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Hi! Yes, I got the approval on the 23rd and they submitted everything on the 15th. They were off for Good Friday so it took 6 business days to get the approval. They did however, ask for more info on the 17th and my insurance coordinator faxed it over that same day. They seemed to be most picky about seeing my weights for the year. Here’s the requirements taken right out of my plan for the Bariatric surgery. I have the basic plan. Just make sure you get as many letters of medical necessity from all your drs. Especially your primary. That seems to help things. Good luck and keep me posted!!! Procedures to treat morbid obesity – a condition in which an individual has a Body Mass Index (BMI) of 40 or more, or an individual with a BMI of 35 or more with one or more co-morbidities; eligible members must be age 18 or over. Benefits are available only for the following procedures: o Roux-en-Y o Gastric bypass o Laparoscopic adjustable gastric banding o Sleeve gastrectomy o Biliopancreatic bypass with duodenal switch Note: Benefits for the surgical treatment of morbid obesity are subject to the requirements listed on pages 66-67. Note: For certain surgical procedures, your out-of-pocket costs for facility services are reduced if you use a facility designated as a Blue Distinction Center. See page 91 for information. Note: Prior approval is required for outpatient surgery for morbid obesity. For more information about prior approval, please refer to page 23. • Benefits for the surgical treatment of morbid obesity, performed on an inpatient or outpatient basis, are subject to the pre-surgical requirements listed below. The member must meet all requirements. o Diagnosis of morbid obesity (as defined above) for a period of 1 year prior to surgery o Participation in a medically supervised weight loss program, including nutritional counseling, for at least 3 months prior to the date of surgery. (Note: Benefits are not available for commercial weight loss programs; see page 41 for our coverage of nutritional counseling services.) o Pre-operative nutritional assessment and nutritional counseling about pre- and post-operative nutrition, eating, and exercise o Evidence that attempts at weight loss in the 1-year period prior to surgery have been ineffective o Psychological clearance of the member’s ability to understand and adhere to the pre- and post-operative program, based on a psychological assessment performed by a licensed professional mental health practitioner (see page 104 for our payment levels for mental health services) o Member has not smoked in the 6 months prior to surgery o Member has not been treated for substance use disorder for 1 year prior to surgery and there is no evidence of substance use disorder during the 1-year period prior to surgery
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Some folks would rather have their intestines rerouted rather than have 3/4 of their stomach removed![emoji4] And don't forget the RNY gastric bypass is called the "gold standard " of bariatric surgery. If you have to have the bypass you'll do fine! Hope your reflux gets better soon. Sent from my SM-N960U using BariatricPal mobile app
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Thank you so much. Everything you said is 100% right. I’m so glad I have come back to bariatric pal for some support. I’m trying to go back to bariatric basics. No water while I eat. Protein, protein, protein. Getting to goal is nowhere near as hard as maintenance. I have to accept that always going to be dealing with my “food issues”. Have to be vigilant!
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If you know insurance doesn't cover surgery
Briswife15 replied to Musicsings14's topic in Insurance & Financing
Hi. I'm sorry your employer's policy doesn't cover bariatric surgery. That's a bummer. Unfortunately, even if it is a "medical necessity " if they don't cover it, they don't cover it. I'd suggest talking to HR or whomever decides what your policy covers, and ask them to consider covering it in the future. Good luck to you! Sent from my SM-N960U using BariatricPal mobile app -
Dr. Carlos Altamirano Cano
Briswife15 replied to JoniR's topic in General Weight Loss Surgery Discussions
I agree with Mikeyy. This is a big deal having bariatric surgery and you should be 100% confident in your surgeon. Sent from my SM-N960U using BariatricPal mobile app -
You are a work in progress. It's all normal. You don't have to "be a better bariatric." You are already good enough now. ((hugs))
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So I think as everyone here agrees: 1. This is a very common experience many bariatrics share. 2. You should really seek a referral to a bariatric therapist to help facilitate your movement through this process. Or maybe join a local group session with your surgeon's practice. I'm a member of 2 -- 1 I attend monthly and is awesome. We talk about our feelings, our challenges and triumphs and life in general and it's awesome! Plus this place is just super duper! But what you are experiencing is grief. There are 5 stages of which anger is one of them. It's important to share your feelings, talk, get the anger out and work thru each stage so that you can progress to the last stage which is acceptance. I knew about this going into surgery and so had done a lot of the head work in the year leading up to surgery. Because I was ready for it, lol, wouldn't you know? I didn't have any grief over food. I'm lucky. I did have bouts of being hangry/angry/terse and did have bouts of sadness that came and went like a flash. That's due to the hormonal shifts happening as we liberate fat for fuel. It can totally jack with us. But it wasn't related to lack of food. I had been eating healthy for so long leading up to surgery that I actually had a taste preference for healthy "clean" low fat foods like lean proteins, leafy grees/low glycemic veg, and low healthy fats. I know now, that's because I actually re-built my gut microbiome because of my great diet and that biome caused my preferences to shift. Now, that didn't and doesn't mean I don't have cravings, head hunger, and desire for bad stuff. It didn't mean I was 100% perfect. But I strove to be, cuz I knew, that way too soon--that bad decision making would express itself and I would cave and eat something "bad"--and feel miserable (hurting, sick, nausea) afterward as a result. So it's not that you will never eat your old foods. You should work on reframing your brain. Use this honeymoon period that is WAY too short, to shift your thinking. Think instead: Look at what GREAT choices I'm making, and let me see how healthy and dense I can eat, while keeping my calories and food quantities the lowest and let me see how quickly I can get this 10lbs off of me! See how MUCH nutrition you can get per calorie. Focus on "nutrient dense" low calorie, real food!!! And resign that it's OK, to be hungry! Cuz hunger only lasts 20 minutes then will go away if you don't feed it. It won't grow. It won't kill you at this point. You have a feast table on your tummy, thighs, and bottom. I kept a spread sheet. And each decade of weight, I knew approximately how many days it would take me to lose that decade! And I made a game of it. I was so thrilled with the movement on the scale and the smaller sizes of clothes, that it kept me busy and engaged in the process in a very positive way. I was laser focused on losing the current decade of weight. Then it was onto the next decade. It's all about the spin you put on things. You know?
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Welcome to the WLS mental battles. It’s ok to be angry. Many of us start with some buyer’s remorse. First food stages made me a bit hungry and angry. things got better with real food stage. Focus on the scale moving with your healthy choices. Keep your eyes on your short- and long-term goals. Recognize when food addiction is talking to you. Noting taste as good as weight loss:-) (make sure food suggestions are on your plan) (make sure they fit your calories and macros for the day) I like how it was said above. It’s what you can eat. bariatrics should not be torture. Food should be long term sustainable. Real food stage nutrition should be flavorful. There are healthy options for the foods I enjoy. I eat hamburgers without the bun (lettuce wrapped) I even enjoy the taste of a turkey burger patty over beef. Healthy pizza, Chicken fajitas without the tortilla, Check out bariatric friendly recipes. You will be able to go to restaurants. Make it about the conversations and quality food not crap foods. Your safe orders are protein and veggies. (replace carbs with more veggies) Kids or lite menus are also great.. You are now a cheap dinner date. Take home leftovers in a box for no cook meals later. Log them. Most restaurant menus are in MyFitnessPal food log.
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Dealing with regain
Healthy_life2 replied to LaLaDee's topic in General Weight Loss Surgery Discussions
Sorry for the length of this, Sorry to hear about your health issues. Medications can be difficult on weight loss. On the positive side, You have figured out the key to getting your weight down. It’s finding your calorie and macro range that puts your body in weight loss mode. Low carb and 1000 calories range is working for you. People on this site are going to benefit from your story/experience with getting a gain back down. I’m no expert. Just from my experience. I was sleeved in 2014. (almost 5 years out) I had my first gain in my third year. I worked it back down. What I have learned over the years. Getting back in weight loss mode after a gain: Get rid of temptation foods in your home and go grocery shopping. Accept that you will feel crappy detoxing off the extra carbs sugar and calories, It will pass. Log your food and go back to bariatric weight loss basics. Once you found your current calorie range dial them in to where your body starts losing weight again.( I'm 5"5" my range is 950 to 1100 carbs n higher tha 60 grams) If you are not in weight loss mode, Start by logging and dial in your calories back by 100 and adjust your carbs. These numbers will be specific to your body. If you need help setting things up in your food log app ask. Sleeves will have some extra compacity to fill. Eat dense protein and the other items allowed on your plan. Eat as much veggies as you like until full. The bulk/fiber will help you feel full. They are low in calories and will keep you in your daily calorie range. This is the trick. Because we can eat more does not mean you have to go over your calories and macros. Keep healthy sweet and salty options on hand for cravings. Ditch liquid/soft food protein sources. They will not satisfy hunger (except for on the run/emergency food) If you are low on time. Meal prep Sundays. Freeze portioned foods for you and the family for the week. Find some great recipes to get out of food ruts. Maintenance mode: THE WORK DOESS NOT END AFTER GOAL!!!!! Maintaining is Keeping an eye on the scale. Don’t let a 20-pound gain become 40 70 100+ pound gain. (*** Newbies*** you will be surprised on how quickly a gain can happen and how slow it comes off years out) It takes time to adjust getting out of the bariatric rules of what’s good and bad mindset – You will be adding carbs to slow stop your weight loss Yes, you get to indulge with in reason. Know what foods may trigger you. Notice if they lead you down a path to over consume and gain. Give yourself a bounce range to maintain. (I maintain a ten pound bounce up and down the scale) When you gain your bounce range, go back to bariatric basis to get it back off Over the years. We tend to get lax, old behaviors and stress eating can slip back in. Don’t beat yourself up. Anyone of us can gain. Come back here for support. Join a weight loss challenge. My reality is I log. I’ve tried to guess my way and it just does not work for me. Especially when I go back to weight loss mode. For those of you who maintain without logging I give it up to you. Find what works for you. -
I am an old veteran... but I'm actually fighting back from some regain at the moment. These are my must haves: MyFitnessPal app (know your calorie and protein targets and stick to them) Spotify - to listen to music and true crime murder podcasts while I walk/work out meal prep containers NutriBullet Spiralizer (I gave up pasta and do the zucchini noodle thing) hand held blender for making soups (also helpful during the nightmare post-op puree phase) In the pantry: plain whey protein powder, vanilla protein powder, cacao powder, natural peanut butter, protein balls/bliss balls (preferably homemade), nuts (almond, peanut, cashew, pecan) In the freezer: ground beef/minced meats, chicken breasts, bananas (cut into halves), berries, stir fry veggies, pre-made soups, chilli, meat sauces bariatric vitamins yoga mat (fight the stress and anxiety in a healthy way instead of binge eating) proper exercise leggings/tights that suck me in so I don't feel my stomach or skin flapping around when I walk or exercise, also a good sports bra comfortable sneakers/walking shoes jackets/sweaters (I swear I was never cold before surgery but spent the first year freezing) volumising hair spray, hair gel, hair paste, volumising shampoo, dry shampoo, epic hairdryer (to hide hair loss) Estee Lauder Advanced Night Repair serum for weight loss wrinkles on face Bio Oil Epsom salts eBay account to sell clothes and shoes that no longer fit
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Congrats on your decision. We are all her to support you. Some suggestions to mentally prepare. Counseling/ therapy to work on stress and emotional eating and overcome barriers of having surgery. The library or purchase books on topics you want to work on. Start making some changes now and practice them pre surgery. Log food, hydrate, don’t drink with meals. talk things out with us. Ask anything Books https://www.amazon.com/s?k=emotional+eating+books&ref=nb_sb_noss https://www.amazon.com/s?k=bariatric+personal+stories&ref=nb_sb_noss https://www.amazon.com/Such-Pretty-Face-Cathy-Lamb-ebook/dp/B003IYI7L4/ref=sr_1_fkmr3_1?keywords=bariatric+such+a+pretty+face&qid=1556393382&s=gateway&sr=8-1-fkmr3 https://www.amazon.com/Emotional-Wound-First-Aid-Comprehensive-ebook/dp/B0755Q71BX/ref=sr_1_7?keywords=emotional+first+aid+kit&qid=1556393469&s=gateway&sr=8-7 You will progress out to eat real whole foods. It is sustainable long term. Here is my dieticians web site to get ideas of what food after surgery can look like. https://karenmangum.com/tag/bariatric-friendly-main-dishes/ https://karenmangum.com/recipes/bariatric-friendly-recipes/ https://karenmangum.com/tag/bariatric-friendly-appetizers/ https://karenmangum.com/category/bariatric-friendly-desserts/
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They get very cranky and sometimes evict you from the premises and deny,you further access to their facility. My college team that I support and I had my bariatric surgery in their hospital on campus, Ohio State University, will not allow umbrellas in the football stadium. Crazy laws formulated by crazy politicians and the ones we were dumb enough to vote for. Pfft I often would like them to disappear in a puff of noxious smoke!
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Jen, my pivotal moment came when I realized I dreaded major surgery much less than continuing as I was, sad,defeated, sitting or lyi,g down as much as possible, because it hurt to much for me to be up . Hearing that I might only live 2 years or less, knowing that even if I hadn't developed them yet I was at risk for some nasty nasty things, any one of them could do me in. Repeatedly getting infections and colds, no resistance it seems. I did not have a very good quality of life, I was 5ft 8in and 365+pounds, a nice weight for a tree but very heavy for a Human Being. And I had drug this Weight around for 72 years because I was obese even as a toddler, I was strong, athletic as a teen, but my inner strength was fading fast. Maybe I should just sit in my rocker and wait for the Death Angel to claim me? But then I read about Bariatrics, the new lives it had given others, what would it harm to at least try? That was 4 years ago in August, I did not have an easy time securing surgery. You see many programs have an upper age limit, 60,65,or 70. I was almost 70 when I started out and 72 years 8 months and 8 days when I received my RNY. And my recovery has not be usual, if you find any of my early postings you will see what I mean. Many twists,turns ,some quicksand I almost got swallowed up by, but I will not go back to the old existance, I am losing weight, rediscovering ME, under recostuction
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women over 65 that had 100-130 pounds to lose and care to share their success stories
Marya69 replied to mermaidenlor's topic in Gastric Bypass Surgery Forums
I’ve used bariatric pal to research different topics from food suggestions to clothes. I also use the app Lose It! (Use it to lose it) To track my calories. I try to do an hour a day on my stationary bike(it’s become an obsession). Although my weight loss has slowed down considerably, my shape is still changing. I’ve donated most of my big clothes(3x) and even my new xl s are too big. And at this stage of my life, I don’t care if I have loose skin. Eating slowly is still my biggest challenge. I buy protein snacks from amazon to satisfy snacking. -
Long term ( 20 years ) and developing autoimmune symptoms?
Healthy_life2 replied to Eveband's topic in LAP-BAND Surgery Forums
https://www.ncbi.nlm.nih.gov/pubmed/26906303 I’m sorry you are going through these health issues. I may be wrong. I’m not a trusting person. Can you find a surgeon that is not part of your bariatric program to diagnose if the two are related? I am concerned that your surgeon’s office may be worried about liability issues. Side note: Breast implants have the same connection to autoimmune issues. This was posted by the US national Library of medicine J Clin Rheumatol. 2016 Mar;22(2):89-91. doi: 10.1097/RHU.0000000000000363. Is Bariatric Surgery a Trigger Factor for Systemic Autoimmune Diseases? Cañas CA1, Echeverri AF, Ospina FE, Suso JP, Agualimpia A, Echeverri A, Bonilla-Abadía F, Tobón GJ. Author information Abstract Bariatric procedures are an effective option for weight loss and control of comorbidities in obese patients. Obesity is a proinflammatory condition in which some cytokines such as leptin, a proinflammatory protein, is elevated and adiponectin, an anti-inflammatory protein, is decreased. In patients undergoing weight reduction surgeries, these hormone levels behave paradoxically. It is not known whether bariatric surgery protects against development of autoinflammatory or autoimmune conditions; nevertheless, changes occurring in the immune system are incompletely understood. In this case series, we describe 4 patients undergoing bariatric surgery, who subsequently developed systemic autoimmune diseases. Patients in our case series were asymptomatic before surgery and developed an autoimmune disease within 11.2 months. Two women fulfilled criteria for systemic lupus erythematosus (one associated with antiphospholipid syndrome), and 2 men developed rheumatoid arthritis. A causal relationship is difficult to establish because factors that could trigger these diseases are multiple, including genetic susceptibility, time elapsed until achievement of ideal weight, and vitamin deficiencies, among others. However, clinicians must be attentive to this possible association. -
June 2019!!! Surgery Siblings!!!
alex76 replied to BulletWithButterflyWings's topic in Gastric Bypass Surgery Forums
I'm tentatively scheduled for RNY on July 2, so I'll be quietly lurking in the shadows on this group. I can be like the a very distant cousin in your little family LOL I'm a teacher, so my bariatric team knew that I wanted a summer surgery. I'll be done with all of my requirements Monday April 29, so I'm a little ahead of the game. Good luck to us all! Sent from my SM-N960U using BariatricPal mobile app -
BCBSIL anyone? How long to approve?
alex76 replied to cubyblue6's topic in PRE-Operation Weight Loss Surgery Q&A
Definitely a long road, but it gave me a chance to make a lot of necessary changes. I also had a chance to read info on this site, listen to WLS podcasts, watch many episodes of 600 lb Life, so Ive seem the good and bad sides to surgery. It's a lot to think about. But I feel ready. Which surgery are you having? I originally was hoping to get sleeved, but my bariatric rn is a bypass patient herself, and she convinced me to get rny too. Sent from my SM-N960U using BariatricPal mobile app -
Patients screening for the biggest weight loss event
MoElShafie added images to a gallery album in Member Photo Gallery
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My largest was 28-30w, now in 20s just about ready to go down to an 18, 20s are getting loose, especially the slacks and jeans. My Goodwill just remodeled and moved into a new facility. They are going to gave a drive-thru drop off. In the old store you had to bring donations in the front door. People shopping could look and sneer at what you were bringing in. Never liked that! This way as I undergrew each size I ,packed it in a box so I have 5x,4x and 3x items as well as the corresponding in mens, often I bought my sweats in that department. All nice and clean , mostly Wal-Mart but a few from Lane Bryant or Added Demensions and one church outfit with Catherine's label. Really okay stuff. Kinda like not wearing the largest size each store carry. And pants slipping down and nearly falling off, "Oh Yeah Baby", to channel Austin Powers. And day by day I look less like a salami and more like a Human Female. Nobody will as me any more whether I'm Male or Female, my figure will end the controversy. Attempted to sell some of these on our local Buy- Sell- Barter- Trade radio show called Tradio. Put a reasonable low price, got 2 calls, one wanted 5x mens instead, sorry the man items I had were 3x-4x, the other claimed she would be buying them for her mother, gave her directions to my house but she never showed up. Wasted half a day waiting on her. Some bariatric Facilities have a Clothes Swap Area , you bring in what you have outgrown and exchange them for the same # in a smaller size. Wish mine would do that, but they don't seem interested or have the space to devote to it.
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I got my RNY surgery on April 1st. Im very heavy and I'm short so thats what I needed for optimum weight loss. My bariatric surgeon told me that they do tons of sleeve to bypass surgeries because the sleeves fail for multiple reasons. My sister in law got the sleeve 2 years ago and had major complications with strictures. Sent from my SAMSUNG-SM-G890A using BariatricPal mobile app
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Overeaters Anonymous - Should I go??
Danny Paul replied to mousecat88's topic in General Weight Loss Surgery Discussions
In May I will have been a member of OA for a year. I find the fellowship and comraderie a great source of support for me. There are people in my meetings that have had WLS. There are others who are working the steps. We don't read from the Bible. We use the AA Big Book. It isn't religious but spiritual and you can believe what you like as far as a higher power guiding and helping you. I have a sponsor who I call everyday and we go over the program and address any food concerns that I might have. I also call or text other members if I need additional support and they call or text me for my support. Together with my therapist, bariatric group sessions and therapist group sessions OA is an internal part of my recovery from my Compulsive Overeating. I had my WLS in August of 2017 by April of 2018 I had reached my goal weight. This April marked one year that I sustained that goal weight. I'm now working on year two of sustaining that goal weight. OA, for me is an important part of that strategy. It isn't for everyone. I attend three meetings a week. Sometimes we have as little as four people show up and there are times when 25 people show up. As long as there are two of us we can conduct a meeting. Like I tell my friends who have had WLS, if you are looking for a quick fix this is not it. It is a program that you have to work at to gain the benefits. I lived a long time with my compulsive overeating and I didn't know I had such a condition. Now that I know what I'm up against, I'm using as many tools to combat it. OA is one of them. I hope this helps. If you have any questions you can PM me. -
Happy to report I’ve been approved by my insurance for a panniculectomy and am also doing a full body lift and thigh lift at the same time in San Francisco. My plastic surgeon is affiliated with Dr Jossart, my bariatric surgeon and will pay $14k out of pocket for the additional surgeries that are considered “cosmetic”. I’ve lost nearly 180 lbs and really excited to see the results once I’m complete. My pre-op appointment is tomorrow and my surgery is scheduled for May 20th. On a side note I happened to meet Olivia Ward, winner of the biggest loser in 2011 at a SoulCycle class in Atlanta. She also had a panniculectomy, but wishes she’d done the full body lift. Excited to share my results.
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women over 65 that had 100-130 pounds to lose and care to share their success stories
Frustr8 replied to mermaidenlor's topic in Gastric Bypass Surgery Forums
Should still be some active on here, perhaps they will see your post and answer back. I'm only a bariatric cousin myself, a 73 year old RNY bypass last September 5th. -
Are you taking a good half hour to eat,? laying down your spoon between bites?, and they should not be bigger than a dime. You never can bolt down food like you once did. Pretend you are at the Dolls Tea Party. What still works for me is the 2oz cup of fluid every 15 minutes, that makes 8 oz in a hour. If you keep up for the 8 or so hours you are awake you will have fluid enough (64oz). I still. often will even do my protein shakes in that manner. Your tummy may not want the solidness of eggs, you can step back down to liquids, clear and murky soups, thin puree, see if that will stay down better. If you continue doing this you should bring your bariatric team into the loop. You could end up like me , 8 months out, still battling a strictured stoma to my pouch and multiple ulcers in my jejunem, the part of small intestine my pouch is supposed to empty into. And I still vomit,3 times this week, tried to introduce some tender ground chicken, Precious Pouch would have none of that so up it came. The next was trying to drink,instead of ladylike sips, and the 3rd? Don't really know why it happened just that it did. I still have pain over the location frequently. But I realize for me, it is what it is, and might as well accept and still move forward with peace and 😂 joy.
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I’m gonna order the one a day from Bariatric pal. I’m so happy for you! I’m struggling with this preop diet. It’s only a week. But, I ate a small piece of pizza last night. Oops!