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I would call back and insist that you be granted an appointment with the surgeon or the insurance coordinator. If they are that confident of the appeal, they may be able to instill that confidence in you. For other BC/BS patients out here - can you provide information on what state you are from & how you were approved? That may be good information for the surgeon to include in his appeal. While BC/BS are independent of each other - have similiar "franchise" coverage information in addition to medical support for the sleeve could be very beneficial in this appeal.

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.

So far, I've only told my husband, my parents, my sister and I'm telling my brother this week. They all love me and have seen me struggle my whole life with being overweight and they are very very supportive. I've told a couple people at work, but only bc I was hoping they could be banded along with me. Sadly, their insurance doesn't cover it and they can't afford to pay out of pocket(which i can't either, but luckily my insurance covers 100%) I'm worried about the people that are skinny and have never really had to deal with weight issues and the people that have at some point in their life been overweight and eventually lost the weight(whether it be by dieting and excercise or diet pills) I myself know I am not taking the easy way out(that was made even more clear in my 1st nutrition appt), but I know there is a certain stipulation by society that weight loss surgery is an "easy way out". I just feel I have dealt with criticism my whole life about being overweight and now I'm afraid I will get criticism for doing something about it. I have no intentions to lie about it, but I have no intentions of posting it on my twitter either...

Sorry but I would run far and fast from a surgeon who would say something idiotic like "your body is comfortable at 200 lbs." Find a surgeon who will work with you to set an ambitious and healthy goal and hold you to strict standards in reaching it, not engage in new age BS about where your body is "comfortable" or "happy."

Thank you so much. I've been a little discouraged today bc of it. I'm SO thankful my recovery has been smooth so far but I was a little concerned bc I don't "feel" different. I guess it's just a process of retraining my mind as I go? Sent from my SM-N950U using BariatricPal mobile app

Hey Jess! After reading your comment, it sounded a lot like me. I was considering the surgery and worried bc I haven't been to the doctor in years and "my insurance won't pay". What insurance do you have? In most cases your insurance requires 2 to 5 years of medical records, but you can use your jenny craig as records too. Don't be discouraged! I'd look into different weight loss surgeons in your area. You have nothing to lose! :thumbup: Good luck!

Hi my name is rose I'm new to all this but I'm post op day 3 and have the most uncomfortable gas pains and I walk a lot! I see I'm struggling with fluids and broth bc I'm not hungry so if anyone has any pointers please fill me in???? I did the sleeve and I'm happy with my choice but I feel like this week is gonna be hard bc I'm on clear liquids and I'm allergic to Aspartame, so my choice are limited! Please help with ideas on staying hydrated and energized!

Congrats!! I cant wait to get the call with my surgery date but i have 2 more months of nutritionist appts!! Got delayed by six months bc my mom fell ill. Feel like goin to mexico and paying out of pocket to finally get it over with!! I want to lose a good amount of weight before summer!!!! 😧

Science of food and nutrition is sketchy at best. every year they re-define what was previously 'obvious' knowledge- saturated/unsaturated fats and cholesterol for example. Remember the low fat diet of the early 90s? Phen-phen (I think?) oh and calories in = calories out. I call total BS on that one. Not all calories are created equal. So this stall notion.. Who knows... No one has it figured out yet.

My name is Ashley and I'm a 25yr old mother with a wonderful son and a amazing husband. My husband loves me the way I am but sees that I need to get healthy and get some of this weight off. He sees that it is starting to affect me. As a child I was never overweight until I hit puberty then it all went down hill. I was very athletic and fluctuated between 160-180, until I got pregnant with my son when I was 20. I have never been able to get the weight off. I have been at my highest these past few years, 275lbs. My self - confidence has always been an issue for me, but i have been working on it and all i want right now is to lose this weight and be healthy, being skinny wouldnt be a bad thing either. :tongue_smilie: My weight hasnt caused any other health problems yet but i dont want to give it a chance to. The only thing that it has affected is my ability to get pregnant. My husnband and i have been trying to get pregnant for 4 years now with no avail. :thumbup: My insurance makes you go through a 6 month diet program and if you miss one visit, bc you have to go every month, you have to start all over. needless to say that i have had a rough time bc when i started the program eveything was great at home then my husband lost his job and with only 3 months left to go i had to start the 6 month diet program all over again. so i started my journey back in 3/2009 and i just finished the 6 month diet program and got approval. my dr. requires a liquid diet for 2 weeks before the surgery with the optifast shakes and i am on day 4 with the shakes. all you can have with the shakes is sugar free calorie free drinks, popsicles, and jello. have you ever taste sugar free jello? its disgusting!!! i can also have broth if i get lightheaded or anything. the first day was hell for me. all i wanted to do was eat. i was exhausted and felt like crap. i went home and my family was having bbq chicken and yellow rice. i stuck my finger in the bbq sauce then made a cup of broth and cried myself to sleep. my husband is very supportive of me in doing this. he knows its something that i want BAD. so he was there to comfort me and tell me i could do it and it will be ok. it has gotten easier with each day but yesterday i wanted a smoothie soo bad i was good and didnt get one. when i got home i went with my husband to the store and he ran to bk. i told him i didnt want to go bc this is soo hard but we went ahead and went and my husband asked me if i wanted anything. i just looked at him and started crying and then it dawned on him what he did. he kept apologizing which made me cry even more and then i was able to calm down but as soon as i went home i went to bed. i dont blame him for it and i know he didnt do it on purpose but it still hurt somewhere inside. todays day 4 and like i said its gotten easier with each day so im hoping todays a good day.

well i just wanted to send an update on what happend when i had the my second stricture procedure yesterday. i went in and had my stricture stretched to the maximum 20mm. that's the good news. the bad news is that once he did this he noticed i have a kink in the middle of my stomach from the way it healed after surgery in december 2011. so, if i am still unable to keep my food down it is no longer because of the stricture since that has been stretched to the max it will be because the food hits the kink and and cannot make the bend. i am on 4 more weeks of soft/pureed foods then i go back for my recheck. of course if i am still getting sick then i will have to go back to my origional surgeon i guess to have the kink fixed. please keep postitve thoughts that i will be able to keep my food down and not need to have the surgery to fix the kink. that would be inpatient at the hospital and i really don't want that. the dr. said because of the kink i will always have to eat 6 meals of no more than 4 oz and i will always have to make sure to take VERY small bites so that it will have a better chance of passing the kink. he said i will also have to be very careful with what food i eat to ensure that i can get it chewed enought to pass by the kink. gees if it's not one thing it's another. who would have thought i'd get hit with 2 complications from it. i would still do it all over again just would like to do it without the stricture and kink! i'll keep updating if anything new happens over the next several weeks. but i hope to have an uneventful 4 week of soft/pureed meals. i am so very thankful that i am not hungry or by now i would have gone mad only eating such a limited food choice for almost 19 weeks now. my focus over the next 4 weeks will be fluids, and trying to get my protein in. i don't want to have to have a 4th procedure and i don't want to become any more malnursihed then i already am at this point because they have tossed the phrase iv nutrition around if i cannot get my numbers up from eating over the next few days. sleeve patients cannot be tube fed because we don't have enough stomach to handle that type of feeding so that only leave iv nutrition and it's pretty expensive. so i'm trying real hard to focus on just getting the food to stay down and eat has high protein count and i can handle.

My first appointment with my surgeon is on July 14th, so I have a good 5 weeks. I would like to use this time wisely. I don't feel the need to go on weeks of food funerals, though I am sure I will have 3 or 4 favorite meals during this time. But how else can I best use the time til mid-July? Here's what I am in the process of doing now: I have read several books and am well versed on the different surgery types, am uncertain btw. sleeve and RNY, will rely on physician input once he sees the whole health picture. I am seeing my primary care doc on this month to officially record starting weight, and let them know I am getting WLS. I will attend support group meetings. Am getting my psych eval done this week. Trying out different protein products. So I guess the big question is, do I start serious, low carb, dieting now, in the meantime? I am the type who can lose 20 pounds fairly easily, but then....I stall, and I stall HARD, and then I usually get sloppy and start slowly regaining. So I am a little worried about losing my 20 easy pounds, showing up to the surgeon mid-July and he says, hey lose 10% of your body weight before surgery please, and then I am stuck "starting over" right in the really hard part of every diet I have ever been on. Maybe I am whining here? I would like to do everything I can to get a head start before that first surgeon appt, since I'd like to do the surgery as soon as I can bc of work cycles (I work in college administration). I supposedly have no mandatory diet and exercise waiting period (we'll see on that....). I figure that starting to lose weight now will just mean it's some weight at least that I don't have to lose later, so maybe I should just jump in and diet? Try bariatric recipes? What do you recommend? Thanks for any input or advice.

I have BCBS NC and that code is covered. I know each insurance is different, but I was given a CPT code of 43659, which is also a covered procedure. I looked both of them up (https://catalog.ama-assn.org/Catalog/cpt/) - and the description for 43843 is "Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty " and the description for 43659 is "Unlisted laparoscopy procedure, stomach." You might contact your HR department, too. Find out if the fed is self-insured. I work for a municipal government and we are self-insured. That means that the city itself determines what coverage is offered and BCBS administers the insurance. If you're willing to discuss it with your HR rep, they might be able to help you out. I'm not sure if any of this will help you at all. Good luck!

I gained 3 lbs in hospital bc of the fluid retention from IV. By end of first week was down 15 lbs. it leveled out in week 2, been steady at .5-1lb per day as I move into week 3.

YES!!! This is exactly how I’ve been doing it. My mom had the sleeve done and there have been times when I’m crying bc I want something off my diet and she keeps saying “be good to yourself.” So I bought an airfryer and made my favorite thing for dinner tonight: Chicken Parm. Homemade gravy, fat free cheese, air fried and breaded in branflakes!! Was a great variation of my favorite food. Buying an airfryer was a great idea bc I don’t miss out on my favorite foods!!

Dang, Anthem BC/BS finally,came through for you! So do you also have a surgery date given? Or,Oh No, you have to wait somemore-' this time for the surgeon's office and/or hospital . You either are going to have your hair turn gray or you will be bald from tearing your hair out by the roots. Well you have the right person talking to you, I started on my journey in August 2015 and it isn't over yet The old joke was: it ain't over until the fat lady sings" well I AM a fat lady and I haven't burst into song yet, in fact I haven't even sat down at the piano🎹 yet. La la lal!!!😛🎵

Thanks for all the well wishes everyone! I've actually been doing alright - not too hungry, bit of a gas pain everyonce and a while still but I also know I haven't been walking as much as I should (and to top it off it snowed today lol). But I'm doing alright! Looking forward to moving onto the full liquids stage as the Clear Liquids is starting to get a bit boring. Today was a quiet day so even for day 3 post surgery, it wasn't too shabby. I did however get to take a shower today - first day since surgery that I was allowed and well - that was quite the experience. We just have a stand up shower stall so DF stood at the open door and took a wash cloth to all the iodine, etc on my belly. The Water wasn't super hot the way I usually like it as I thought it was probably not a good idea on my tummy. I had just finished washing my hair and rinsing it when I knew bad things were about to happen. I think it is from a lack of calories/nutrients and the hot water as I opened the door and told DF "must sit now" (he was waiting outside the shower for me in case I needed him) as I knew if I didn't sit down I would have passed out in the bathroom (which isnt very spacious). So dripping wet I made a beeline for the toilet seat and had to sit there, leaning against him while the dark cloud came over me (I don't know if any of you have ever passed out before or almost passed out - but it's not fun). This is not a feeling that I am a stranger too and I knew the signs that it was coming - I've had issues with this since I was a kid (blood tests come back fine though everytime and it's VERY sporadic and occasional). I was leaning against him and I think I did actually pass out (wasn't from pain as I wasn't in any) leaning against him. When I was able to we got me to the bed, I lay down and just chilled there for about an hour. So note to everyone, if your low on your calories/blood sugar, careful with warm showers as that is usually what triggers me on my "near black out" moments, and post-surgery was no exception. On an exciting note - my official "weight day" isn't until Wednesday so I am not updating or putting it on my tracker but so far - down 8 lbs since surgery on the 23rd. I realize that I will likely gain some of this back once I start mushies but I'll be so damn happy to have mushies I don't think I will care!! Hope everyone is doing well! *big hugs and well wishes to you all* It's actually been my experience (as well as that of friends) but also what has been told to me on more than one occasion by doctors. Thank you! If you check out the Canada boards there is a group that posts under different threads related to BC Bandsters, you should check them out some time. None of the lapband procedure is covered by BC Medical unfortunately, and likely won't be any time soon. Gastric Bypass is covered but I believe the waitlist is about 6 years now for it if you have it paid for by medical. I don't know if he does bypasses or not (I don't think he does though) but he does do the "sleeve". His cost is $400 consulation fee (first time you meet with him) and the cost of the surgery is $14,000 (includes free aftercare fills no charge for them). I believe he is accepting patients you just have to call and ask how to go about getting a consult (they send you a questionnaire to fill out) - I'll pm you his number. I will say though - if you are seriously considering the band and have the money to self pay - give it great thought before going to Mexico or the US at this point. Not due to lack of great surgeons but due to there not being very much aftercare options in BC right now. Dr.Leung in Surrey also does the lapband and WILL NOT accept any other surgeons patients. Dr.Woodhead *may* and I say that with great emphasis as I know he prefers not to as well. Other than that, your only other option for aftercare would be to travel to Everett area in Washington to one of the fill places there. So be sure you check out all of your options before settling on a location/surgeon. I would have loved to go to Dr.Kirschenbaum in Denver for a cheaper price but figured by the time I have to go through the hassell and paying for fills (most places charge $150-200 in the states , per fill) that it wasn't worth it and that it was worth shelling out the extra $5000 up front. Good luck on your journey and decisions, feel free to message me at any time. :cursing:

I didn't find it pornographic in the least. I think your writing style is unique and relatable. I, myself, had a long standing love affair with B&J, but the guys kept putting my flavors in the graveyard. Oh, how I mourn the loss of From Russia With Buzz. After our affair ended, I spent nine years bouncing around the same twenty bloomin pounds and now, fed up, I am finally going to get banded on 5 January.

I have only been under twice in my life (within the last 4 years both times) and it always goes like this: I wake up, I am crying tears and I feel pain and the nurse asks why I am crying , but I can't really speak bc my throat is so dry. I choke out an "ouch" and they know why. Then when I am in recovery it is amazing how I am aware of everything going on and can hear everything, but I feel like I am in a coma. My last surgery (not lapband), the nurses couldn't figure out what kind of surgery I had done, so they were standing there in front of me, talking about me, where to put me, what meds should they give me, etc and I could hear everything, but couldn't speak up or open my eyes. It was quite frightening!!

Awwww that sucks. Hopefully u get that all cleared up. When you first started the process they didn't give u a written list of requirements? If so and that's not on there than they can't just spring it on you. I submitted my papers to both my insurance n the hospital August 15 n good thing I did bc I called my insurance company on Monday n they said they r waiting on the clinic and so after I called the clinic n they said the nurse is reviewing the psy eval n then they can submit to my insurance I was like ummm I'm one step ahead I already did they just waiting on you lol. So I wish u good luck!!!

Thank you so much. I'm so tormented by this weight. I think once I finally got the courage to ask for help and decided to have WLS I realized how fed up I really am and how it really is effecting so many aspects of my life and the lives of those around me.

HiI Everyone! So I went to my nutritionist today to ck in and it'll be 3 months since my surgery nxt wk. Ive had a 1cc fill about a month ago and I've lost 10lbs (I was careful to NOT say ONLY 10 lbs bc it's a loss nonetheless!) anywho in reviewing some bloodwork I did about a month ago she said my thyroid is out of control...(hypo).. I'm going back to see the MD nxt wk to see if medication wb required but I've been diagnosed before (2010) as "intermittent hypothyroid" most annoying diagnosis ever.. However THC levels have only gotten worse post surgery.. I read that having surgery, stress and other factors can trigger the hormonal imbalance.. Has anyone else experienced this? Where you put on meds? Had surgery to remove thyroid/did it help? Change of diet? Any info would be helpful.

What's really wild? My great grandparents (Slovakian immigrants) planted a poppy field JUST to make this old world bread (and of course planted it by the road to share the pretty flowers with their neighbors)...and got visited by the feds because their dozen children were out there barefoot working the fields and neighbors driving by got concerned. LOL No, officer, our children are not opium slaves, we are making tasty sweet bread. That said....this is some addictive freaking bread.

My insurance company (Empire BC/BS) approved the procedure as an out-patient, but my doctor says IT WILL be medically necessary for me to spend the nght.

At my psych eval today he said i shouldn't deprive myself and that the first 2 bites are the best the.rest is really pointless and ur just eating it just bc i heard that some where before i hope it helps me i did bad this week food wise bc its that time of the month and i just want chocolate but......Im bk on track