OK. Yesterday I met Dr Timothy Shope ..and..

[ocdgirl2000 1]

I registered for the first class. I already checked with my insurance company to see if they would cover the surgeries. Since I work for Montgomery County Gov, we have a really great comprehensive plan out of BC/BS, and I purchased the "high option" one..of course.. so.. they said 35 BMI with one of the co-morbid conditions.. and I seem to be riddled with all of them, unfortunately.. and I'm on my way to my exercise class, right now, at cardiac rehab, phase III, at Montgomery General Hospital, to keep up the good work I've been doing to impress my cardiologist!LOL! I'm 57, 200 lbs, at the moment, although I have NOT been overweight ALL of my life..(long story)..but over the last 15 yrs I just let myself "go".

Genes kinda took over.. and my lack of seeing a physician didn't help..being a Nurse, I thought I knew everything. Well.. Denile is NOT a river in Egypt!LOL!

Anyway, after discovering I had advanced coronary artery disease, with a 100% blocked right coronary artery from top to bottom and most likely had some kind of heart attack or a few, along the way, over the years, but, of course, was too busy working and figured.it would "go away"..I just went along with my business untill all of these UTI's started, and my bloodwork came back with an elevated blood glucose.,mildly..and a slightly elevated HA1C..

Ok..here comes the good stuff. The HA1C keeps rising, finally, I'm diagnosed with full blown diabetes, and then, took the sleep apnea test...oh yeah, I have that thing too!

Never mind that I always had gerd!hahah! ok..,so..now what?? cardiac rehab...gotta go! I'll be back, and update you all on my long and sordid "fat story" later..

But..I was always an "exerciser"! for many years!!yay! I have collateral blood vessels around my heart for all those 13 yrs I taught aerobics and ran 5 miles with the sargeants program..in my "fit and normal sized years"..hahah!

[wishes 125]

I am glad to hear everything will be covered for you, and that you are making steps towards a healthier life. Welcome to the forum! There are tons of helpful people here, so don't be afraid to ask questions.

[ocdgirl2000 1]

I am glad to hear everything will be covered for you, and that you are making steps towards a healthier life. Welcome to the forum! There are tons of helpful people here, so don't be afraid to ask questions.

oh!! I won't! I'm here to ask lots of questions!

I think I have a bunch of stuff already done, for that "passport checklist" thingy required for the insurance co.. "hoping and praying" that the 4 month 3x a week cardiac rehab classes & weigh-ins with exercise routine, monitored by both my cardiologist & the nurses, (also was paid for by BC/BS since end of Nov.-March) included nutritional counseling, exercise physiologist, mediterranean diet (my cardiologists' fav, lol!) and aggressive meds..yikes, I'm even seeing a bariatric weight loss dr TOO, with appetite suppressants and even THOSE don't help, for heaven's sakes!! and I've continued the program at phase III level, paying "out of pocket" on my own, while being weighed monthly since April/May and still being weighed at the cardiologist's (saw him April 18th)..

I just started seeing the dietician prescribed by the endocrinologist, since starting the metformin 2 months ago, so I'm due for bloodwork again which I will be doing tomorrow, since I'm seeing her on the 26th. My last visit with her, was when she told me I had a BMI of 35, so when I called the insurance co and they said the 35 BMI was accepted with the ONE complication, I figured since I had even MORE than the one, it wouldn't be an issue.

The deal is, I have to pass the cardiac stress test again. BOO. no fun. then, the endoscopy, which I've never had any of those things done before. ewwww.. those things are entrances and exits, you know??LOL! just kidding! Guess I better get used to it! It's easy when it's "other people" when you are an RN, but when it's YOURSELF? omg.

[ocdgirl2000 1]

wellll...today was the first day I met with the dietician who kind of co-ordinates the program for the surgeon, and got all my paperwork together, checked off what I "had" and didn't have, for the checklist. and reviewed the diet before and after.

Yes, it was interesting. The stuff I didn't know that kind of upset me was that I'll never be able to eat raw oranges ever again. No citrus fruits? the stringy stuff and stuff with seeds..ok, I mean, after surgery I can understand that for a good while..but NEVER??? sigh.. oh well..looks like I'm buying some heavy duty pureeing equipment like a vitamixer and a Jack LaLanne Juicer, heh? LOL! You guys all know which of those products are the best and where to get them?

I'll be ok with the clear liquid and the liquid part after the surgery...before it...hehe..we'll see how strong I am?

I spoke to the Dr about the insurance, and he seems to think my insurance won't pay for the sleeve no matter what they told me. He said "oh yeah they SAY they pay for all weight loss surgeries, but what they meant was that they would pay for the bypass and the lapband, not the sleeve" he told me I had to have a BMI of 50 for the sleeve but with my other complicating factors, I could have the roux-en-Y with the 35 BMI and it would be paid for without any problem. Now WHY is that? It's a riskier surgery!Stupid! He seems to think all Blue Cross plans are the same, but I do not think so. my Montgomery County MD plan is exceptionally good, and covers more than most plans do, even more than the Federal Government plan. (I work for local Maryland Government)..like I said, when I called the pre-cert office they said ALL the weight loss surgeries would be covered with a BMI of at least 35 and at least one complicating health factor, (which I have more than 3)..

[azsenior 12]

OCDgirl, keep plugging on the insurance. I am a NJ state employee retiree. I have Medicare Primary and Aetna Secondary. Medicare does not cover the sleeve yet, but I was told by five different Aetna personnel that they would pick it up once Medicare declined. Aetna covers all three procedures with the high BMI and comorbidities. The insurance clerk who works with my surgeon was furious that I was relentless about wanting her to apply to Aetna for the sleeve. She said I was wasting her time.

She went on a medical leave. The new clerk made the application to Aetna and I was approved within a few days. I don't doubt the wealth of experience the surgeons and clerks have, but sometimes they might know as much as they think.

Keep pushing. When you get a denial in writing, then you can pursue it through the channels. Suggest that you check out the insurance thread on this forum. There are people there who can help you should an appeal be necessary.

Good luck and keep us posted!