Blue Shield of CA Ultimate PPO-Depserate insight needed-Help

[NewLife4Jen 28]

I was banded in 2012, had lost almost 75 lbs. at one point. I'm now at a total weight loss of 57 pounds.

Ever since my surgery, I have never really done well with solids. I didn't wrooy about it at first cause I was losing but then, my weight plateaued and I gained a bit then plateaued again that I began to get concerned that about 90% of my diet is liquid. I got sick of Protein shakes so occasional ice cream shakes and sodas came into play (thus the weight gain). But, the main problem is...when I try to eat solids, even healthy solids, I am in the bathroom getting rid of it. Finally heard from the dr. that my body produces too much digestive mucous/juices too fast and attacks the food before it can get down to my stomach and be digested so the only option...my body tries to get rid of it. I miss healthy foods and am tired of not eating and having to leave the second half of meals in the bathroom. The second half of the issue is I eat/drink so very little...I cannot lose weight anymore. So I am stuck. My band has been filled and unfilled, filled and unfilled.

So medically, I have a reason for insurance to pay for the band to come put but not necessarily to be converted to sleeve. My dr. is well known and he's affiliated with a center of excellence. They said that they have not had one insurance company pay for direct conversion. My dr's office says that in order to pay, all insurance require you to meet original parameters (bmi of 35 or more with problems or bmi of 40).

Therefore, I will actually have to gain some weight (go backwards) in order to reach a bmi of 35 in order to have a sleeve. Plus then, I will need hope that they will think that my sleep apnea is bad enough that I can qualify. I have Blue Shield of California Ultimate PPO that we pay for ourselves(not through an employer). I haven't actually been turned down yet cause I have to submit for approval but before I can do that, I have to pay for and re-do my psych profile AGAIN.

It is SOOO frustrating to think that the insurance company would make me meet ORIGINAL guidelines...including attending possible nutrition classes (I know what is involved and how to eat by now). I refuse to gain ALL my weight back to get back up to a BMI of 40. Ugh!

Has anyone, who has this insurance, gone from lap band to sleeve as a direct conversion?? Has anyone had to meet the original guidelines.

Any insight you have, I'd appreciate it.

Thanks-

Jen

[Natasha Estrada 36]

No advice to give to you but I have the exact same plan so this worries me though I'm a first time preop patient getting the sleeve.