- 20 years ago. Then when the sleeve came out I was all excited. Hopefully the bypass has improved since I first read about it.
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I'm so sorry you went thru all that! Wow! That's a lot to think about. Did you have gerd due to a hiatal hernia? I thought that some surgeons repaired that while they are in there and that would take care of the GERD. Glad to hear you are so much better after the revision.
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I have not talked to a surgeon yet. I have one picked out, but figured I would see my PCP first on 07/19. I'm hoping they will just repair the hiatal hernia. I'd much prefer the sleeve over the bypass.
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Thanks JennyBeez, I guess my concern is not so much my BMI dropping too low, as it is that the insurance will say, "See?? You can lose weight on a diet! Just keep doing what you're doing!"
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After many years, I finally decided to have wls. I made an appointment with my primary care physician to talk to her about it and get set up for a sleep study for sleep apnea. Other than that, I have no idea what I need to do to get the ball rolling. Does anyone have any experience with United Healthcare Choice Plus insurance and using it for wls?
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Made my decision, how to get started?
Alisa_S replied to Alisa_S's topic in Gastric Sleeve Surgery Forums
Thanks! I think my insurance requires 6 months supervised diet, psych eval, and nutritionist too. I do have a surgeon in mind. My PCP appt is the 19th. -
I joined BariatricPal in 2008 & I FINALLY made the descision to have WLS!! I'm so excited & not sure what I need to do to get the ball rolling, but I made an appointment with my PCP for 7/19. It's a start I guess.
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Anyone here know anything about the intragastric balloon? I'd like to hear about it...prices, success rate, problems, & such...
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Pretty much, yeah...
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I found some info on it. It's only good for 6 months & then they have to remove it. You can have another placed if you want. All it is, is something to take up room in your stoumach so you don't eat as much. During that 6 months you'd have to train yourself in healthy foods, and portion control, and excercise and try to continue that after it's removed. It's mainly for people that don't have a high enough BMI for bariatric surgery, or for people that are SO big that they have to lose weight BEFORE surgery. It's just a temporary fix at best, but I was thinking it might be a jumpstart to weightloss. If I could lose 60 lbs or so in 6 months, then I'd be healthy enough to really excercise & hopefully be on the right track with foods... Thanks for replying!
