MommyTawnie

I started my 3 months of charted dieting and exercising in June.. I have had my pych eval done, and just completed my 3 months charting with my doctor. I meet with the dietician on Monday and go from there to meet with a new surgeon. I am worried about the submiting part. Not because I have done what I was told, but because the new office informed me that my exercise was suppose to be charted by a professional.. My first question for the lady was "what do you mean a professional" then it turned to "isn't a doctor considered a professional" I mean come on I would rather exercise under the care of my doctor then a trainer at the gym. I feel they are going to take my health more serious then a trainer I pay to help me loose weight. I just worry that insurance isn't going to take the exercise regimin from my doctor and deny it bassed on the exercise part. Has this happened to anyone going through insurance? If so what is something I can do to insure my approval is granted? I started this long journey back in March, but had to put it to the back burner when health problems came up and surgery was needed.. But since June I have stuck with it and have done all that I can to insure nothing is missed. I went by what the surgeons office told me. My husband and I are switching insurance in January and we are not sure if the new insurance will cover WLS. So I wanted to do what I could to get it done this year. Are my worries for nothing?

I was chating with my consultant lady the other day over the phone kind of touching base on where I am in my journey to surgery. I was explaining to her that I had to restart my 3 months due to a surgery that came out of no where and not being able to get to the gym. Going on to explain that even though I was unable to get to the gym I was able to loose 8lbs by myself from March-June with just the diet and exercise plan my doctor put me on for the 3 months charting. I was pretty dang proud of myself for loosing the 8lbs yes it may have taken 3 months to get that 8lbs off, but it was off wasn't it. Her next response hit me in the gut and made me a bit angry. She informed me that if I loose more then 4lbs a month insurance won't pay for my surgery, because they will feel I can do it on my own. Hello woman I just lost almost 3lbs a month so I am pretty sure I am safe of the 4lb mark. And anyways aren't we suppose to loose weight during the 3 month period just to show we are willing to stick it out and do it no matter what the amount of weight loss a month is? From June-July I only lost 2lbs. Starting to get back to the part of the diet that always shows up the brick wall. I just hope I can manage to loose atleast a pound between now and August. Has anyone of you been told this same thing? Is there truth behind it? :cool:

I have met with a weight loss surgeon back on the 1st of March. I was set and ready to use him, but the farther I get into the process the more I realize they are not helping me with any of it. I am doing it all myself and doctors are limited for in-network with Aetna. I have an appoinment on Monday with a surgeon for a different surgery, but have found out that he does the bariatric surgery as well. So now I am considering switching and going with him for this journey to a new healthier me. They have everyone in there office that is needed through each step. Plus they are ALL covered through my insurance. Am I making a better choice going with someone that is local? I feel I am for the simple reason if something happens during the first few months after the band is placed I won't have to make an emergancy trip to Houston 1 1/2 hours away. All of my fills can be here in town, and it makes for an easier journey. Am I wrong for wanting to switch doctors? Is it going to mess up anything with insurance? And what about the pysh eval I had done is that something I can have sent to the new doctor? I meet with the doctor on Monday like I said for a seperate surgery, but I will be asking him these questions as well. I want was easiest and best for me along the way. :tt1:

Thank You all for the replies you have left. I never try to bring myself down "only up in spirits" I catch myself all the time writing things down on notes and posting them throughout the house example "I will control my portions!!" or the "Goal of the day burn 500 calories" sometimes it's more, but the 500 I stick with is my goal everyday. I have lost 4 lbs from the date I weighed in with the weight loss surgeon, and I AM PROUD!! I will be happy no matter what the out come simply because I am doing this for a happy healthier ME!

I was sitting here thinking to myself last night "I don't remember what I looked like when I was (skinny)" I have searched and searched through pictures and cannot find a single one of me prebaby/preweight gain. I was a little over weight when I got pregnant "145-160 depending on the day or the week at 5'3" The one picture I can find has me hiding my size with an over large coat. So then the panic started to kick in. If I don't like the road I am on now what makes me think I am going to enjoy the new journey? And then it hit me I'm not doing this so I can be skinny. I am doing this for my health, and for my children. I want to watch them grow up. I want to enjoy life more. I want to feel free to swing on the swings with them, and run and chase them. I want to be happy and HEALTHY. Never mind what I will look like after I loose weight. As long as my health is better I will take what I can get. If by some crazy reason the band doesn't work for me I can live life knowing I tried. My name is Tayna I stand 5'3" tall and I weigh in at 248 my bmi is 43.3. I have to beautiful active children and I hope to one day be able to stand outside and play with them, and know that I have no limits. Sorry all just my thought of the day.

My surgery is scheduled for 8/9/10. I feel like something is wrong though. I went for my first and only appt and they scheduled the date at the end. They set me up for all my pre work right then and there. At first I assumed that I was approved for everything but as I read more I feel like it can't be that easy.

Are you self pay or will you be going through insurance? If you are self pay then I suppose it could be that easy, but insurance no way. There are diets and things you have to complete before insurance will even consider approving the surgery. Like I said before with my insurance it takes 3 months of charted dieting and exercise along with a dietician and a pysh evaluation before they send in for approval through the insurance. With out these things being completed I will not get approved. I would contact the office again and start asking more questions. Did they set you up with a case worker? The office I am going through assigned me a case worker the day I went in for my consult. She is the one that is helping me along the way with appoinments and insurance. Best of Luck to you!:cursing:

Well I'm not quiet sure when the surgery would be, but I do know it's looking like maybe July/August my insurance requires a 3 months charted diet program before even considering approval. I am in month 1 month 3 will be June then request for approval cross my fingers it goes smoothly. Everyone I have seen or talked to that has the same insurance "Aetna" has said theirs was approved with the first letter. I am hoping for the same we are aiming for July to be a the surgery month, but it could be August. Best of Luck to all on the journey to a happier healthier you..:scared2:

Congrats to you. I sure hope it's that quick with me. I am still in month 1 though so maybe by July. Fingers crossed.. :frown:

I am in the first month of my insurances coverage process. I have Aetna and with our insurance they require you to have atleast a 2 year history of being obese along with a bmi of 40 or higher with no comorbidity. Or 35 or higher with comorbidities. Along with this I have to have a 3 month charted weight and diet plan with my doctors office. I have to meet with a pyschologist "I have already done" and meet with a dietician "doing so next week". The best thing I can offer you is telling you to contact your insurance company and see what your plan covers and what steps you need to take to get approved. Go ahead and meet with the doctor his office will help with the insurance part and seeing what you need to do if you want to do it all through them. Don't be afraid to call your insurance company and ask questions. I did everything and set everything up myself before I ever met with the surgeon. I wanted to speed things up as much as I could on my end. Best of Luck to you as of now with your hight and weight you are at the required bmi with no comorbidities.

Well after seeing pictures of me at our family Christmas this past year. I realized I was larger then I thought I was hitting the scales at a big fat 255. I was never "fat" as a child, and never really had weight issues as a teen "other then the normal pick on your self" I was a fit and active 140 lbs at the age of 20. Then I became pregnant with my daughter and boom the weight started adding up. I realize you gain weight during pregnancy, but I gained a total of 95 lbs in 8 months. My prengnacy was a high risk pregnancy and I was on bedrest pretty much the first 5 months. After her birth I started back with daily walks, and workouts at home. But it was doing nothing for me. The weight had made the decision to stick around. Then the excuses started well she's only 3 months it can take up to a year to loose baby weight. Then 9 months hit and I told my husband the same thing. After new years 07 we started a hard core low carb diet loosing 28 lbs in the first month. I was thrilled the weight was coming off so quickly. Then I became pregnant with our son. After his birth and 30 lbs later I was right back where I started 240lbs. It was devestating to know I worked so hard to get what weight I could off just to have it come back. Don't get me wrong I was thrilled to have our son, but the weight why couldn't it just fade away? I tried everydiet out there to the point of drinking the Apple Cider Vinager "Nasty Nasty Nast" nothing was working. Finally I decided I wasn't that big, and I would be ok. Besides I just had a baby a few months before I was fine. Then he turned 1 and the weight was still there. I realized I had to try to get it off. I started diet pills and working out, but it just wasn't going away. This past Christmas when I seen a real picture of me from my daughter's point of view I realized I have to change my life. I have to loose this weight, and if diets aren't going to work for me then I have to move to the next step. Going through our plan coverage I realized "AETNA COVERS WEIGHT LOSS SURGERY" I called Aetna that day just to confirm what I had just read, and ask what the first step was for the surgery. The lady "her name was Carol" gave me the name and number of a weight loss surgeon in my area that took my insurance, and that I could go through them to figure out my next steps. As soon as I hung up I was making the next call setting up my appointment for a consultation. I went in on March 1st and met with Dr. Felix Spiegel he explaned to me what would happen during in surgery, and the diet to follow after the surgery. They set me up with a case worker to get the insurance verified, and get me on my way. 2 days later she called to tell me insurance will cover the surgery, but I have to follow the steps to get it approved. step 1. 3 months of a charted diet/exercise program through my pcp

step 2. meet with a dietician

step 3. meet with a pyschologist for the pysch eval.

I meet with my doctor on the 9th to start charting my weight. I joined a gym 4 weeks ago. I meet with the pyschcologist on the 10th and the dietician the following week.

I am excited about the journey ahead. I look forward to the day when I can run and play with my children without getting out of breath. I can't wait to walk into a room and no longer feel like I am the fatiest person around, or looking for someone fatter then me so I can feel better about the way I look. Aetna has been wonderful helping me find doctors that take the insurance. I can't wait for June to get here so we can send off our request for approval. Please keep me in your thoughts as I go through this and I will post as I find out what's next..:smile2:

I have been open about this subject from the day I made the decision to look into it and do my research. But after meeting with the doctor on the 1st I decided that I wanted to keep the official decision to myself "my husband knows of course". Yes my family knows that I was looking into it, but they do not know that I have officially decided to take that journey. I know they would be supportive of my decision, but I want this to be about me, and me alone. I live far away from my parents, and have not gotten to see them in over a year. I want them to see me as a happy person again the way things are looking now the surgery will be somewhere in July or August. We have a family event at the end of August, and yes I will more then likely tell everyone at that time that I had made my decision and was past the surgery. I don't need to hear an opinion from everyone. I want them to know this was me and only me that made this choice.