MelissaAnd 3 Posted February 11, 2011 I had to jump through a few hoops because my insurance company did not want to accept my condition of sleep apnea as a comorbitiy. My BMI was only 38. That was in December. First denial came 12/14/2010. The doctor told me I could just add 10 pounds and then I should have no problems. So, I enjoyed my holidays thoroughly and ate whatever I wanted and as much as I wanted. I started eat all the things that I know are not good for me in hopes that I would gain those extra pounds. It sounds silly to gain weight to have weight loss surgery and I have been criticized tremendously by family, friends and strangers! However, they do not have to sleep with a CPAP every night so that they won't stop breathing, they are able to enjoy all the activities that I miss out on due to my asthma and weight, and they are all so quick to say, "You don't look 100 pounds over-weight. You aren't big enough for surgery. You should just go on a diet!" HA! I have tried every diet out there and I do loose on them, but only about 25 pounds and then nothing for months! I went to my doctor this week and weighed in after drinking about 3/4 of a gallon of Water and wearing my heaviest clothes. I was so happy when I was over by 3 pounds of the required weight that my insurance company set! The doctor's office submitted my paperwork yesterday and they called me today to say that insurance APPROVE ME! My surgery date is very quick. I am set to be sleeved on Monday, February 28, 2011 by Dr. Ludwig in Chico, CA. I am so excited! And I can't wait for day that will change the rest of my life forever! I couldn't be happier! Share this post Link to post Share on other sites
Oopsseedaisy 90 Posted February 11, 2011 I am so glad you are going to be able to have your surgery. And am very sorry you had to go to such measures to get your insurance company (that you pay) to finally work for you. Share this post Link to post Share on other sites
Margaret 4 Posted February 11, 2011 Congrats to you! The naysayers really do get in the way of the entire process, in my opinion! My surgery hasn't happened yet, but my surgeon did tell me he didn't want me to lose too much weight beforehand. That's a FIRST from a doctor! Hilarious. A sense of humor will save your life. Keep us posted. I had to jump through a few hoops because my insurance company did not want to accept my condition of sleep apnea as a comorbitiy. My BMI was only 38. That was in December. First denial came 12/14/2010. The doctor told me I could just add 10 pounds and then I should have no problems. So, I enjoyed my holidays thoroughly and ate whatever I wanted and as much as I wanted. I started eat all the things that I know are not good for me in hopes that I would gain those extra pounds. It sounds silly to gain weight to have weight loss surgery and I have been criticized tremendously by family, friends and strangers! However, they do not have to sleep with a CPAP every night so that they won't stop breathing, they are able to enjoy all the activities that I miss out on due to my asthma and weight, and they are all so quick to say, "You don't look 100 pounds over-weight. You aren't big enough for surgery. You should just go on a diet!" HA! I have tried every diet out there and I do loose on them, but only about 25 pounds and then nothing for months! I went to my doctor this week and weighed in after drinking about 3/4 of a gallon of Water and wearing my heaviest clothes. I was so happy when I was over by 3 pounds of the required weight that my insurance company set! The doctor's office submitted my paperwork yesterday and they called me today to say that insurance APPROVE ME! My surgery date is very quick. I am set to be sleeved on Monday, February 28, 2011 by Dr. Ludwig in Chico, CA. I am so excited! And I can't wait for day that will change the rest of my life forever! I couldn't be happier! Share this post Link to post Share on other sites
InProgress 3 Posted February 11, 2011 I, too have been told not to lose too much weight. For my insurance the sleeve is only covered at a high BMI so I have to be sure to stay above that. It seems so counterintuitive! Luckily I don't have to gain anything but I'm not going at it (losing) hardcore either. Since I'm still down about 40 pounds from last fall I tend to justify my lack of "diet" now with that loss. Good luck! Share this post Link to post Share on other sites
LilMissDiva Irene 3,282 Posted February 11, 2011 Hi Melissa! Wow, sounds like you really struggled to get qualified! Don't worry about that on the serious side. I was sleeved in September and I was very restricted during the holidays - so I couldn't eat but a bite of this or a taste of that. I kinda felt I missed out on a lot. I'm happy you were able to enjoy one last Holidays with a normal stomach. You're also quite lucky you got your date so quickly! Get ready because it will get here VERY fast. Enjoy the ride!!! Share this post Link to post Share on other sites
MelissaAnd 3 Posted February 12, 2011 I am so glad you are going to be able to have your surgery. And am very sorry you had to go to such measures to get your insurance company (that you pay) to finally work for you. I couldn't agree with you more about the insurance company! We have been with the same insurance for over 10 years. You would think that they know we are loyal customers of their coverage and that we are not going to skip out on their policy after the surgery! They are all about making money off of their policyholders that their quality of customer care is really going down the drain! We pay a large amount each month, of which some is reimbursed by my husband's employer, but it still leaves us a considerable payment. It was a struggle, but at least it wasn't too long. I have friends that have fought the same company, Anthem Blue Cross for months or even over a year! I feel lucky and fortunate to have been able to "tweak" their system to get the surgery that I do need! Thank you for your support:)! Share this post Link to post Share on other sites
MelissaAnd 3 Posted February 12, 2011 Congrats to you! The naysayers really do get in the way of the entire process, in my opinion! My surgery hasn't happened yet, but my surgeon did tell me he didn't want me to lose too much weight beforehand. That's a FIRST from a doctor! Hilarious. A sense of humor will save your life. Keep us posted. It is so easy for others to criticize when they are not in the same shoes as one of us! I have gotten to the point where I don't say a whole lot to anyone about what is going on, other than my friends who do support me as well as the few family members that show support. People who are ignorant to what this surgery provides, which is a weight-loss tool, are too quick to say that it is an easy way out. HA! I am fully aware of the commitment that is takes to have this done and that it will entail my entire life to use the tool successfully to get to the healthy weight that I need to be. It is not an easy fix and it definetly is not the easy way out! My doctor was great about the whole thing! He also has a good bedside manner and was open with me from the beginning. He predicted that the insurance company would hassle me as this particular company tries to get out of anything that they can. He also told me that now until surgery to follow the liquid diet beginning next Friday, but to be careful not to loose a large amount of weight. In other words, he was telling me to cheat a little so it won't be so obvious! I love a great sense of humor! Share this post Link to post Share on other sites
MelissaAnd 3 Posted February 12, 2011 I, too have been told not to lose too much weight. For my insurance the sleeve is only covered at a high BMI so I have to be sure to stay above that. It seems so counterintuitive! Luckily I don't have to gain anything but I'm not going at it (losing) hardcore either. Since I'm still down about 40 pounds from last fall I tend to justify my lack of "diet" now with that loss. Good luck! It is pretty ironic to have to put on weight or maintain an adequate weight in order to qualify for weight loss surgery. All of the doctors that I see, who supported my decision 100% and wrote letters in support of my choice, were all surprised that the insurance company didn't accept my sleep apnea as a comorbid condition for the lower BMI, even though it is clearly listed in the policy as an acceptable condition. Their response was that it was not severe enough! My sleep doctor said, "How much worse do you have to be? You are already using a CPAP machine with a moderate pressure to maintain an open airway during sleep!" He, too, is fighting the same insurance company on different issues. Now, I just have to sit and wait until my surgery, which is not too long, and hope that I don't loose much weight in the meantime! I know that it will be so worth it in the end. So, I continue to stay positive and focus on my outcome! Thank you for the support and for sharing your struggles, as well! The best of luck to you, as well:)! Share this post Link to post Share on other sites
MelissaAnd 3 Posted February 12, 2011 Hi Melissa! Wow, sounds like you really struggled to get qualified! Don't worry about that on the serious side. I was sleeved in September and I was very restricted during the holidays - so I couldn't eat but a bite of this or a taste of that. I kinda felt I missed out on a lot. I'm happy you were able to enjoy one last Holidays with a normal stomach. You're also quite lucky you got your date so quickly! Get ready because it will get here VERY fast. Enjoy the ride!!! A girlfriend of mine also had surgery near the end of September, only she had the roux-en-y procedure. She said her holidays were pretty much like what you explained. We joked about it and I told her that I would eat all the "bad" stuff for her! We had a lot of fun with that. She said it helped make her stay more focused because she hated to see me have to go through all of that. It was very comforting! My family asked me who was going to cook next year, as I always make Christmas dinner. I told them that even though I will be limited on what I can eat and how much, that I still plan to make their dinner as special as always! I just might add a few items that I can have. So funny how people worry so much about food! I was one of them! The date is definetly coming up VERY fast! I am so excitied! Thank you and I wish you continued success with your weight-loss:)! Share this post Link to post Share on other sites
renniemommie 8 Posted February 12, 2011 I discovered that I'd shrunk during a annual exam. Going from 5 10 to 5 9 was enough to knock me into 40 BMI, that is what got me started. All this time I was going on my old height! So when I went to the barbaric dr I remembered how my knee felt that day at the original dr and how I was standing..5 9 thank you very much, much better than gaining 4-6 pounds and keeping it on for 2 years. IF I choose the Sleeve, we will be Sleeve buddies, as I am tentative for the 28th as well. Share this post Link to post Share on other sites
swizzly 901 Posted February 12, 2011 I was also on the borderline re: BMI -- actually was like 38, but have high blood pressure (um, thankfully? LOL). But as of 1 Jan this year, there is no longer a requirement that insurance has to approve, and they dropped the BMI to 35 (30 with comorbidities). So I would have been fine anyhow. My surgery is scheduled for the 24th of Feb. Re: "taking the easy way out" -- this is my recent rant about that: Perhaps it is just me (and saying this as pre-op, keep in mind) -- but rather than "the easy way out," I think it's the "only effective way out." I don't care if people think it's the easy way out, I am happy if it IS the easy way out. After all the blood, sweat and tears of losing weight and regaining it again, and being fat in a fat-phobic world, why the feck should I NOT take the so-called "easy way out"? How about the only way out that actually shows any indication of being effective? If someone ever wants to have words with me about taking the easy way out, they will find not arguments about how difficult it was; but rather a single, non-rhetorical question back to them: Why should I NOT take the easy way out? The idea that it should should be hard and grueling and painful and permanently dangerous and risky and especially painful and potentially ineffective after all, ya big fat fatty with no willpower, is based on the premise that being fat is everyone's own fault, is a clear moral failure, and that they haven't been able to keep weight off is because they are just wrong on many different levels. I cannot even express how vehemently I reject the entire notion that fat people are "bad" and deserve only some "very difficult and punitive way out." No. Just no. It's my business when I have my blood pressure treated due to medical need and I feel no need to tell anyone that I'm taking the easy way out by popping a pill for that. Neither do I need to justify my well-considered decision to have a surgical intervention for my BMI-related medical need. This is, for me, a hopefully permanent solution to a chronic medical problem, not an undeserved shortcut. I'm quite passionate about this. Share this post Link to post Share on other sites
AwesomeSleeve 5 Posted February 12, 2011 Insurance companies can really be a pain. I am so happy that everything worked out for you. Good luck with you surgery and keep us posted. Share this post Link to post Share on other sites
big2twig 0 Posted February 12, 2011 I have anthem blue cross also and they said my company doesn't cover any type of bariatric surgery.I didn't fight it just decided to get a loan from my 401k and get it over with.Scary part for me is that if anything goes wrong I'm all out of $. So worth it though(I hope).I'm scheduled for the 28th also in Lagrange,GA so guess we'll be going under on the same day.Good luck! Share this post Link to post Share on other sites
2bslimkim 11 Posted February 13, 2011 I had to jump through a few hoops because my insurance company did not want to accept my condition of sleep apnea as a comorbitiy. My BMI was only 38. That was in December. First denial came 12/14/2010. The doctor told me I could just add 10 pounds and then I should have no problems. So, I enjoyed my holidays thoroughly and ate whatever I wanted and as much as I wanted. I started eat all the things that I know are not good for me in hopes that I would gain those extra pounds. It sounds silly to gain weight to have weight loss surgery and I have been criticized tremendously by family, friends and strangers! However, they do not have to sleep with a CPAP every night so that they won't stop breathing, they are able to enjoy all the activities that I miss out on due to my asthma and weight, and they are all so quick to say, "You don't look 100 pounds over-weight. You aren't big enough for surgery. You should just go on a diet!" HA! I have tried every diet out there and I do loose on them, but only about 25 pounds and then nothing for months! I went to my doctor this week and weighed in after drinking about 3/4 of a gallon of Water and wearing my heaviest clothes. I was so happy when I was over by 3 pounds of the required weight that my insurance company set! The doctor's office submitted my paperwork yesterday and they called me today to say that insurance APPROVE ME! My surgery date is very quick. I am set to be sleeved on Monday, February 28, 2011 by Dr. Ludwig in Chico, CA. I am so excited! And I can't wait for day that will change the rest of my life forever! I couldn't be happier! My surgery date is also Feb. 28 in Dallas TX Share this post Link to post Share on other sites
LilMissDiva Irene 3,282 Posted February 13, 2011 A girlfriend of mine also had surgery near the end of September, only she had the roux-en-y procedure. She said her holidays were pretty much like what you explained. We joked about it and I told her that I would eat all the "bad" stuff for her! We had a lot of fun with that. She said it helped make her stay more focused because she hated to see me have to go through all of that. It was very comforting! My family asked me who was going to cook next year, as I always make Christmas dinner. I told them that even though I will be limited on what I can eat and how much, that I still plan to make their dinner as special as always! I just might add a few items that I can have. So funny how people worry so much about food! I was one of them! The date is definetly coming up VERY fast! I am so excitied! Thank you and I wish you continued success with your weight-loss:)! That is very sweet of you to still offer to cook the Holiday meals. By the time we all hit the next Holiday season you will probably be able to eat more than I was. The wonderful thing about the sleeve though is you *still* won't be able to eat nearly as much as pre-sleeve. Wishing you all the best. You will be so happy Share this post Link to post Share on other sites