AngieBear 2,524 Posted September 3, 2018 (edited) Hi all. I am just getting started on this process. I’ve had my intake appointment, next week I meet with my gp for an official referral (I’ve already run it by her, and she is THRILLED for me), and on Friday I meet with my nutritionist for the first time. My new job has far better insurance than what we’ve had, and this is the first time surgery has been covered. My BMI is only 6 pounds away from being 50, the point where I won’t need any comorbidities. I have a sleep study coming down the pipeline (first appt. for that is next week). If I have sleep apnea, which is entirely possible, then that will be the comorbidity piece. If not, then I’ll need to gain 6 pounds, which seems absolutely ridiculous, but it is what it is. Until my sleep study, I’m in a holding pattern weight-wise. A bit about me: about 5 years ago I lost 100 lbs. through eating a Protein and veggie heavy diet, logging through MFP, trailrunning and weightlifting (all of which I’m taking back up). Over the past few years I’ve put 3/4 of that back on. Like most people struggling with obesity, I have yo-yo’d several times. It’s maddening, and frustrating. But, I’m not into pointlessly chiding myself for being amongst 95% of people, I’m into whatever works. And surgery works. So, here I am. I’m delighted that my insurance covers it, and I’m hopeful for the future. Last night I had the realization that any weight I take off prior to surgery will more than likely stay off. Not a 5% chance like before, but 65%. It was an amazing thought. I’ll mostly be lurking here, like I have been, due to not having gone through surgery and most of the process yet. I don’t have any answers that aren’t just theoretical. But already this place has been a wonderful source for me as I look forward and try to wrap my head around what I’ll be doing and going through during the next year. I’m already planning next summer’s backpacking trips, with the hope of being in far better shape than I am now. Otherwise, I’m an artist, I love my day job, volunteer for a kitten rescue org, previously with wildlife rehab, and I have 2 very supportive adult sons that live with us while they go to college. I’m inserting a recent picture so that you can put a face to my name, and to get it over with so that I don’t stay shy about how I look right now. Edited September 3, 2018 by AngieBear 1 Wanda247 reacted to this Share this post Link to post Share on other sites
AngieBear 2,524 Posted September 3, 2018 WHOA, that was a wall of text. Mad props to whoever makes through it! Share this post Link to post Share on other sites
J San 1,071 Posted September 3, 2018 Read it all, great introduction. Welcome to the site and Congrats on making the choice to have the surgery. I joined here about a month pre-op and learned more from the people here than from my surgeon and NUT. Everytime I go into the office they ask if I have questions and I never do. Best of luck to you on your journey and hope all goes as planned. Share this post Link to post Share on other sites
Orchids&Dragons 9,047 Posted September 3, 2018 (edited) Welcome, AngieBear! This is a very supportive community and I hope you make friends here! And, yes, I read the entire post as well! Edited September 3, 2018 by Orchids&Dragons Share this post Link to post Share on other sites
Ellens531 81 Posted September 3, 2018 WHOA, that was a wall of text. Mad props to whoever makes through it! Welcome. I'm pre op. Wednesday is my 2nd nutrition appt. I'm at that 50 bmi. I'm looking at sometime in December to have surgery. Nice to meet you!Sent from my SAMSUNG-SM-G920A using BariatricPal mobile app Share this post Link to post Share on other sites
mrbsf 0 Posted September 3, 2018 The BMI to qualify for WLS without comorbidities is 40, not 50.Sent from my SM-N950U using BariatricPal mobile app Share this post Link to post Share on other sites
AggiG 176 Posted September 3, 2018 Welcome I too am pre-op I have this month and 2 months to go. I am opting for the Gastric Sleeve. My Dr. said that I may be possible for to have my surgery sometime in December. My BMI is 46.6. I am 5'1" and my knees and right hip is hurting my so much. Good luck on your journey and when the comes we will see you on the losers bench. Share this post Link to post Share on other sites
AngieBear 2,524 Posted September 3, 2018 (edited) 49 minutes ago, mrbsf said: The BMI to qualify for WLS without comorbidities is 40, not 50. Sent from my SM-N950U using BariatricPal mobile app Unfortunately, not for my insurance to cover it. Their criteria is 50 or more without comorbidities, 40-50 must have at least one comorbidity, under 40 must have more than one or be type 2 diabetic. At 49.4, it’s put me in an odd position. But, I am thrilled that it’s covered at all. Edited September 3, 2018 by AngieBear Share this post Link to post Share on other sites
AngieBear 2,524 Posted September 3, 2018 (edited) 1 hour ago, Orchids&Dragons said: Welcome, AngieBear! This is a very supportive community and I hope you make friends here! And, yes, I read the entire post as well! Yes, I’ve been very impressed with the community as I was lurking for the past few weeks. Thank you so much for the warm welcome, all. Like everyone at the beginning stages, I’m nervous, excited, nervous, grateful, nervous, and hopeful. Edited September 3, 2018 by AngieBear 1 Orchids&Dragons reacted to this Share this post Link to post Share on other sites
mrbsf 0 Posted September 3, 2018 Unfortunately, not for my insurance to cover it. Their criteria is 50 or more without comorbidities, 40-50 must have at least one comorbidity, under 40 must have more than one or be type 2 diabetic. At 49.4, it’s put me in an odd position. But, I am thrilled that it’s covered at all.Wow...that is extremely stringent and not the norm. Most commercial payers follow Medicare guidelines. If you're only six pounds away or need a single comorbid you should be able to get qualified either way. Best if luck to you and keep us posted.Sent from my SM-N950U using BariatricPal mobile app Share this post Link to post Share on other sites
AngieBear 2,524 Posted September 3, 2018 (edited) 5 minutes ago, mrbsf said: Wow...that is extremely stringent and not the norm. Most commercial payers follow Medicare guidelines. If you're only six pounds away or need a single comorbid you should be able to get qualified either way. Best if luck to you and keep us posted. Sent from my SM-N950U using BariatricPal mobile app Yep, it is. The other requirements are pretty standard (x number of meetings with a nutritionist, psych evaluation, lose 5% of BW, etc.). But the BMI piece is higher than what is the current recommendation by the AMA. I think I’m close enough. I’ll find out soon. I’m certainly not putting on weight in anticipation of needing to. If I have to, I will, but I’d love to be starting to chip away at the 5% right now. The not knowing what I should be doing is a bit frustrating. Edited September 3, 2018 by AngieBear 1 Frustr8 reacted to this Share this post Link to post Share on other sites
Frustr8 7,886 Posted September 3, 2018 Maybe Angie you should tell out this orney insurance company so we all know who to avoid. A little insurance humor(well it's funny now -wasn't then) when late hubby and I were going to be blessed with a third child, we checked. into our insurance coverage to see what kind of maternity benefits we,had, wasn't very clear so we filed a request for clairification. Back flew a letter, they were attempting to deny coverage,their excuse? Quote -Pregnancy is an avoidable disease -unquote. The insurances company. was Connecticut General. They had a a commercial ditty which we paraphrased: Making sure we'll all be screwed That's what Connecticu General people do! We appealed and they finally,agreed to cover. See when they and my,life husbands company had initiated the coverage they thought only adults would need coverage. And outside my family and doctor, no one knew how hard I battled infertility to achieve that pregnancy! Incidently that "disease" is now 39 years old and the joy of my existence.😜&👨 1 Malcy reacted to this Share this post Link to post Share on other sites
Danny Paul 761 Posted September 3, 2018 2 hours ago, mrbsf said: The BMI to qualify for WLS without comorbidities is 40, not 50. My insurance wanted a BMI of 35, I'm guessing all insurance companies have different criteria. Share this post Link to post Share on other sites
Malcy 132 Posted September 4, 2018 Welcome! I have learned so many valuable things from the discussions on topics that I wouldn't even know to ask. I check with my Dr on specific or major issues but other than that I refer to the chats. I hope you find there's a wealth of information and some great folks on here. 1 AggiG reacted to this Share this post Link to post Share on other sites