KabinKitty

Angie, I haven't been on this site since I was denied by BC/BS of Ohio. It's been great to follow your progress, it enforces the hope I have to one day be a healthier happier me. You looked awesome in that little red dress!! If little tiny gals like you and Tiffykins can lose the weight, it gives us gals sho are 5'5" or more alot of hope that we can too! BC/BS is now covering the sleeve in Ohio, so I'm waiting and hoping to hear something this week.............! Congratulations, you look GREAT!!

My surgeon's office called me this week to let me know that they were resubmitting all my information to Anthem. They got an email from Anthem, informing them that they now cover the Sleeve as a stand alone surgery! They usually get word from Anthem within 2 weeks. I asked how far out she was scheduling surgeries and she said she just scheduled the first one for February. It's been a long wait and I had almost given up hope that I would ever get to have surgery. I'M SO HAPPY!!!

Thanks for the good wishes. I'm still waiting to hear anything from the surgeon's office. In 3 days it will be 2 weeks since my paperwork was submitted. Anyone else in Ohio that recently got approved by BC/BS? I would love to hear from you!

Dear Mouse, Obviously I have offended you in some way and that absolutely was NOT my intention. I'm not "that" kind of person. I come on this board and others to most of all learn, support, share my situation (including my personal medical experiences) and to offer help or advice. I hope you will reread my post again in a different light, and realize I was in NO way being critical of you! I have not had my sleeve yet and I don't claim to be an expert. I also intend to use humor to deal with servers after my surgery. I only can imagine that it gets frustrating having to "explain" why you have such a small appetite. My husband are already trying to come up with a game plan on sharing food, and planning what I can order, and how we can handle the situation. Please don't stop posting because of me. I would like to be friends with you. You seem like a very nice person. Now I'm afraid of offering any comments to anyone, for fear of offending them. Can anyone tell me what I did wrong. I'm here to share and learn.

1. I don't think the doctors know as much as they think they do. A few years ago, I lost 72 pounds in six months (and gained all but 3 pounds back but that's a whole 'nother story!). I didn't have hair loss and I didn't suddenly get cold all the time before I had even lost any weight like I do now. This single digit weather is killing me! WHAT DID THE DR'S TELL YOU THAT WAS UNTRUE? I'VE HAD ABOUT 10 SURGERIES AND ONLY HAD HAIR LOSS AFTER THE MOST SERIOUS ONE. THE ANTESTHESIA DID NOT CAUSE ANY HAIR LOSS, EVEN WHEN I HAD GALL BLADDER SUGERY THE OLD FASHIONED WAY, WITH AN 8 INCH INCISION. 2. Cookie cutter dietary recommendations do not work. I can measure my time since surgery in weeks instead of months and have had several stalls and even gained over and over again. I have found that the closer I stay to 1,000 calories, the more and faster I lose. When I try to stick to 600-800, I lose nothing - not weight, not inches. 3. Diabetes doesn't always go away. When I started adding HEALTHY carbs like fruit, dairy and vegetables, my blood sugar went up again. I am back on the oral meds but only one of the insulins once a day. Hopefully this will change when I lose more weight, but I am not holding my breath since my beanpole husband takes a long acting insulin every night and a short acting for every carb he eats (and he eats a LOT of them!). DOESN'T INSULIN USE DEPEND ON WHAT'S CAUSING THE DIABETES AND WHAT YOU EAT? OBVIOUSLY YOUR HUSBAND IS GOING TO NEED TO CONTINUE TO USE ALOT OF INSULIN IF HE CHOOSES TO HEAR ALOT OF CARBS. THE BODY REACTS TO SIMPLE CARBS AS IF YOU WERE EATING PURE SUGAR. 4. You don't necessarily lose weight from the same places each time you lose weight. My boobs and butt are disappearing this time but my gut stubbornly stays the same size! 5. Weighing every day can be a good thing. If I didn't weigh every day, I would never have known what broke my stalls. 6. If you don't want food servers commenting on how much you eat, take small children with you. Nearly everyone at the table shared my potatoes and I shared my granddaughter's fruit yesterday and no one had any idea how much anyone else had eaten. Yesterday was the first time I have been in a restaurant since surgery and I felt completely comfortable and knew exactly what I was eating since I entered it into my phone app. We had Thanksgiving dinner and I was still 200 calories short of my goal at bedtime. So I had a cup of Silk Nog. (mm mm good!) IF AFTER I HAVE SURGERY A SERVER COMMENTS ON MY FOOD CONSUMPTION, I'LL JUST SAY THE FOOD WAS GREAT, I GUESS I SHOULDN'T HAVE EATEN A WHOPPER BEFORE DINNER. LOL And, as I said, your mileage may vary, but this has worked for me. I am not exercising a lot yet until my blood sugar is totally in control but I am doing plenty of housework since I don't have tall enough boots to go tromp outside and play! I THOUGHT EXERCISING HELPED TO LOWER YOUR BLOOD SUGAR.......? I JUST CAN'T WAIT TO HAVE MY SURGERY AND SEE WHAT WORKS FOR ME. I'M SURE EVERYBODY IS DIFFERENT AND LOSES IN DIFFERENT WAYS. GOOD LUCK TO EACH OF YOU!

BC/BS of Ohio just started covering the sleeve as of 11/18/10. My paperwork was recently resubmitted and I'm waiting for my approval. The weight considerations are: 1.BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid conditions. I hope this helps!

Liza, Are you kidding me? You guys will be second to know, after I tell hubby! I read Anthem's webpage over the weekend and it states that the change was actually in effect since November 18th. It's been a long journey since I first called the surgeon's office in March 2010. Like alot of people on these boards I have only shared my surgery secret with 2 people (who basically know nothing about the sleeve). I have felt very lonely in this situation, but sharing with all of you has helped tremendously. I've gone to alot of the surgeon's support meeting and I'm sick of hearing people discussing "the surgery", which is referring to gastric bypass. I always raise my hand and ask a question about the "cadillac surgery", the sleeve. Sometimes I go to people in the room after the meeting to discuss the sleeve with them. None of them had ever even heard of it. I know that's not true as my surgeon discusses all the surgical options at the seminar. I'm so happy I stuck with my surgery choice and didn't opt out for the band or the bypass. Twice I was asked by my surgeon's office if I would reconsider either of these. I hope this gives someone else the courage to hang in there!!

Here it is Sunday, December the 5th and I still can't believe what's happened in the past week. Chris from Dr. Lalor's office called me on Thursday, December 2nd to let me know that she resubmitted my paperwork to Anthem BC/BS on Wednesday, December 1st. She had gotten an email from Anthem stating that they now cover the sleeve as a "stand alone" surgery! My paperwork was submitted July 29th, and I had gotten a denial letter in September due to the sleeve being considered experimental/investigational. I have been waiting for the surgeon to send an appeal letter for me since that point. I'm just in shock! I called Chris back on Friday the 3rd to ask her when she was scheduling surgeries. She told me that she just started scheduling for February 2011 and that she expects to hear back from Anthem within 2 weeks. That means I should be having my surgery in February if all goes well !!! I expect to have to redo my bloodwork and chest xray, but I hope that's all. What a great Christmas present!!

I don't mean to throw a wet blanket on your hopes and dreams, but I too have BC/BS. I'm in Ohio and like many other states BC/BS is still considering the Sleeve to be investigational/experimental. I recieved my expected denial letter just under 30 days from when my surgeon's office submitted the paperwork. It was not a surprize at all, just a big disappointment to read it in black and white. My surgeon's insurance gal said she would call when he submitted a letter to appeal the denial. The deadline to submit the appeal letter was yesterday October 9th, and I've not heard anything. If his appeal letter results in another denial, then I'm told my surgeon will request a peer review meeting. This is when a provider meets in person with a doctor who is not involved with BC/BS to plead my case. I am getting more and more depressed everyday. The surgeon's nurse asked me if I would consider RNY and I told her absolutely not. This week the surgeon's ins. gal called to ask, since my plan covers the Lapband, if I would consider that. I again told her "no, there are too many complications with it". She then told me that this could be a long drawn out process, since my plan does not cover the Sleeve. I feel so lied to, as she told me at my initial seminar that she was getting Sleeves approved by BC/BS easily. I had read on this site that it was not happening, that's why I asked her. I feel my surgeon is an excellent doctor, but his office staff gets patients to switch with a covered surgery, instead of fighting for the Sleeve. He does ALOT of RNY's. My husband say's that I never take the easy way out, and he's right!! It's just so depressing to see all these people getting approved and having their surgery, when I've been working since March of 2010 to get through this process! I am head strong and will perservere. Good luck to you, don't give up!

Krys, The thing that gets rid of my Water weight the best is to stop eating anything with gluten in it. No bread, Pasta, cereals etc. You can eat basically any meat, veggie and fruit...just forget the simple carbs. I find when I eat like this I also feel SO much better! I'm not so depressed, I think better and just have an all around better attitude. I hope you do well on your journey!

Michiganmama, There are hundreds of us out here that wish we had your problem! We're fighting our insurance companies to let us have our sleeve, when all they want is to give us the lap band or gastric bypass. If you want a little more convincing that the sleeve is better, go to Obesityhelp.com and start reading under the heading of "Complications or Problems". Then compare the same heading on this website. I have coworkers who had the RNY and believe me some of them are now packin' the pounds back on....and as an added bonus they are going for regular iron infusions! :thumbup1: Seems like a no-brainer to me. Hope you make the best decision for your health!! :001_tongue: Wish I was in your shoes.

The letter came on Friday, Sept. 17th. It stated I had 10 days from the "date of the letter" to ask for a peer review. The letter was dated Sept. 9th. Today is the 10th day and it's a Sunday....SCREWED on that option. I will contact the surgeon's office tomorrow about filing an appeal. Then (if I'm reading the letter correctly) when the appeal is denied, we can ask for a peer review. Their reason for the denial (of course) was the ole experimental/investigational excuse. My hospital was the first in the USA to perform the Biliopancreatic Diversion with Duodenal Switch. It is a malabsorbtive procedure in which a portion of the stomach actually is removed. In addition to the stomach becoming much smaller, much more of the small intestine is bypassed than with the RNY. In 1978 Dr. Hess perfected and began performing this surgery. So, 32 years ago he began removing a large portion of his patient's stomach (a sleeve gastrectomy) and then doing the duodenal switch at that time or at a later date. So, with a 32 year track record of success with the sleeve part of that surgery how can any ins. company call it investigational/experimental! BEATS ME!

Hubby called my surgeon's office to cancell my Monday visit with the nutritionist, after she left me a message to say that I am doing good on my own and since my case is in appeal the appt isn't necessary. Hubby also talked with the nurse, who said the surgeon has dictated a letter for the appeal and it's waiting to be typed. He told her that I would like my letter to be a part of the appeal if possible. Then Friday (yesterday) afternoon I got a call from my pcp's office to say that my test for Celiac Sprue was negative. As soon as I had the blood draw I went back to eating gluten free and all my syptoms that were starting to show up again, began disappearing. My rashes are going away, my "gut" feels so much better and the gas and bloating is going away. I'm sure I have some intolerance to gluten, but maybe it's just not at the stage it shows up in a blood test yet...darn! I will NOT settle for the RNY, no way, no how, NEVER! I sure do appreciate all the support of you all. More than you will EVER know!! :thumbup1:

Kelkie, I guess my surgeon is just the opposite in that I don't think he wants my imput. I don't know for sure, cause they are not communicating with me. I called and left a message with the nurse to let her know I had blood drawn for the Celiac test this morning (thanks to my pcp). I told her I'd let her know as soon as I get some results. She has not called me back. I think that office is used to people giving up on being approved for the sleeve and they just get the RNY. I think I'll call them again!!

Thanks to Fitatfifty I may have some more ammo to get my denial overturned. She got approved because of her diagnosis of Celiac Sprue. So, I looked up the symptoms and I have ALOT of them. I'm in the process of getting my pcp to order a blood test. If that's not conclusive the next test is to be scoped and getting a biopsy of my small intestines. Heck they can biopsy anything they want if it gets me approved! I talked to my surgeon's nurse (she's going to talk to him between surgeries today) and to my pcp's nurse (he's out of the office today) and should hear something later today or tomorrow. I told both of them how important this is to get an approval...if I have it. Celiac Sprue is gluten intolerance and if you have it and continue to eat gluten it can permanently damage your small intestines. Good ammunition against an RNY surgery! Oh, my surgeon's nurse asked if I was set on having the sleeve!? I said yes, I will NOT have gastric bypass!!! I think they have alot of people who have requested the sleeve switch to RNY just to get approved. NOT THIS CHICK!

I called the surgeon's office this morning and talked to the ins gal. Of course she is saying that this would be a long process, since BC/BS does not cover the sleeve. Duhhhhh I told her that at the seminar, but she insisted at that time she was getting BC/BS approvals for the sleeve with no problem. I told her I have composed a letter to BC/BS for the appeal. She told me that the surgeon would be handling the appeal, be it a peer review or an appeal. She told me if I sent a letter that it would be considered the appeal. I said that I would hope that the surgeon could use the letter along with what ever he was going to say. She told me that would not be a good idea, that the surgeon would handle it. I asked if I would get a chance to speak to him before the appeal or review...I didn't get the feeling that it would happen. I don't have a good feeling about this now! :w00t:

I have Blue Cross/Blue Shield Blue Access PPO in Ohio. In some states BC/BS is approving the sleeve, but not in Ohio yet. I have had some other health issues that my surgeon believes would help the ins co consider the sleeve as my only option. So, the fight begins!! :001_tongue: Of course there is the appeal, but the peer review is where my surgeon says he goes nose to nose with a doctor who would basically let my surgeon plead my case in person. It's rumored that my surgeon is real good at this. Anyway, I expected the denial, but when you read it in black and white it's so REAL! I've already begun composing a letter to BC/BS. It's basically a letter to introduce myself to them and explain what's gotten me to this point in my life and how I and my surgeon feel the sleeve is the only option for me.

I hope Tiffykins is right in your case. I also have BC/BS, but I'm in Ohio. I just got my denial letter in the mail on Friday. There are a few states where BC/BS is finally approving the sleeve, but most (as in Ohio) still consider it investigational/experimental. I will be appealing their decision. I'm VERY surprized your surgeon's ins. gal didn't understand the language in your policy!! My surgeon required me to be under the supervision of his hospital's nutritionist for 3 months. They don't really expect you to lose weight, but it is encouraged. I still got denied. I'm sure they would have approved an RNY in a heartbeat, as I meet all their requirements. You should be able to go to your BC/BS website and read what is allowed and what is excluded. My surgeon's ins. gal basically lied when she told me at the seminar that she wasn't having any trouble getting approval's for the sleeve through BC/BS. I expected to be denied and figured she was not being honest with me. I'm ready for a fight now!:thumbdown:

I got a call from Chris (ins. gal) from Dr. Lalor's office on Friday. She told me that my paperwork was submitted to BC/BS that day. She told me that because my ins. still consideres the sleeve "investigational" that I may be in for a long wait. I told her that I was already expecting that. She told me that when she received any word from BC/BS that she would let me know. Nothing to do but wait, wait, wait......

Like another poster, I work with alot of nosey women who gossip and love to put people down. I'm pre-op and don't want to lie. I've told two good friends who know I'm counting on them to keep quiet. All I have to give my boss is a note from the surgeon for time off work. If anyone asks me, I will tell them I did not have gastric bypass, if they press it to find out what I did, I will tell them that I only share the details with someone who is considering wls for themselves. I just remember when on obesityhelp.com I learned about this surgery I thought that removing most of my stomach would be the stupidest thing ever! Actually, I felt sick even thinking about it. I thought HOW DRASTIC! Actually it is, but gastric bypass is even more drastic and people don't bat an eye when they learn that someone has had that done.

You need to check with your provider or the surgeon's ins. person on this. I believe you have to have a medically supervised weight loss, but I'm no expert. BC/BS is a stickler for following their policies exactly. I hope all goes well for you. My surgeon has a dietition that works directly out of his office. I am billed through the hospital and it's always $20, just like a co-pay. My surgeon has a very smooth running operation and I'm hoping for an approval sooner than later. I've jumped through all the hoops as far as he knows. Now I just wait and see if I get approved. His ins. gal is not hopeful that I'll get approved the first time.

Two days ago I had my 3rd visit with the dietition and my only visit with Dr. Dawley (internal medicine doctor). The dietition said she was very pleased with my progress. I lost 3 3/4 lbs in the last month, despite alot of heel pain, which limits my walking. She told me to continue to practice chewing my food very well, small bites and eating protein first. My surgeon, Dr. Lalor, requires all of his patients to be cleared for surgery by Dr. Dawley before submitting the paperwork to the insurance company, and he is VERY thorough with his exam. He reviews all the tests results, does a medical history and an exam. He told me at the end of my visit that he will recommend to Dr. Lalor that I would be a candidate for surgery. He did say that he will be requesting the results of my echo cardiogram test. I told him that my pcp said it did not show any problems with my heart. When I told Dr. Dawley about the pain I have in my hips he said it is most likely due to osteoarthritis. If he puts that in his report, I'm hoping it will help me get approved for the vertical sleeve surgery. I understand that if you have arthritis that gastric bypass is not the best choice, due to malabsorbing the needed medications. With all my previous abdominal surgeries, adhesions and diverticulities Dr. Lalor is really against gastric bypass for me. BC/BS of Ohio is currently still considering the sleeve investigational, but I'm hopeful they will make an exception in my case. More and more states are approving the sleeve (ie Illinois), as they see it is effective and there seems to be fewer complications after.I will wait two weeks and then call Dr. Lalor's office, if I don't hear anything, to see where things stand. I will update this post at that time or before if I get news. It's my goal to try and lose 10 lbs before surgery.

Nana, I'm so sorry that you're feeling down. It sounds like your new job isn't really a good fit for you. If you have the option, you might go out and do some job searching. Even looking can lift your spirits, and who knows you might just find a much better more fulfilling job! You deserve it!!! Isn't it great to have a forum like this, where there are people who care and do the happy dance right along with you? Chin up gal! I'm just starting my journey and have NO ONE to talk to but my hubby. He knows practically nothing about the feelings I'm having and his poor ears are tired of me trying to educate him. Congratulations on your weight loss and your NEW LIFE!

I am no expert here, but I did have an experience with sleeping pills. After I got my Bi-Pap machine the doc prescribed Ambien to help me relax and get used to the machine. He did not say how long to stay on them. I pretty much took them for a month. I slowly noticed how I was beginning to have thoughts of paranoia. I would imagine that someone was lurking outside, and that at night he would break in. My husband was working nights. One night I started crying as he was getting ready to leave. I explained to him my crazy fears, he offered to stay home, but I told him to go and I'd deal with it. I got on the internet and learned how addictive sleeping pills can become and that people have done some crazy things while on Ambien. I quit that night. It took about 3 nights to be able to get any real sleep. When I told the doc later he said I should have gotten off of them gradually. Hope this helps you or someone else!