quick update

I was denied for a second time due to not having the 12 month diet falure so i went to the pcp and she wrote in my files that i started a 1200 calorie diet and she is not making me do it . i have done so many diets and she feels that i don't need to do one more to mess up my system anymore.. she feels that bc/bs is just playing a game to see if i will give up .well they are wrong i'm going to go the whole 9 yards with this. i'm not one to give up.. TTFN Kimberly

Kimberly, Hun good for you, that is great that your PCP will help you fight this!!! Awesome and I am glad to hear that you are not going to give up because that means THEY win.....and I don't like THEY. It is all a numbers game to them, they are not really worried about us long term because we all change Ins Comp at a blink of an eye (well our employers do it) so they know we will not be around for the long hall. Good luck hun and hang in there, it will go quickly for you......can you have a couple of months behind you now or does this month count as your 1 of 12? Take care hun and keep us posted! ~Hugs~ Debra P

This month i started the first visit on the 4th..so it will be all year .. so i have to spend 20 copay every month and they have to pay the rest so they have to fork out more money in stead of just letting me have the surgery.. it just makes no sense to me Kimberly

Kimberley, Its not supposed to make sense. Its the insurance. I tried to find out about eye surgery so I wouldn't need glasses. Its not covered by any company. It would be cheaper than paying for new glasses every year! Stick to your guns! You willbe on the losing side before you know it! Linda

Kimberly, Yes I had to do that for a 6 month time period, what a waste of the Dr's, the Nutrionist and my time... Hang in there hun, keep us posted and it will move quickly for you ~Hugs~ Debra P

Thank you for your support .. I plan on taking this all the way .. Kimberly

Kimberly. I'm sorry your having all this trouble.Now I'm worried as well b/c I have Dr.Boss.He is in the same office as Dr.Omally.I am having a heck of a time with the nutritionist.I noticed you have bc/bs of Il????????? I have bc/bs family healthcare plus.I hope I'm not going to have all these problems too.I guess we just have to stick to are guns and do what ever it takes to get approved.Do you have any thing like diabetis or hypertention? your bmi is over 40 so that helps qualify.mine is 60.? I had to have 6 months of documented dieting(at least thats what the pcp said).I had called the insurance to see what requirments I needed to get the wls and they said I just needed a BMI over 40.I'm hoping things havn't changed since I talked to them.keep fighting it.by the way who is your nutritionist???? Darlene

Good for you hun don't give up I didn't even thou there were times I wanted too.....but you have to fight for what you want.....I was denied 3 times before I finally got the approval on a techncality....you go on a do what ever it takes to get to you healthier and happier lifestyle.... many {{{{{{{hugs}}}}}}}} Christine

Kimberly, I am sorry that you are getting the runaround. Hopefully by this time next year you will get what you wish. However, something bothers me about what you said. You said you weren't going to do another diet that failed. Well, imagine how much more you will have to lose if you don't do something for the next 12 months. Perhaps it will be too easy for you to say that you will have the WLS in a year. What happens if something else gets in your way? After WLS you are going to have to adopt healthy eating habits. When I was seeking the surgery I took the time to get my head in order. As a result of this I realized that I didn't need the surgery after all. Start by making small changes and it will greatly help you in the "head" department when the time comes for your approval. Good luck, Kimberly. Donna- non-op 342/250/200

Kimberly: I am sorry to hear of your struggles w/ your insurance carrier. More and more companies are making it harder to get WLS. We all know it is about the almighty DOLLAR! DO NOT BE Discouraged BE DETERMINED ...(*looks like u r ready to fight!) ***(also consider some insurance companies won't approve surgery if you don't lose some wt/keep off, because they then say: YOU ARE NOT ABLE TO FOLLOW LIFESTYLE CHANGES NEEDED TO BE SUCCESSFUL POSTOP! Just be aware of that because your plan to not do a 'diet' could backfire on you (*have heard this happening across the country!)! What they need to see is progress, some weight loss, DEFINATLEY EFFORT AND STRUGGLES ARE OK!, but not a large amount of loss (like the surgery can give) some of the time frame is also to not make this an IMPULSIVE decision (I am not alluding it is on your part) BUT some people see oh so and so had WLS lost 100# that is what I want, get into a thing they know NOTHING about and not only don't do well now are struggling w/ all sorts of issues postop! May I offer a few ? & thoughts..... When was your last 'diet' effort? Do you have any documentation of WW, TOPS, etc you could 'submit' as evidence? hOW WILL YOU DOCUMENT EXERCISE FOR THEM? sOMETIMES THEY WANT THAt (LIKE CURVES OR PHYSICAL THERAPY ETC) The way to spin this negativity to something positive is (Make lemonade when given lemons!): USE THIS time to get yourself as educated and prepared as possible so the time is not WASTED! What I mean is this: Spend this 12 months researching the good/bad/ugly.....read, talk, ask, absorb all you can! (*I realize you'd rather NOT have 12 mo to do this but seeing as you do use it!!!) The below is to help you, I know people will say wellIF I could do all that I wouldn't need the surgery...I agree...again FOCUS on small, realistic, attainable goals..NOT PERFECTION, look at this as progress. a jump start so to speak! ANY change will help you, and it is LESS you'll need to do after! (once u read it allu may agree w/ me that it is alot to expect postop....) Start making lifestyle changes slowly now, ones that will EASE your recovery and transition after WLS....I recommend this to all preops regardless if they have 12 months or 12 days.....what I mean is: (DO NOT THINK DIET HERE) Start focusing on the things you'll need to do after (and the tool will help with but won't make you do by any means). 1) start some sort of exercise routine, or at the very least become as active as possible...the surgery helps as u lose wt I agree but it won't make you get up and move...practice now will help you after heal better and improve heart and lung functioning thereby DECREASING surgical risk of complications/death etc! 2) Start trying to not eat/drink together, again NOT easy for many of us and the tool may help some (if you do drink/eat together early on u may vomit) but some don't and doing so will push food through not allowing u to feel full and possibly stretching that stoma and leading to bad habits to defeat the tool longterm. wait 30 min after a meal to drink! 3) try to avoid: Caffeine, carbonation, alcohol, sugar, chocolate...teh 5 things in many postbariatric programs they caution against for at least a yr....each has its own reasons (gastric irritants, stretching stoma, dehydration, dumping etc or a mix of all)... 4) Start focusing on fluids, getting 64 oz water in (pure water) and more of things that are non-calorie: such as crystal lite, diet koolaid etc 5) If your a smoker work on quitting! blood clots kill..this is something we can work to avoid (and I wont go into why else quitting will help) 6) work on focusing on good lean protein first, followed by lower GI veggies/fruits, lessen carbs/starches..I like the south beach philosophy, it is a perfect marriage with WLS! (IMHO) works for me! 7) Focus on smaller portions, using a smaller plate, chewing your food very well, eating slower, cutting things to size of eraser... 8) Start taking a multivit a day, calcium citrate 1,000mg now (may need more after surgery)... 9) Find a whey protein shake you like (*NOT Carnation instant breakfast but something like Champion pure whey stack or PVL whey gourmet or the like...www.vitalady.com has many samples or www.bethsproteinboutique.com also has good ones!) maybe use to decrease hunger now as a good snack alternative! (mix w/ water/ice only) although tastes can change postop it may be something u can tolerate after! boost your protein to help you heal after! 10) Start looking at your emotional food issues (the head stuff)...Identify what triggers eating (for non physical reasons) what you crave, how can you delay urges? Find alternative coping...Some say get into therapy to work on ahead, find what you are struggling with, because no matter what tool/surgery you have they don't operate on the brain and that head stuff comes back , sometimes w/ a vengence and to bite us and sabotage us at times! A head start means less issues after...hopefully..Start journaling maybe feelings/food, look to triggers, correlations. Awareness is first step in change. then maybe develop some alternatives to food, because u willneed these after, esp. when on liquids (as many have 2 weeks postop on fluids only) not being able to chew is darn hard! It messes with our brains!!! 11) Maybe log food, we all know doing this helps us be aware and accountable! Meaning work on the lifestyle, work on the mental frame of mind...DO NOT make the choice to have 12 months of LAST SUPPER SYNDROME< to gain wt, unhealthy wt (the fatty wt around our internal organs) that will put ou at increased surgical risks, that will be more wt to lose and less chance you'll lose to a ideal body wt. So many programs now requrie preop wt loss (motivation, to improve health, lessen risk of nicking liver when protein sparing diet used, lesson all complication, allow people to get to a ideal more likely anyways, less to lose after!, shnow ability to adheare to a program etc) Remember how bad you want this everyday, to keep self on the right path....that frame of mind is needed postop as well... I do not mean attempt all things at oncce...work on each one at a time, after a few weeks move to another...This willhelp you be ready, and successful for the long term! Just a way to wrap your brain around this issue differently perhaps? I wish you the best! Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"