Recent Posts

WASaBubbleButt
on 1/26/11 2:14 am - Mexico
Topic: RE: BCBS Alabama-- HELP!!!
Insurance doesn't really cover cosmetics. Are you having any medical problems that require surgical intervention?

Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
WASaBubbleButt
on 1/26/11 2:11 am - Mexico
Topic: RE: Help with insurance lingo
There are some seriously fantastic surgeons in Mexico. I have had surgery twice in Mexicali and will do my plastics the same.

Just do your research, don't pay high deposits, before paying the deposit get it in writing if it is refundable or not. Pay your deposit with a credit card when possible. That holds true for the US or MX.

A sleeve is a great procedure for MX because there is no after care, you have surgery and you are done.

If you check out the link in my sig you can see how to research surgeons.

Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
Crabadams72
on 1/25/11 11:02 am - Silver Spring, MD
Topic: UHC (govt employees health assn) ?
Hello,
     I am working on gathering my diet records for the last 12 months.  I went to a diet clinic at the end of 09 and beginning of 10'.  I just got copies for the records but the sheets do not list a contact number.  It has the billing codes and lists my visits.  Will UHC call the diet clinic to verify I went there?   I don't think they require 6 consecutive months-just 6 visits in the previous 12 months (I think).
slhobbs81
on 1/24/11 5:44 am - Goldsboro, NC
Topic: RE: Help with insurance lingo
OMG!!! That was some really good info! Thank you for breaking everything down for me, I needed that. So after reading your post, I'm really considering looking into doing this in MX. I was a bit scared to even think about getting surgery done there, but after reading what you wrote, I'm really excited, and the price is considerably cheap. Thanks again!
trouble256
on 1/24/11 4:31 am - Athens, AL
Topic: BCBS Alabama-- HELP!!!
I am wanting to have plastics (a panni and breast lift) and was wondering how I go about figuring out what is covered and not covered on my insurance?  Where do I find the info?  I tried to call, they werent very helpful.

I had WLS RNY 2-2009. I have maintained a comfortable stable weight for quite a while now (almost a year with even being pregnant most of that)

I rarely check back - i will try to, but if you have the answers or suggestions to help and have spare time, please email me at [email protected]
Lilypie Second Birthday tickers Lilypie Pregnancy tickers
SugarGrl
on 1/23/11 8:46 am
Topic: RE: Tricare ins
I'm tricare prime and am wanting VSG. I've been working on this for about a month and have not heard that I can't get VSG by my surgeon's staff. Oh don't tell me I can't get the VSG!! I'm even sleeping with the bleeping sleep apenea mask to get through the process!

    
  WE ARE ALL IN THIS TOGETHER!  LET'S GET HEALTHY!     STARTING WEIGHT 211.8, SURGERY 23 MAR 11; ONEDERLAND 30 MAR 11 199.2                                                                                                                                                                                                                                                    

Nan2008
on 1/21/11 1:35 am - Midland, MI
Topic: RE: can anyone approved by Aetna answer a couple questions for me?1
Hi!  I'd be glad to help you with your questions.  I was approved by Aetna and had surgery in March 2009.  My daughter, approved by Aetna and had surgery in May 2010 and my two sons both just had surgery in Dec 2010, both being approved by Aetna.  Three of us did the # month multidisciplinary program and my one son did the 6 month physician supervised diet.  So I pretty much have it nailed down as to what they are looking for with the 3 month MD program.  I will send you a PM that details what we did for our approval.

To answer your question about the exercise consult.  It has to be documented in the notes to the PCP.  I work at a place where we have health facilities right here.  I went to the health center and had an excercise specialist set me up on a weight training/cardio program.  I took a copy of that along with a letter signed from that person stating that I had been set up on an exercise program.   That is all that I did for the exercise part of the requirements other than my PCP documenting in her notes that I was continuing my exercise program set up by so and so.........

One thing to keep in mind is this is a 90 day program - not 3 months.  So Aetna will count out 90 days from the time you saw your physician and dieticien and go from there. 

As far sa the success vs failure on the supervised diet.....during my 3 month MD program, I gained 6 pounds.  My daughter dropped about 5 lbs and my sons each dropped about 10.  I don't think it matters either way! (as long as you don't drop enough to push your BMI under 40!!)

I'll PM you.  And feel free to ask any questions you may have.  Two of us were denied at first and I appealed and the decision was overturned, so I have experience filing appeals with Aetna too.  You have to make sure all your i's are dotted and t's crossed and it can be a very easy approval.  But if you don't, they will definitely deny. 

Sounds like you are well on your way to a good start.  Key thing to remember is your PCP is the one who has to keep everything in his/her notes! 

And they will be looking for the 'behavior modification' requirement.  I talked to my dietician and my physician about behavior modifications I was making (joining a support group, not drinking with meals, cutting out pop, etc....) and both of them documented it in their notes. 

Hope this helps!

Nan


Nan

HW 300
/ SW 280 / CW 138 /
GW 140
Hit Goal 4/2/2010

        
WASaBubbleButt
on 1/20/11 9:42 am - Mexico
Topic: RE: Help with insurance lingo
Much to say here regarding MX and bypass. ;o)

Bypass, it's a trade off. You'll lose the same with bypass as you will with a sleeve, statistically speaking. The trade off is faster weight loss with bypass in exchange for a lifetime of malabsorbing nutrition. You'll only malabsorb calories for 6-24 months but you'll malabsorb nutrition forever. With bypass you have high risks for vitamin deficiencies, reactive hypoglycemia, and dumping, you also risk bowel obstructions for life. About 3 years post op bypass you are seriously metabolically challenged so losing a pound 3 years post op is not like losing a pound today. And in the end you have to follow a sleeve diet to maintain anyway. So is the trade off worth it?

Bands are horrible surgery types, sleeves are the safest surgery type long term, bypass is great for people with severe reflux not caused by obesity or a hiatal hernia, and DS provides the best weight loss long term.

Sleeves... it removes Ghrelin produced by the stomach and Ghrelin is what tells your brain you are hungry. Most sleeved people don't experience hunger often. About the only time I do is if I eat a lot of white carbs. Then the blood sugar spikes cause hunger. But otherwise, I might experience stomach hunger a few times a year. Bypass requires lots of labs, sleeves require far fewer labs since we don't malabsorb.

Bypass folks often times dilate their stoma. Food acts like a water slide down their esophagus, through their pouch, and into their small intestine, they are always hungry and since they aren't malabsorbing anymore the regain starts. Since they are metabolically challenged they have a hard time losing that regain.

Sleeves... perfect restriction forever, your pyloric valve isn't stapled off so you have a fully functioning smaller stomach minus the Ghrelin.

Mexico... much to say about that. There are really great doctors and bariatric butchers in every country including MX and the US. See this:

http://wasabubblebutt.blogspot.com/

Those are examples of US and MX surgeons that are questionable.

This is why research is critical regardless of who does your surgery in any country and you do it this way:

http://wasabubblebutt.blogspot.com/2010/03/researching-mexican-or-us-sleeve.html

I went to a fantastic surgeon and a fantastic hospital. I had my band there and then I revised to a sleeve there. I'm having my plastics done at the same hospital as well.

You just want to avoid Tijuana and Juarez, they are too dangerous and really, IMHO there are no good bariatric surgeons in Tijuana or Juarez anyway. When the US, MX, and Canadian gov'ts warn about Mexico it is not the entire country they are warning about, it's very specific cities.

You know, most of the popular MX surgeons have more experience than most US surgeons. They have been doing bands for 10 years longer than US surgeons, they were saying years ago sleeves are the way to go. US surgeons were drinking Allergan's kool aid and they were just sure bands were the way to go. Turns out the MX surgeons were right but they've been doing stand alone sleeves longer than US surgeons so of course they had experience with both.

I can't speak for all the doctors in MX but my surgeon... there are no hotel fees. He keeps you in the hospital until you are okay to go home. Two nights for bands, three nights for sleeves, and a week or so (I forget if it is 6-7 nights) for bypass. I don't know how long he keeps you for DS. You arrive the day before your surgery for pre ops and then you do go to a hotel the night before surgery. That's included in the package price and the doctor's driver provides ALL transportation from when you arrive in San Diego, from hospital to hotel, from hotel to hospital, and from hospital to the San Diego airport. So, no transportation costs once you arrive in San Diego.

I paid more because back in the day it cost more! ;o) Today it is $8750 and figure in a $250 airfare ticket. You are talking $9K for surgery in a US inspected, Joint Commission Hospital.

http://www.jointcommission.org/

My surgeon has done well over 1000 sleeves, thousands of bands, around 500 bypass and I don't know how many DS. His stats are great. My sis is considering a sleeve and I won't let her go anywhere but my surgeon.

There is much to research regardless if you stay locally or travel. My surgeon is my personal pick, that's why I went to him! ;o) But he's not the only good surgeon in MX, there are about three that I would personally go to.

So how was my experience? I had perfect surgery twice and I plan on having two more perfect surgeries for plastics. At the time I lived in Phoenix and so my surgeon was driving distance for me for aftercare with a band but there is no aftercare for sleeves.

My surgeon is a proctor surgeon, meaning he travels the world one week out of every month teaching other doctors sleeves and bypass. He was previously a proctor surgeon for US docs when the band was approved in 2001.

BTW, regardless if you have surgery in the US or MX don't forget, all your expenses are tax breaks if your income qualifies. ;o)))

Previously Midwesterngirl

The band got me to goal, the sleeve will keep me there.

See  my blog for newbies: 
http://wasabubblebutt.blogspot.com/
onmywaytoskinny
on 1/20/11 3:36 am - Texas, TX
Topic: BCBS Healthselect State of Texas employees
I have search for this and didn't come up with anything. I don't post a lot....just a long time lurker. But I have a question:

Has anyone had any luck getting approved with BCBS Healthselect for State of Texas employees (ERS)? I am almost finished with my 12 month attempted weight loss requirement and I am just wondering.
slhobbs81
on 1/19/11 8:03 am - Goldsboro, NC
Topic: RE: Help with insurance lingo
Thanks for your response. I'm not really set on having gastric bypass, but I'm a little nervous about going out of the country.  How was your experience in Mexico? I didn't know if it would be worth it, with paying for airfare, hotel fees, etc.  About how much did you end up paying including all expenses? 
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