I am brand new here...advice, support appreciated

[kmr 4]

Hello!! I am a 41yr old female...i have struggles with my weight my whole life. Weight watchers works for me for a while, and then I end up giving up...I usually lose about 40 lbs tops, which is great, but I need more help. I was just diagnosed with type 2 diabetes. i am a short woman...5' 11/2 and weighing about 242. my BMI is about 44. Considering I have the diabetes now, I am eligible for the surgery at a BMI of 35...but my insurance is BCBS of MA and it looks at the sleeve as investigational. This is the surgery i am most interested in. My doctor suggested we explore weight loss surgery if I was interested. I am!! I feel this will be a great tool to help me on my journey, and I know I need to change my lifestyle regarding food, especially with diabetes. i feel like I am babbling now...sorry! My questions...what can I do if i get denied for the sleeve? My 2nd option would be the band, but i would rather fight it and try to appeal. i live with chronic pain and need to take motrin for life...I have also had issues with anemia, and it seems as if this surgery would allow me to continue taking medications and not have to worry about Vitamin deficiencies like the bypass. Has anyone had isurance issues? has anyone went with the lap band and regretted it? thank you soooo much!!

[MINI-Me 196]

I was self-pay since my insurance excludes any WLS. But, based onyour need for motrin and anemia, I would have your doctor write up a case for the sleeve. You will probably be denied on the first pass, but ask for an appeal. If the appeal board turns you down, many people have had luck with an outside review (which you are entitled to). Hopefully they can pitch in and provide you some advice on how they won their appeals.

Don't give up! Fight for what you want and need.

I will say ... Please, please, please, don't "settle" for a band. I've never had one, but have heard horror stories on here as well as friends who have never met goal and have had scarring/swelling/food issues. While it is technically "reversible" it can leave scars and damage. I'm sure many others on here can jump in with their own personal issues with the band.

Welcome to the board.

[Yorkie Fan 16]

Welcome KMR! I can tell you, as well as many others, that I would not go with the band. This is from my own personal experience. I currently have my band and am in the process of getting a revision to the sleeve. I have had numerous complications and to this day I am in pain constantly. I would recommend that either you self-pay for what you know is right for you or hang in there until BCBS of MA adds it to the approved list of surgeries.

As far as insurance goes, I would definitely appeal to them with lots of evidence. You never know what they are going to say. I would look on the internet for appeals specifically geared towards the sleeve. That will help you with your appeal. Feel free to email. I'm more than glad to share my personal experience with my band. Also check out the band to sleeve revisions section tons of good information.

Good Luck! Let me know if I can be of any help.

Nichole

[kmr 4]

Thank you so much for replying...some of my friends think I am nuts for wanting this procedure, saying I can do it alone...I am glad to have found this forum!! if i could do it alone, I would have years ago...they think I dont really have THAT much to lose...well, 100lbs is alot to me....and I need all the help I can get. I dont want to settle for the band, i really like the whole idea of the sleeve...I'm going to research and try my best to get what I feel is best for me. Thank you again!!

Welcome KMR! I can tell you, as well as many others, that I would not go with the band. This is from my own personal experience. I currently have my band and am in the process of getting a revision to the sleeve. I have had numerous complications and to this day I am in pain constantly. I would recommend that either you self-pay for what you know is right for you or hang in there until BCBS of MA adds it to the approved list of surgeries.

As far as insurance goes, I would definitely appeal to them with lots of evidence. You never know what they are going to say. I would look on the internet for appeals specifically geared towards the sleeve. That will help you with your appeal. Feel free to email. I'm more than glad to share my personal experience with my band. Also check out the band to sleeve revisions section tons of good information.

Good Luck! Let me know if I can be of any help

Nichole

[kmr 4]

Thank you so much, I am going to keep reading, researching and work towards my goal. Sooooo thankful for this forum and all of you in it!!

Welcome KMR! I can tell you, as well as many others, that I would not go with the band. This is from my own personal experience. I currently have my band and am in the process of getting a revision to the sleeve. I have had numerous complications and to this day I am in pain constantly. I would recommend that either you self-pay for what you know is right for you or hang in there until BCBS of MA adds it to the approved list of surgeries.

As far as insurance goes, I would definitely appeal to them with lots of evidence. You never know what they are going to say. I would look on the internet for appeals specifically geared towards the sleeve. That will help you with your appeal. Feel free to email. I'm more than glad to share my personal experience with my band. Also check out the band to sleeve revisions section tons of good information.

Good Luck! Let me know if I can be of any help.

Nichole

[MICHELLE LEE 19]

Dont let your friends discourage you. Until they have walked in the shoes of an overweight person, they have absolutely no clue what we deal with. I would just say, jump through all the hoops and try not to get overwhelmed with "what if's" as far as approval goes. It might end up being an easier process then you think.

I was worried too and put off seeking surgery for over a year. When I finally went for it, I was approved in 2 weeks and had surgery within a month from the date I first met with my PCP. I have found that a little bit of determination, knowledge and "pushiness" on the patient's part can go a long way!

[kmr 4]

Thank you, the support here is amazing!! I hope and pray that this ends up working out for me...I want this healthy change in my life!! i will continue to keep you all posted!!

Dont let your friends discourage you. Until they have walked in the shoes of an overweight person, they have absolutely no clue what we deal with. I would just say, jump through all the hoops and try not to get overwhelmed with "what if's" as far as approval goes. It might end up being an easier process then you think.

I was worried too and put off seeking surgery for over a year. When I finally went for it, I was approved in 2 weeks and had surgery within a month from the date I first met with my PCP. I have found that a little bit of determination, knowledge and "pushiness" on the patient's part can go a long way!