April 2022 Surgery Buddies

[Flab-U-Less Forever 140]

6 hours ago, Mariann812 said:

THIS ⬆️

Exactly my concern. Should I wait and not do the pre-op diet till insurance approves? I am trying to do the surgery April 11 or pretty much any day that week as it is spring break and i do not want to take time off from school. My surgeon and his admin know this.

Not gonna lie...I had a food funeral that lasted a few weeks (ok maybe more like a month) so I actually put on weight right before my pre op diet started. On the day of surgery, I was exactly 40. My doctor said my moderate sleep apnea was a co-morbidity (sleep apnea was discovered during sleep study required in my pre op testing) so I could actually be 35. I worried that since I was not doing anything to prevent the sleep apnea (i.e., CPAP), they could still deny me at 35. The hoops insurance puts us through is ridiculous!

[Ralph1974 8]

17 hours ago, Kimmy Kaye said:

I grew up in Grand Rapids and camped in the Newaygo area often as a kid. Live in Livonia now.

Sounds like we moved in opposite directions. My dad worked at Ford - Livonia Transmission Plant.

[Mariann812 268]

10 minutes ago, Flab-U-Less Forever said:

Not gonna lie...I had a food funeral that lasted a few weeks (ok maybe more like a month) so I actually put on weight right before my pre op diet started. On the day of surgery, I was exactly 40. My doctor said my moderate sleep apnea was a co-morbidity (sleep apnea was discovered during sleep study required in my pre op testing) so I could actually be 35. I worried that since I was not doing anything to prevent the sleep apnea (i.e., CPAP), they could still deny me at 35. The hoops insurance puts us through is ridiculous!

I'm doing the same thing - I'm calling it my 'food bucket list' -- favorite foods, favorite restaurants.

Here is CIGNA's criteria:

Adults Bariatric surgery for the treatment of morbid obesity in an adult (age ≥ 18 years) using a covered procedure outlined below is considered medically necessary when ALL of the following criteria are met: •

EITHER of the following:  BMI (Body Mass Index) ≥ 40 kg/m2 (BMI ≥ 37.5 kg/m2 in Asians- when ethnicity is confirmed by provider attestation) 

BMI (Body Mass Index) 35–39.9 kg/m2 (BMI 32.5–37.4 kg/m2 in Asians- when ethnicity is confirmed by provider attestation) with at least one clinically significant obesity-related comorbidity, including but not limited to the following:

mechanical arthropathy in a weight-bearing joint (symptomatic degenerative joint disease in a weight bearing joint)

diabetes mellitus o poorly controlled hypertension (systolic blood pressure at least 140 mm Hg or diastolic blood pressure 90 mm Hg or greater, despite optimal medical management)

hyperlipidemia

coronary artery disease

lower extremity lymphatic or venous obstruction

obstructive sleep apnea

pulmonary hypertension

evidence of fatty liver disease (i.e., nonalcoholic fatty liver disease [NAFLD] or nonalcoholic steatohepatitis [NASH])

gastroesophageal reflux disease (GERD) refractory to medical therapy

• A thorough multidisciplinary evaluation within the previous 12 months which includes ALL of the following: 

a description of the proposed procedure(s) 

documentation of failure of weight loss by medical management 

unequivocal clearance for bariatric surgery by a mental health provider 

a nutritional evaluation by a physician, physician assistant, nurse practitioner or registered dietician

I meet the 40 BMI and at least 3 of the criteria for the lower BMI. Initially I was extremely confident I would be approved, but even with reaching all their milestones, I don't trust them.

[Quesodip251 125]

7 hours ago, Mariann812 said:

THIS ⬆️

Exactly my concern. Should I wait and not do the pre-op diet till insurance approves? I am trying to do the surgery April 11 or pretty much any day that week as it is spring break and i do not want to take time off from school. My surgeon and his admin know this.

Usually insurance goes by the weight you’re at when the doctor’s office weighed you at their approval so you’re good if the surgeon’s office isn’t planning on calling you back in for any reason. As long as you’re over the surgeon’s required minimum to do the surgery it won’t matter. I’d call your insurance company to confirm.

[Quesodip251 125]

I’m one of those people that does have to gain weight prior to surgery as I’ve lost weight since my approval (stress) and don’t have my surgery for another month. Thankfully I only have a 2-day preop diet! I’m self-pay and my surgeon’s office is the one requiring it due to my bmi being at the minimum for surgery.

[Goldengirl321 52]

11 minutes ago, Quesodip251 said:

Usually insurance goes by the weight you’re at when the doctor’s office weighed you at their approval so you’re good if the surgeon’s office isn’t planning on calling you back in for any reason. As long as you’re over the surgeon’s required minimum to do the surgery it won’t matter. I’d call your insurance company to confirm.

If your paperwork is already submitted, you’re good to go. If not, I would maintain. My surgeons office originally told me that it would only matter what my first weigh in was but then they corrected themselves bc what really mattered was the weight I was at when I did my testing for cardio, pulmonary, psych and nutrition because it was after that they submitted the packet to the insurance.

[Mariann812 268]

On 03/25/2022 at 17:19, Goldengirl321 said:

If your paperwork is already submitted, you’re good to go. If not, I would maintain. My surgeons office originally told me that it would only matter what my first weigh in was but then they corrected themselves bc what really mattered was the weight I was at when I did my testing for cardio, pulmonary, psych and nutrition because it was after that they submitted the packet to the insurance.

So…I’m going to get weighed before my echo stress which is this coming Tuesday, the 29th?
I will see my surgeon after that since my pre-tests/qualification tests must be completed prior to meeting with him.
I’m just going to keep eating. 🤷🏻‍♀️

[Quesodip251 125]

It’s crazy what insurance requires to prevent paying for this! I don’t have any requirements at all and the first time I get weighed is day of surgery

[Goldengirl321 52]

9 minutes ago, Mariann812 said:

So…I’m going to get weighed before my echo stress which is this coming Tuesday, the 29th?
I will see my surgeon after that since my pre-tests/qualification tests must be completed prior to meeting with him.
I’m just going to keep eating. 🤷🏻‍♀️

That was my experience, obviously every dr does things differently but I would rather not risk not getting approved. Good luck!!!

On 3/11/2022 at 7:38 PM, sugarbee24 said:

Thank you goldengirl321.

Have you already had your surgery? If not do you have a date scheduled?

I’m scheduled for 4/19!

[Pastor Tracy 19]

20 hours ago, Kimmy Kaye said:

Sorry to hear about your husband's upcoming surgery. I had hernia surgery about 8 years ago now and because of the mesh they used, the surgeon thinks the sleeve is probably the best choice for me.

Sent from my Lenovo YT-X705F using BariatricPal mobile app

Blessings to you and your husband. Everything is going to be okay.

[Kimmy Kaye 43]

22 hours ago, Mariann812 said:

Thank you --- this is extremely helpful. I am 67 so that explains the stress test. My dh is 56 and is having hernia surgery in 2 weeks and no stress test for him.

I know that the cardiologist told me if I can't complete the regular treadmill stress test, he will do a thallium stress test ( which I've had in the past with the IV etc). Is a chemical stress test the same as a thallium stress test -- with the IV and all?

Thanks again.

I am not a doctor, of course, but by chemical, it means it is drug induced instead of exercise induced. So, I am guessing it probably is. You stick to your guns and let them know you are not comfortable doing the treadmill. You will do fine.

[Kimmy Kaye 43]

21 hours ago, Richard. C said:

Its actually not too bad. I thought it would be worse, the only problem ive had that cleared up, was having a headache for couple days cause of the caffeine withdrawal(i use to drink alot of coffee until now.) When i started the other day, i went in it with a clear head and im actually only consuming around 500 calories cause of the sugar free Jello/pudding and sugar free popsicle's. the only thing that really has any calories is the Proteins shake. I think cause i started the liquids with a clear mind, i really dont feel all that hungry either.

Good to know! Thanks for the update. Glad you are past the caffeine withdrawal. I never drank tea or coffee and gave up Coca cola years ago, so once less thing to endure at least for me. Lol I'm counting down the days til surgery now. I have to have a COVID test on April 1st then laying low until the 6th. My surgery is scheduled for 9:45am. When is yours?

[Kimmy Kaye 43]

16 hours ago, Ralph1974 said:

Sounds like we moved in opposite directions. My dad worked at Ford - Livonia Transmission Plant.

You got the better move though. Lol

[Quesodip251 125]

8 minutes ago, Kimmy Kaye said:

I am not a doctor, of course, but by chemical, it means it is drug induced instead of exercise induced. So, I am guessing it probably is. You stick to your guns and let them know you are not comfortable doing the treadmill. You will do fine.

8 minutes ago, Kimmy Kaye said:

I am not a doctor, of course, but by chemical, it means it is drug induced instead of exercise induced. So, I am guessing it probably is. You stick to your guns and let them know you are not comfortable doing the treadmill. You will do fine.

I’m a healthcare professional. Kimmy is right, the thallium will be inserted via IV most likely into a large vein in the inner elbow (called the AC) or higher up in the arm.

[Kimmy Kaye 43]

On 3/25/2022 at 6:14 AM, jenniferever said:

I finally got a surgery date of 4/6 after having my 12/24 surgery date rescheduled due to Covid. I am nervous but excited! How about you guys?

Sent from my SM-A215U1 using BariatricPal mobile app

Same day as mine. I'm having sleeve and live in Michigan. Where you from and what procedure are you having?