Hello world! I am a brand newbie!
OK this is my first post to these forums- though I have been stalking them for months and months. Lol. I had my first consultation with a wls doc, and they submitted it to insurance. Insurance (BCBS Texas ANTHEM) came back in two days and said that I needed to complete 6 months of diet monitored by a doctor or dietician, a psych evaluation and that's it. Is this considered an approval? And if so...6 months? How is the fact that I have been on a diet since I was 12 and am now 41 not enough? What should I think now? What is there to expect? I have an appointment with my gp tomorrow morning to see if she will back me at all since I just dished out $400 on Qsymia in March and April (which did absolutely nothing) and have kept a food journal for the last year almost daily. Can you get around that requirement? Why would they do that? Is a BMI of 43 not enough? Please lemme know your thoughts! I can't wait to be where some of you are and I cannot wait to become a very active member on here!! You need extra support? I got you, babies!! Thank you in advance for all your help. I know you guys have great advice to give.
Brandi
on 5/31/17 9:10 pm
If you have documented proof that you have been working with a doctor to lose weight for the last 6 months, it sounds like you should hound your insurance company until they accept that you don't need another 6 months. If you hounding them is not enough, get your surgeon's office to hound them!
I can't help you with your insurance questions, as I am from Ontario, and our sytem is very different from the States, but I wanted to wish you good luck and welcome to the boards. Its a very supportive and informative forum and website over all.
Good luck with your GP visit.
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Orientation April 2016 - Final approvals December 2016. Surgical Class January 23, 2017. Met with Dr. Reed February 7, 2017. Opti start date March 1, 2017. Surgery March 15, 2017 (Dr. Foute-Nelong).
HW 348 SW 316 CW 191
GW 160
on 6/1/17 1:36 am
Insurance companies have set rules about the requirements, and doctors are very familiar with navigating and working with them. I hope they can help you. On the other hand, if the diet you have been on with your doctor does not count for the approval process, here is advice from a new sleeved... take the time. This is a major life changoing and non reversible process. Use whatever time you have to spend on getting approval to work with your body, learn about what post op is like etc. I wanted to be in a hurry too but had a four month span with doctor and dietician, and think it helped prepare me for some challenges. I do hope it is faster for you, truly. This forum is a very useful tool, and you can learn much from the veterans who kindly share their wisdom. I especially read a lot of post op postings to know what was ahead, for example coping with two week liquid diet before surgery, pains, side effects, etc. you will get there.
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Surgery date May 4, 2017
HW 290. Start weight 229. Day of Surgery 209. Month 2: 190. Month 3: 182. Month 4: 174. Month 5: 164. Month 6: 159. Month 7: 153. Month 8: 147. Month 9: 145. Month 10: 142. Month 11: 138 Month 12: 137. Month 13: 139 Month 14: 131. Month 15: 130. Month 16: 131. Month 17: 128. 162 pounds lost!!
Two year anniversary upon me in 3 days: 136. Need to lose a few pounds..
Welcome! 6 months of monitored diet is totally normal for insurance companies. And if that's what they require, it's unlikely that you can get around it sadly.
VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)
Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170
TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)
In good news, you can use this time to work on building good habits for post-op. Weigh and log everything you eat, work on getting liquid calories out of your diet and drinking 64+ ounces of water a day, find a therapist you click with, etc, etc. :)
VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)
Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170
TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)
In good news, you can use this time to work on building good habits for post-op. Weigh and log everything you eat, work on getting liquid calories out of your diet and drinking 64+ ounces of water a day, find a therapist you click with, etc, etc. :)
^^^ This.
In addition, I tell this to all the pre-op folks.. enjoy the ride. Six months seems like along time, but before you know it you'll be six months post op and posting about your progress.
A word of warning (Not necessarily for you, but for all the newbies reading this):
There seems to be two eventualities, from what I've observed- Either $WLSPatient comes to share their success, or they come to stress about why they aren't losing anything. After $WLSPatient is grilled about their eating habits, $WLSPatient reveals a "modest" diet of mostly high carb items (banana, fruits, mashed potatoes), without portion size information. $WLSPatient then stops replying to their post, and disappears entirely.
End result being get used to weighing and tracking your meals. Download MyFitnessPal on a mobile device, and familiarize yourself with it.
OP: Just out of curiosity.... Are you a programmer by any chance?
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M/34/5'10"
HW 293 CW 180
I have noticed this trend as well. Or $WLSPatient is unwilling to share what they're eating at all - which is always a good sign that they're eating poorly and know it.
A strong case for finding a therapist to work on the mental stuff when you have the time prior to surgery. That way you can try to avoid self-sabotage after surgery!
VSG with Dr. Salameh - 3/13/2014
Diagnosed with Binge Eating Disorder and started Vyvanse - 7/22/2016
Reconstructive Surgeries with Dr. Michaels - 6/5/2017 (LBL & brachioplasty), 8/14/2017 (UBL & mastopexy), 11/6/2017 (medial leg lift)
Age 42 Height 5'4" HW 319 (1/3/2014) SW 293 (3/13/2014) CW 149 (7/16/2017)
Next Goal 145 - normal BMI | Total Weight Lost 170
TrendWeight | Food Blog (sort of functional) | Journal (down for maintenance)