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HORIZON BLUE CROSS BLUE SHIELD NEW JERSEY PRE-APPROVAL REQUIREMENTS Weight loss surgery for treating morbid obesity is considered medically necessary if the patient fulfills the following criteria: The patient should be at least 18 years of age AND/OR the patient’s skeletal growth is complete. Weight loss surgery for patients under 17 years of age is not considered medically necessary unless full skeletal growth has been reached and the patient suffers from a co-morbid condition, such as sleep apnea or hypertension. The patient is morbidly obese (i.e. has a BMI of over 40 OR has a BMI of over 35) with a life-threatening co-morbid disease such as: Congestive Heart Failure Metabolic Syndrome Coronary Artery Disease Hypertension Cardiomyopathy caused by obesity The patient, in the 12 months prior to the surgery, has to have: Completed a weight loss program for at least six consecutive months Participated in a surgery preparation program to enhance results and lower risk of complications after the procedure. Your surgeon will typically have these available. Undergone pre-operative psychological evaluation and understands the impacts of weight loss surgery The patient should have a letter of recommendation from his/her primary doctor. The bariatric surgeon should submit the proper paperwork for approval. The patient has to fulfill all of the criteria listed above to be approved for bariatric surgery. TYPES OF WEIGHT LOSS SURGERIES COVERED BY HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY Horizon Blue Cross Blue Shield New Jersey covers the following weight loss surgeries: Biliopancreatic Diversion with Duodenal Switch Laparoscopic Adjustable Gastric Banding Gastric Bypass with Short-Limb Roux en Y anastamosis Gastric Bypass with Long-Limb Roux en Y anastamosis Vertical Banded Gastroplasty Sleeve Gastrectomy These procedures are considered medically necessary for treating morbid obesity. PROCEDURES EXCLUDED FROM COVERAGE Mini-gastric bypass, gastric plication and other surgeries not listed above are considered experimental and not covered.

LOL yes, you seriously look incredible!! I can’t even fathom wearing a size 12. That would be amazing in itself! How long after surgery did you start to feel “normal” again? And how old are you? You don’t have to answer that if you don’t want. 😂. I’m 41. Just hoping I can bounce back from surgery now that I am not exactly young anymore. Journaling is a good idea... I need to write down the reasons I’m doing this. So I can focus on THOSE and not all these complications that probably won’t even happen to me.

I’m getting a sleeve to bypass conversion because of uncontrollable GERD. GERD is pretty common after a sleeve because your stomach becomes a high pressure system so lots of doctors put you on prophylactic PPIs for a few months. As you see above, most people don’t need conversion. GERD is either controllable on meds or goes away. I’ve been unlucky with a lot of complications.

Thanks to all of your for your encouraging words and support. They repaired the leak on Wednesday (at 10:00 in the evening!), took the drains out this morning, and the infection has cleared up--so I finally got to go home today! I can't tell you how wonderful it will be to take a real shower and sleep in my own bed. Needless to say, it has been a very rough and discouraging week. Apparently, I am today basically where I would have been last Tuesday if there had been no complications and they had discharged me the day after surgery as planned. I'm feeling surprisingly good aside from being completely wiped out--I'm napping every couple of hours. I have minimal pain and have not needed pain meds, no nausea, and I have not dumped (yet). So, I just need to pick myself up and get on with it and put this week out of my head. All of your posts really did help, even though I wasn't in the mood to respond during the week. Thanks again!

Sorry about the complications, but it sounds like you're okay now. Wow, what a huge weight loss so quickly! Congrats and good luck on the rest of your weight loss journey. I'm in it for the long haul.

Hi everyone, I’ve been a long time reader of this forum, but a first time writer 😁. Today marks 5 months since I had the gastric sleeve and I thought I would share my journey so far. While I was prepping for the surgery, these posts helped me so much so maybe my story can help some people too. I was 310 lbs during my first meeting with my doctor. I didnt have to do a pre-op diet but between my first meeting and surgery, I lost 10 lbs so I was down to 300 lbs day of surgery. I weighed in today, and I am currently 210 lbs. I can’t even process it, I havent ever been this weight during my adult life. My surgery went very well, but I did have alot of complications after the surgery. You know how you read about them but never think it will actually happen to you.. well it happened to me haha. I was good for about a week after surgery, and then I got a kidney stone. Of course I automatically assumed something was going on with my sleeve because of my symptoms ( neausea, stomach pain, vomiting etc), ended up going to the ER after two days and it turned out to be a kidney stone. I also became dehydrated during this time because I couldn’t keep anything down. They didn’t admit me that day and I passed the stone but I was constantly throwing up and my stomach pretty much became irritated and inflamed. This lead to a vicious cycle of constantly trying to take in fluids but not being able to keep it down at all. I went through about a week of hell - would wake up neausous, throw up the entire day and go to sleep neausous. Neausea meds didn’t help, I couldnt even get them down because any sip of water would make me neusous. Eventually, I became super weak, my hands and feet started cramping up and honestly I felt like crap, regretted my decision to have this surgery. I was admitted to the hospital - my heart rate and bp were super low, my liver was getting messed up and I was beyond dehydrated. I stayed in the hospital for about 5 days and left feeling much better. hindsight, I should have gone to the doctor / hospital earlier... Since then, I have been feeling great! Its definitely an adjustment and some days are harder than others but so worth it! Even with all the complications I had starting out, I would go through with the surgery again in a heart beat. My life has changed because of it. I’m fairly young - 30 years old - and I had high blood pressure. My blood pressure is now normal. My knees don’t hurt anymore when I walk. I can keep up with friends. I have so much energy now. Its crazy but I didn’t realize how sluggish and tired I felt until I started not feeling that way.. My quality of life has improved so much and I am no where near done yet. I’m so grateful for my tool. Like everyone says, wls is definitely not the easy way out. I put in work physically and emotionally everyday. I work out 5 times a week and eat clean. Changing my mindset amd emotional attachment to food is a process. But I couldn’t have done it without the surgery for sure. Anyway sorry for the long post! But like I said reading about others’ experiences was so helpful to me so I figured I would share just incase others find it helpful as well.

Complications

It seems to be not recommended. The surgeon I went to no longer places them as stated above. We do have people here that have had no issues and you can look in the surgery specific boards, but there are tons of posts about people that had to revise due to complications. Of course, you can have complications from any surgery. So is this cold feet or do you need to postpone and do some research before you decide to have this surgery Saturday? Good luck!

I also had a drain. I had to baby it. I emptied, measured cleaned and logged its contents. It was work. But I believe I'm healthier for it. I had low energy for quite some time after surgery but i rolled with it instead of fighting against it. I didn't need stress adding complications to the pot so i tried to remain super chill about everything. It was major surgery after all and i was honesty happy to be alive. My incisions took a while to heal and were very itchy so i cleaned *around* the incisions with alcohol before putting the hydrocortisone cream *near* the incisions. It helped alot. One week down many more to go !

Prayers up for further safe recovery! You could write the handbook on how to navigate the complications with style, fortitude and grace 👑👑👑👑👑👑

Post-gallbladder surgery report - Surgery was last Wed. Turned out my gallbladder had fused itself to my colon and the stone was trying to work its way through into the colon. Doc said it was a gawd-awful, infected mess in there. Had my 1-week follow-up today. Best news: Drain is out! Other news: I'm cleared to go back to work next Wednesday barring any further complications. The surgeon thought it was one massive gallstone, but he got the pathology back today and it was 2 large stones, 3.0 cm and 3.7 cm that were kind of stuck together. Anyway, my weight has dropped down to 147.4, but not in a good way. Right now, I look like death-warmed-over. Hopefully, another week of recuperation and I won't look like a desiccated mummy. I still have a lot of fluid/swelling in my belly so I don't know, for sure, how much weight I've actually lost but I think it all came off my face. On the upside, I think I've now successfully navigated all the standard complications that can come with WLS, so it should be smooth sailing from here on out! Anchors away!

Do all sleeves or bariatric surgeries need revisions? I’m seeing posts that some people think the sleeve stops working and will need a revision at some point. Where are people getting this information? Yes, some people may need surgery revision. It can happen with any type of surgery. This site is filled with new people and people that have gained weight. People that are maintaining have no need for support here. I’m wondering if this is the reason people think surgeries will “need revisions” That we are all doomed to regain. Understand some may need a revision for various reason: examples: (I’m sure there are more reasons than what I have listed) Complications procedure not done correctly it was the wrong type of surgery for an individual. Many reasons why people gain weight. (Most People can control gains on their own, If the contiune to gain, they can consult their surgeon on options) Examples: Hormones medical conditions medications pregnancy/ menopause eating disorders stress Grazing – Eating a combination of heathy and unhealthy food over their calories and macros. The sensation is no restriction. Its as if you never had surgery and you will gain weight. Mistaking stretching as your restriction becomes less as you progress out from surgery (Your stomach is not back to full size) You still can fill it with food within your calories and macro’s Not knowing how many calories they are eating daily Will all surgeries stop working. NO. Will everyone gain weight - no. If you gain you can work it back down. Weigh yourself before a 20 pound gain continues on to a 40, 80, or 100+ weight gain.

Yeah- I think I have a slightly larger pouch, but it’s still drastically smaller than what my stomach was before.. so I just try to focus on filling it with healthy things and try to be mindful of calories. I’m still kinda stalled in the low 220s. I can’t wait for the weather to break so I can get outsidddddde. Hoping to find a local hiking buddy to hit some trails with once it warms up. My bff is having surgery next week. I’m nervous and I’m hoping her journey goes as smoothly as mine has, otherwise I’m afraid she’ll resent me for inspiring her to go through with it. We’ve had some pretty open/honest conversations about my journey so it’s not like I’ve pressured her or told her I thought she should do it. However, I am positive that, barring any complications, she will absolutely be successful, because my girl can commit to things. Just wish she didn’t live 3 hours away!

I am so sorry you are going through this. Complications were touched on briefly during my journey, however everything I have experienced was never discussed. I went from band to sleeve to y n roux. Last year alone I had 4 surgeries, two of them I could of died...we go with the flow with our doctors advice and each procedure makes everything worse than when I started. I don’t blame, or hold any resposible but myself, but life is now very painful with constant attacks and no answers. My doctor told me “ if all surgeries went like this no one would get this done”. Not very comforting. I am young and have resigned myself to a life of chronic attacks, I am really depressed but I have no options. I feel your despair.

I haven't had any complication so far!

Thank you, I’m definitely not in a rush just nervous to get started. It seems like almost everyone has some kind of complication.

Hi guys, I understand that I am supposed to consume 60-80g of protein daily, but I know it will be complicated with the recommended amount of water I have to drink. Has anyone doubled up on the dose of protein powder, like two or three scoops to get the required amount of protein?

I had it last Monday, February 4. There were complications and it has been rough so far.

I have to take a multi with iron, a calcium citrate, a B-complex and a probiotic everyday. I wouldn't try to get by with less of the 3 golden requirements. Water, Protein and your supplements. That's when people start running into health problems after WLS. All of the horror stories you hear of when it comes to post-op complications like teeth loss and brittle bones and stuff like anemia can most often be traced back to complacency when it comes to following the nutritional requirements.

I'm so sorry that you had a complicated course. I hope it's smooth sailing after the infection clears and leak resolves. Best of luck to you, I will keep you in my thoughts.

Any pay for the surgery out of pocket in the US? My insurance won’t cover it and I’m not comfortable going to Mexico. I’m wondering what happens if I have any complications. Does the insurance refuse to cover any issues related to the surgery. Planning to ask my doc and the insurance company. But I’m interested in any info from the group too.

HI, March buddies. I had my bypass on March 3 and am still in the hospital due to complications. My surgeon told me that everything had gone beautifully. However, I was in pretty severe pain a few hours later and it just kept getting worse. I figured it was just the gas pains everyone talks about and I'm just a wimp. They did a blood test at the following day thought I had an infection, and I had tachycardia, which made them suspect a leak in the pouch. Unfortunately, both were true. I'm spending this entire week in the hospital. Tomorrow they will install a drain to remove as much of the infection as possible, and I'm also on liquid pain killers and antibiotics via the IV. Once the infection clears, they do a second operation to fix the leak. Two morals of the story: Leaks hurt like hell, and if you think something is not right, contact your doctor immediately! i'm hoping this is just a temporary setback and that I'll be back on track in no time. Best of luck to the rest of the February club!

Sorry to hear of your complications. I hope it's just a minor detour too, and you will make it eventually, albeit you're taking a little longer route. You're in my thoughts, I hope for a speedy recovery once they get you all fixed up.

So far bafflement... still undergoing tests but nothing conclusive so far... has anyone else experienced post-op complications several years out? Surgery July 2016. Only lost 100lbs (I know, I know, "only"), but I'm still about 100lbs overweight. I'm not unhappy w/the amount lost at all and feel much better overall so I do not regret the surgery. First, not sure any or all of these symptoms are related at all but since they're all (potentially) GI-related, I can't help but think (especially now) that they are. So here goes: I can't remember exactly when the first one occurred, but it was after "healing" for sure but the first time it happened, it was definitely after surgery: a charlie-horse in my abdomen. These occur very suddenly and occur when I'm bending, reaching or twisting my abdomen--but always forward, not backward. For example, I might just tuck my belly in to look down at my feet and whammo, charlie horse. I reach forward to pick up a kitten... whammo. They can happen at any time and are excruciatingly painful and I just jerk backwards in reaction and take diaphragmatic breaths and they'll ease up. About 4 months ago, I had a sudden pain "attack" after eating a relatively fatty meal... I'm talking waves of pain in the gut so intense that I actually called 911. Since I still have my gallbladder, I assumed gallbladder problems. Pain lasted about 7 hours or so, even through narcotics given in the ambulance and at the hospital. Worst pain I've ever felt in my life. Multiple tests run... no gallstones, so they basically sent me home after the pain finally subsided with a ridiculous "gastritis" diagnosis. Sorry, was crapola. About 6 weeks after that, I started to have diarrhea... for over two weeks straight, every single day. Didn't respond to OTC anti-diarrheals. Saw walk-in doc (my doc was on vacation) who ran a bunch of tests and nothing positive except blood in the stool. Diarrhea eventually cleared. PCP ordered endoscopy and colonoscopy--both normal. About 6 weeks ago, another pain attack--but not after fatty meal... just yogurt. This time I remembered I had meds at home--took anti-spasmodics (hyoscyamine) and oxycodone... took 3x regular dose to make pain tolerable. Faded again after about 7 hours. PCP suspects gallbladder function is to blame, even though no stones, so HIDA test this Thursday. In the timeline, this pain attack was about a week after the diarrhea cleared up... about a month ago. But here's the deal: I can physically (i.e. with my hands) feel that under that trocar scar is a hardening of tissue... it makes sense that it's scar tissue of course, but I feel like it's getting bigger? (as in, over a wider area, not deeper). It's not painful when pressure is applied, just uncomfortable? I have not yet brought this part up to PCP, but she has palpated my abdomen before and didn't call out anything as unusual. So I'm at a loss as to what's going on but something definitely is. Anyone experience anything at all like this? Especially those who are years out from surgery? So confused and tired of taking tests that aren't leading anywhere... thank goodness I have excellent insurance. Michelle

So far bafflement... still undergoing tests but nothing conclusive so far... has anyone else experienced post-op complications several years out? Surgery July 2016. Only lost 100lbs (I know, I know, "only"), but I'm still about 100lbs overweight. I'm not unhappy w/the amount lost at all and feel much better overall so I do not regret the surgery. First, not sure any or all of these symptoms are related at all but since they're all (potentially) GI-related, I can't help but think (especially now) that they are. So here goes: I can't remember exactly when the first one occurred, but it was after "healing" for sure but the first time it happened, it was definitely after surgery: a charlie-horse in my abdomen. These occur very suddenly and occur when I'm bending, reaching or twisting my abdomen--but always forward, not backward. For example, I might just tuck my belly in to look down at my feet and whammo, charlie horse. I reach forward to pick up a kitten... whammo. They can happen at any time and are excruciatingly painful and I just jerk backwards in reaction and take diaphragmatic breaths and they'll ease up. About 4 months ago, I had a sudden pain "attack" after eating a relatively fatty meal... I'm talking waves of pain in the gut so intense that I actually called 911. Since I still have my gallbladder, I assumed gallbladder problems. Pain lasted about 7 hours or so, even through narcotics given in the ambulance and at the hospital. Worst pain I've ever felt in my life. Multiple tests run... no gallstones, so they basically sent me home after the pain finally subsided with a ridiculous "gastritis" diagnosis. Sorry, was crapola. About 6 weeks after that, I started to have diarrhea... for over two weeks straight, every single day. Didn't respond to OTC anti-diarrheals. Saw walk-in doc (my doc was on vacation) who ran a bunch of tests and nothing positive except blood in the stool. Diarrhea eventually cleared. PCP ordered endoscopy and colonoscopy--both normal. About 6 weeks ago, another pain attack--but not after fatty meal... just yogurt. This time I remembered I had meds at home--took anti-spasmodics (hyoscyamine) and oxycodone... took 3x regular dose to make pain tolerable. Faded again after about 7 hours. PCP suspects gallbladder function is to blame, even though no stones, so HIDA test this Thursday. In the timeline, this pain attack was about a week after the diarrhea cleared up... about a month ago. But here's the deal: I can physically (i.e. with my hands) feel that under that trocar scar is a hardening of tissue... it makes sense that it's scar tissue of course, but I feel like it's getting bigger? (as in, over a wider area, not deeper). It's not painful when pressure is applied, just uncomfortable? I have not yet brought this part up to PCP, but she has palpated my abdomen before and didn't call out anything as unusual. So I'm at a loss as to what's going on but something definitely is. Anyone experience anything at all like this? Especially those who are years out from surgery? So confused and tired of taking tests that aren't leading anywhere... thank goodness I have excellent insurance. Michelle