Down but not out

[NikiS 31]

Ok, so the nurse just called me to give me the news. Unfortunately, I will not be having my sleeve surgery I have a BMI of 44.6 and BCBC just updated their requirements for bariatric surgery in Pennsylvania. The potential patient must have a BMI greater than 50 along with other extenuating circumstances, none of which I have. Even after mentioning my family's history with hypertension, high blood pressure and diabetes I was told because I didn't have any of those things, that didn't necessarily have to be my fate. I told the nurse that I still may be interested in the psych eval, seeing the nutritionist and taking the class and she said I could but because BCBS was very clear with their directives to the point of having a 2 day seminar about their new guidelines, if I did proceed my surgeon wouldn't even do a peer-to-peer on my behalf because he wouldn't have a leg to stand on. The nurse did tell me that although I was turned down for the sleeve I am approved for the Lap Band or Gastric Bypass, both of which I have absolutely no interest. So, I guess I could say here is where my journey ends but I refuse. I was and am looking forward to a healthier way of life and with the surgery I would have to learn and discipline myself to exercise and eat healthy and so that's what I have resolved to do in light of not having the surgery. My sister is a member of this site (thickinphilly) and I will be experiencing the surgery vicariously through her...and through all of you. Onward and upward!! I wish you all the best of luck and I continue to look forward to reading your posts, sharing and learning from you all.

God bless you,

Niki

[Brooklyn732 7]

Wow. So sorry to hear this. Hang in there. You were the first person to welcome me here so I want to return the favor by showing you some love. What's important here is that you are committed to making this journey work no matter what. If you've already started cutting bad habits out of your life, then keep doing it. If you have increased your Proteins and changed what your meals look like then keep doing that. If you've started walking or exercising, then keep doing that. Don't give up. You can do it. And use your sister as a support system and be one to her too. Good luck to you. I'm sure as hell gonna keep you in my prayers. And hey, look at it this way, the end of the year is coming up and most companies start their open enrollment for insurance carriers. Do some research and see which carriers cover the sleeve and maybe you can switch to them.

[juliarh 35]

I know this is a wild shot, but have you thought about having surgery in Mexico? I know it would be out of pocket, but so many people here have had such good experiences. I know a couple of people on this forum took out small loans to cover the cost as well. Just throwing it out there just in case . . . I hate to see you lose out on this opportunity because your insurance company is so dumb. (sorry, but they are.)

[LilMissDiva Irene 3,282]

Awww Niki, I'm so sorry to hear about this. Wow BCBS is TOUGH!! That is wrong on so many levels.

I agree with the above poster(s)... check to see if there are other health plans that your employer uses (Kaiser?) and switch to them - or there is always Mexico. I took a loan out to get my surgery, I went there and havent regretting a dang thing.

All the best!!!

[M2G 1,836]

Wow, that is an incredible blow. I'm so sorry.

I like the title of your post, down but not OUT. I agree with everyone else that self-pay or surgery in Mexico is an option you might want to consider. I have been reading the book called "The end of overeating" by David Kessler and it basically has nothing to do with WLS. It is all about the food industry their manipulation of food to make it hyper-palateable, and how our own brains respond and we become chronically hyper overeaters. It has some really great advice about eating less (again nothing to do with surgery) but it might help give you some direction and a plan to follow.

Hugs, I'm sure this was a huge dissapointment. I'm glad you can be a support for your sister, THAT is wonderful. I wish you both the best.

[christina@MIA 12]

Ok, so the nurse just called me to give me the news. Unfortunately, I will not be having my sleeve surgery I have a BMI of 44.6 and BCBC just updated their requirements for bariatric surgery in Pennsylvania. The potential patient must have a BMI greater than 50 along with other extenuating circumstances, none of which I have. Even after mentioning my family's history with hypertension, high blood pressure and diabetes I was told because I didn't have any of those things, that didn't necessarily have to be my fate. I told the nurse that I still may be interested in the psych eval, seeing the nutritionist and taking the class and she said I could but because BCBS was very clear with their directives to the point of having a 2 day seminar about their new guidelines, if I did proceed my surgeon wouldn't even do a peer-to-peer on my behalf because he wouldn't have a leg to stand on. The nurse did tell me that although I was turned down for the sleeve I am approved for the Lap Band or Gastric Bypass, both of which I have absolutely no interest. So, I guess I could say here is where my journey ends but I refuse. I was and am looking forward to a healthier way of life and with the surgery I would have to learn and discipline myself to exercise and eat healthy and so that's what I have resolved to do in light of not having the surgery. My sister is a member of this site (thickinphilly) and I will be experiencing the surgery vicariously through her...and through all of you. Onward and upward!! I wish you all the best of luck and I continue to look forward to reading your posts, sharing and learning from you all.

God bless you,

Niki

Niki, You have a great attitude! But unfortunately for us that struggle with weight loss it's just not that easy to eat right and lose weight. You need this tool! Please look into going to Mexico! In the end the price you will pay is nothing. I paid $5200. I put it on my credit card and will pay it off with my taxes. In a year it pays for it self. Think of what you spend on food, diets, weight loss products, Dr bills you will pay for poor health. Beg, borrow, steal! Just get it done.

Oh my flight tic from florida round trip was $340.

If you need any info on Mexico, call me. 561-714-9946.

[sleeve 4 me 910]

They want a BMI of 50 or greater??? They are crazzzy!

I love your attitude though ...I believe when one door closes, another door opens. God knows all things . Hold on, I'm sure something will come together for you!!!

[LilMissDiva Irene 3,282]

Sleeve that is exactly how it happened for me. It was pretty incredible. The path just opened wide up for me to get this surgery, with money, time off all that.

Keep the positivity Niki - you never know what the future holds!

[mp8btpc 33]

Mommy2Girls: i just purchased that book on Half.com after I read your post.

Niki I am sorry to hear about the requirements for the sleeve being so difficult. I am surprised that they feel that Gastric Bypass is a better option to people who are at a lower weight. ODD

I hope that you are able to figure something out and continue on your Quest to get healthier.

BIG HUGS

[NikiS 31]

Hi Christina! Thanks so much for reaching out and for the encouragement. My sister brought up the subject of Mexico to me and even said she'd go with me if I decided to go there for the surgery but I told her I'd needed to think about it a little more before deciding. It certainly is doable and like you, if I decided to go in that direction, I could pay for it now and reimburse my card with my income tax. Hmmm. I'll let you know. Keep a look out for me. I may be calling you soon with a few questions

Thanks again and I'll keep you posted.

Niki

[NikiS 31]

Thank you so much! I will certainly check that book out. I want to explore all of my options...anything that assists me with my ultimate goal which is being a healthier me is great!! Initially, I was saddened and extremely disappointed but honestly, not for long. The surgery would have been great but the closing of that door won't deter me. Mexico is an option, one that I'm considering, but until I am concrete in that decision I'd like to try dieting, moderation, and exercise one more time. Wednesday (10/20/10), I called and made an appointment with a nutritionist. My appointment is today at 6 PM.

Thanks again, and I'll keep you posted.

Have an awesome day!

Niki

[NikiS 31]

Hi Julie. I was so excited when I first started this journey - and I still am - because I was told BCBS was one of the more lenient insurance companies compared to Aetna and a few others when it came to approval for WLS. Their requirements weren't as strict so I thought it would be easy breezy....ha! I guess I can't really be upset with them either... rules are rules. Mexico is definitely a thought, but at this point it's just a thought. I have a few other options that I'm exploring right now. I'm sure in time I will be posting my after picture. LOL, that means I'll need to posts before pictures too

Blessings,

Niki

[YOLANDA240 13]

Ok, so the nurse just called me to give me the news. Unfortunately, I will not be having my sleeve surgery I have a BMI of 44.6 and BCBC just updated their requirements for bariatric surgery in Pennsylvania. The potential patient must have a BMI greater than 50 along with other extenuating circumstances, none of which I have. Even after mentioning my family's history with hypertension, high blood pressure and diabetes I was told because I didn't have any of those things, that didn't necessarily have to be my fate. I told the nurse that I still may be interested in the psych eval, seeing the nutritionist and taking the class and she said I could but because BCBS was very clear with their directives to the point of having a 2 day seminar about their new guidelines, if I did proceed my surgeon wouldn't even do a peer-to-peer on my behalf because he wouldn't have a leg to stand on. The nurse did tell me that although I was turned down for the sleeve I am approved for the Lap Band or Gastric Bypass, both of which I have absolutely no interest. So, I guess I could say here is where my journey ends but I refuse. I was and am looking forward to a healthier way of life and with the surgery I would have to learn and discipline myself to exercise and eat healthy and so that's what I have resolved to do in light of not having the surgery. My sister is a member of this site (thickinphilly) and I will be experiencing the surgery vicariously through her...and through all of you. Onward and upward!! I wish you all the best of luck and I continue to look forward to reading your posts, sharing and learning from you all.

God bless you,

Niki

Niki, great attitude! I'm sorry BCBS are a bunch of butt heads, but Mexico may be a great option. Just know any decision you make you have support from your sister and this forum. Good LucK

[Kimmysil 0]

Wow! so Sorry, I have KHPE which falls under BCBS and I was approved for the sleeve but I do have sleep apnea and high blood pressure. Are you sure you dont have sleep apnea? Did u have a sleep study recently? I'm sorry and I bumbed for you. If you can put it on a credit card and go to Mexico like the other woman did they I would do that. I've said for a year no I'll join WW's and I'll exercise, etc...blah blah blha and I gained more weight. Just consider all your options!!

Good luck

Kim