Brand Spankin' New all of this! Guide me!

[Alisomniac 0]

Hi!

I just started with these forums, and in my own journey. I've been fat for a number of years (about 7), and before that overweight for 2-3 years and chubby since late childhood (about 10 years old). I'm currently 27 - nearly 28 and am beyond ready for the life change. Being fat feels like my life has been on hold, or even rewind at times, and I'm ready to be a healthy adult, where the daily indignities of being fat aren't ruling my life... the little things like being stared at in the grocery store or mall, or having a less than eventful romantic life.

I saw my PCP (Family Doc) 3/29 and asked for a referral for WLS (Lap-Band; I'm not comfortable doing something that is not reversible). He sent me for a battery of blood tests the same day. My results will be posted in my stats.

Stats:

5' 6.5" tall

280 pounds - 4/15/2010 (BMI 44-ish)

Blood Pressure - 130/80 (mildly high)

Blood Tests indicate Insulin Resistance/Pre-Diabetes

271.5 pounds - 4/28/2010 (BMI 43)

Called the Doc today (4/28/2010) and he has yet to place the referral, but the front desk told me they'd take the message and he would call me back by the end of the week.

My questions - some to him and some to y'all -

1. Does he refer me to a surgeon who will make a referral to insurance or does/can he make the referral directly?

2. What are my chances for approval?

3. What are the approval timelines from inital visit to insurance OK and surgery date?

4. What are the pre-op tests and hurdles to jump through? Are all of them mandatory? (Like the shrink and sleep studies) or are some optional or only for people who are borderline approvable?

5. How do you KNOW how much is the food limit?

6. What exactly can you eat in each of hte post-op phases? Is it really nothing but broth on the thin liquid phase?

7. How long until I can be back at work?

are there any questions I should be asking?

More about my situation: I have Federal Blue Cross/Blue Shield of California HMO. I live in Southern California. I am currently dieting on a modified South Beach Diet. I don't have a recorded or "official" diet history, but I have been dieting for the greater part of hte last 5 years... mostly SBD, and always plateauing at -20 lbs.... and it is nearly impossible, no matter how hard I diet and exercise to lose even that much. I do have a few FitDay - Free Weight Loss and Diet Journal diet journales, but am pretty spotty about keeping it up.

(My hope is, barring any insurance snafus to get banded in August- when I turn 28 - unlikely I know - or by Thanksgiving at the latest ideal date. Do NOT want to wait until 2011.)

[CarolWA 0]

Hi Alisomniac,

When I started this journey, I called my insurance company and found out exactly what I needed for my surgery to be covered. They sent me all the papers I needed, to know what they expected of me.

I have regents/blue cross and had to have a year of seeing a dr. or nutritionalist for my weight. So I've had a long journey.

I had so many test. sleep apnea, colonoscopy, lung tests, blood tests, ultra sound, EKG, and of course the phyc eval.

These are not required by insurance in most cases. I think it's the dr. decision, and they are all different. Mine is a real stickler. I'm on my pre op diet now, and it's nothing but sugar free pops, sugar free Jello, strained Soup, and 3 Protein Drinks a day. Tons on Vitamins.

Some people on this forum get to eat like a lean cuisine meal each day with their Protein drinks. I would love that.

Does your insurance even require you to have a referral?

Mine didn't. I just did a lot of research on wl drs. and picked one. Then attended his seminar. I think most of them have seminars.

My surgery date is May 6th, and I didn't think it would ever get here.

I wish you luck on your journey, but unfortunatly, it will probably not be as fast as you would like it to be.

[Nean4488 1]

1. I made my own choice on what surgeon I wanted, I researched the ones in my area and found one I liked, went to meet with him and and loved him. I haven't included my normal doctor in any of this.

2. It depends on your insurance. My surgeons office was pretty positive I would get approved with my primary insurance and denied with my secondary, and that is what happened. If you meet the requirements and your policy covers WLS then you should be good to go!

3. Its different for everyone. (look at my sig and it should tell you my times)

4. The only tests I took were metabolic, ekg, and a blood test. But there has been people that have had to take so many more.

5. Thats a great question.. as soon as I am banded ill let you kno!

6. For me, my doctor lets me eat only liquids for the first week, Soups, Protein shakes, Jello. More then that, but those are the basics. Then for week 2 and 3 im on to mushies/puree. That gives you a little more options. Then week 4 im allowed to eat solid foods again but have to be very careful!!

7. It seems a lot are back within a week, my surgeon suggests that everyone takes off a week but he says a lot of people are ready to go after 4 days. It all depends!

I would say to go talk to a surgeon, ask them all these questions and more! It wont hurt to go talk to someone and see if this is the right thing for you.

Good luck in your journey!

[Alisomniac 0]

Just got the denial letter from insurance, stated I had not shown proof of past diets etc... even though I had given my history to my doctor... so now I'm formulating my appeal, contacting insurance and trying to figure out the next step.

discouraging, but hopefully this actually makes ultimate approval easier. :biggrin: