Hello from New York!

[Cheryl Ann 2]

I've been lurking here on and off since November, and have finally worked up the nerve to post. To start, I want to tell all of you how helpful this board has been to me -- without me ever having posted anything. I am inspired by your stories and successes, and reassured by your first hand experiences and knowledge. Still -- in spite of it all -- I'm nervous as hell. Not so much about having the surgery, mind you, but the insurance waiting game is killing me. I will probably not find out if I've been approved until days before my scheduled surgery -- which is April 7.

A bit about me: I'm 47, married with two children (9 and 11). I live on Long Island, pretty close to the city. My surgeon is Dr. Christine Ren, at NYU (who I think is wonderful). Yesterday, I had my pre-surgical testing, and tomorrow, get my medical clearance forms filled out by my doctor (who should be receiving all the necessary paperwork from NYU sometime today.

I'm 5'8" tall, with a BMI of 38.4, have hypertension, high cholesterol and triglycerides, orthopedic issues (plantar fasciitis and arthritis in both knees), but only have mild apnea. Evidently, I'm neither fat enough, nor co-morbid enough, to unquestioningly (if that's a word) qualify under my insurance company's guidelines, which requires a BMI of 40, or a BMI over 35 with two co-morbid conditions (my hypertension is enough, but my other issues may or may not qualify as additional co-morbid conditions). There is no six months of weight loss documentation required.

Meanwhile, I started my liquid diet yesterday -- and needless to say, I'm pretty darn hungry. Although cutting my calories is hardly a bad thing in light of my condition, surgery pending or not, I'm very nervous and afraid that I won't be approved by my insurance company. If I'm not, I will have to cancel the surgery, and begin the process of appealing the decision.

Has anyone here ever qualified with similar circumstances. I'm in need of a whole lot of hand-holding right now!

[Miss Michelle 1]

Welcome! My surgeon is Dr. Fielding, Dr. Ren's hubby, who also works in NYU Medical Center. So far, I have passed the psych eval, had a full physical and blood work doen by my PCP, got a medical neccessity letter, and I am going to NYU for my pre-op nutritional consult and nurses visit on 4/2. Did you have to go through all that too?

[Cheryl Ann 2]

Yes, I have; all these things are required for the progran. I attended the seminar in late November, had the psychological evaluation in early December, visited with the nutritionist and nurse, and had the pre-surgical testing yesterday. In the past couple of months, I've had a full physical and bloodwork, and obtained the necessary recommendation from my doctor(s).

I'm keeping my fingers crossed!

[TerMur 0]

I live in Central NY and I had a BMI of 36, by the time I had the surgery I was a 33. I have fibromylgia but I didn't have any of the other things they like to see wrong with people. My insurance covered it 100%. I don't think you have to worry about the insrance coving it with all the things you have wrong.

[Cheryl Ann 2]

I sure hope so, TerMur (and thanks for the encouragement). From what I've been reading, though, every insurance company's criteria is different, and even within an insurance company, the plans vary. But still, your story gives me great hope!

[Guest BiCoastal]

I just finished a post about how I am feeling so down about how long the process is taking but in reading your posts it looks as though my expectations may not have been realistic. I went to the seminar in Jan, have the records and letter from my PCP, went to psychologist end of March and have the nutritionist appt end of April. For those of you who have been through this at NYU or have a date set - what other steps are there after the nutritionist? I keep hearing about tests but not sure what tests or when they are done or by whom? Is the nutritionist appt the same time as the nurse appt? What comes next and how much longer. Ok I'm whining now but really any info would be most helpful!

[Cheryl Ann 2]

What took longer for me (after having seen the nutritionist) was being able to provide additional documentation of possible other co-morbid conditions. I needed a sleep study, as well as a stress test. However, you may not need any of that, so the process might well move faster for you.

That said, my surgery is Monday -- and as of today (Wednesday), I still don't have word of insurance approval or not. Hopefully, tomorrow (or Friday, at the latest).

[Miss Michelle 1]

... For those of you who have been through this at NYU or have a date set - what other steps are there after the nutritionist? I keep hearing about tests but not sure what tests or when they are done or by whom? Is the nutritionist appt the same time as the nurse appt? What comes next and how much longer. Ok I'm whining now but really any info would be most helpful!

I just had my nurse and nutritionist appt today at NYU. It didn't take long at all. Most of the time spent in the office was filling out paperwork. The nurse listened to my heart, took my blood pressure, felt my tummy and back, weighed me and then went over my medical history w/ me. Pretty standard stuff. She did tell me that my next round of blood work would need to be completed two weeks or so before surgery. The nutritionist mostly went over the pre-op and post-op diet requirements. I set my surgical consult for 4/23 w/ Dr. Fielding. I will also be seeing the surgical coordinator that day. I think they give you the requirements for the 2nd set of pre-op tests to be done on the day of the surgical consult. I guess your medical history will determine what needs to be done (sleep test, simple blood work, etc.)

[laurenwhite82 0]

I am doing my 6 months right now and hope to have the surgery with Dr. Fielding in Aug or September (depending on how long my insurance takes). Just curious as to why you had to have a stress test?? (if you dont mind sharing) My BMI is around 48 and i have high insulin levels, PCOS, high cholesterol, and probably a sleep apnea (though i am still waiting to get in to do the sleep study). My PCP doesnt forsee any approval problems (i have Cigna) but I guess you never know. Good luck to you all in your journey. I know I cant wait!

[Guest BiCoastal]

I just had my nurse and nutritionist appt today at NYU. It didn't take long at all. Most of the time spent in the office was filling out paperwork. The nurse listened to my heart, took my blood pressure, felt my tummy and back, weighed me and then went over my medical history w/ me. Pretty standard stuff. She did tell me that my next round of blood work would need to be completed two weeks or so before surgery. The nutritionist mostly went over the pre-op and post-op diet requirements. I set my surgical consult for 4/23 w/ Dr. Fielding. I will also be seeing the surgical coordinator that day. I think they give you the requirements for the 2nd set of pre-op tests to be done on the day of the surgical consult. I guess your medical history will determine what needs to be done (sleep test, simple blood work, etc.)

Its another 3-4 weeks until your surgical consult?? Did they give you any impression on how long after the consult you'll have the surgery? One of the reasons I am freaking out is I am supposed to be in a wedding this summer and a) I want to be healed from surgery I'd like to have lost a decent amount of weight by then and it looks like I'm never going to make it. I'm going to have a melt down:scared2:

[Miss Michelle 1]

Its another 3-4 weeks until your surgical consult?? :thumbup: Did they give you any impression on how long after the consult you'll have the surgery? One of the reasons I am freaking out is I am supposed to be in a wedding this summer and a) I want to be healed from surgery I'd like to have lost a decent amount of weight by then and it looks like I'm never going to make it. I'm going to have a melt down:scared2:

I know, *sigh*, I was dissapointed too that my next visit was 20+ days away, but I guess w/ a surgeon like Dr. Fielding, I did expect there'd be a wait. The day of my surgical consult I will also be meeting with a surgical coordinator who will schedule a tentative date. Luckily I have great insurance, but I am thinking that will be atleast a six to eight week wait. I will be calling them daily though to check for any cancellations so atleast if I can get my consult scheduled sooner, than I can get the insurance review started sooner. As far as weight loss, if your pre-op diet is anything like mine you definately will begin losing before surgery itself. Don't worry though too much because the days will pass quickly and you'll be preping for surgery before you know it. My only goal is to have the surgery before my 26th birthday in July.