Is this too easy? - Page 4 - ThinnerTimes

Momof3 · 04-16-2008, 01:03 PM

ok..so after the insurance company denying me for "policy exclusion", I've gone self pay.

My surgery date is May 15th!!

I have my stress test this Friday and I start my 14 day clear liquid diet at the end of the month!!

sweeeeeeeeeeeeeeeeeeeet

Snow-Belle · 04-16-2008, 06:34 PM

It sounds like your insurance ROCKS!!!!

I have awful Aetna.... when I called (twice, talked to two different people) I was told there was no "waiting' period as look as it was recommended by my doctor and I was over a certain BMI. It wasn't until I actually got started in the process that all of a sudden I to be on a supervised diet, get an mental health evaluation, see a physical therapist, etc., etc., etc.

I wouldn't had a problem with all this if any of the Aetna customer service people had a clue as to what is going on with my insurance for this procedure.

I still haven't been 'officially' approved....I have another 30 days of supervised diet.

My major concern is my company has been heavily hinting at layoffs for the past three months- I'd be SOOOO upset if I lose my job right before I am approved for my surgery. That would make it twice as hard to get it approved at a future job/company as it would be a 'pre-existing' condition.

I'm glad for you--be thankful you do NOT have awful Aetna.

RDKLL · 05-18-2008, 11:38 AM

I am about 2 weeks out from my wls, and after reading these horror stories about insurance, well, I cant imagine if that had happened to me.
We have Regency BC/BS, I think it is out of WA, she works for Boeing. After talking to the Dr. (I had a problem with the $525 in non-insurance costs) but other than that, its all good. My wls is sched for 6-2-08, my birthday.

This has been an awesome resource for me and its my first day in the forum

GaryLondon · 05-18-2008, 08:59 PM

One of the things that I have noticed on here is how hard it is for everyone to get funding in the USA for this surgery.

I don't know about anyone else in the UK but my journey was a very easy one.

The National Institute of Clinical Excellence (NICE) have produced guidelines for people who need this surgery here and who should get it an what the qualifying factors are. (the paper is worth a read and is easy to find on google.)

Being the National Health Service (NHS) in the UK, high cost procedures are governed a lot by NICE who make recommendations on various things, also including high cost drugs.

My BMI was 52 when I seen the surgeon, 3 weeks (June 2007) after my referral from my GP (General Practitioner/family dr). I went into his clinic hoping he would say yes. Within 5 minutes of being there he told me that the best option for me was a RNY and was I wanting to take that route.... I could not say yes quick enough. I left his clinic and went to see a nurse who I spent 30 minutes with.

I left the hospital on top of the world. My local area health authority had to be approached to approve funding and my doctor had to write how I met the NICE guidelines. Being a high BMI of over 50 was the straw the broke the camels back for me and they of course said yes.

I had my surgery in October last year!!! For me the journey started and ended in 5 months... I did not have psych referrals, endless meetings about food and diet or any of the other hoops people in the US seem to have to jump through with insurance companies.

I had thought and wanted surgery for about 2 years but never did anything about it as I was afraid of how things would be afterwards.

Just wanted to ask a few questions if I may.......

1. Does people find the hoops (psych ref etc) useful or a hindrance?
2. Is there printed guidelines on who qualifies for the surgery nationally or is it state to state or insurance company to insurance company?

I have lost 144 pounds and do not regret for one moment what I have gone through... ( 2 strictures and have a current one at the minute... endoscopy and dilation on Tuesday .... for hopefully the last time).

I cannot imagine the stress it causes when your surgeon says yes and then the battle with insurance commences......

Sorry for rabbiting on......

Gary

Lady Greyhound · 05-19-2008, 12:32 PM

Good for you, Gary! You're a role model for the many of us on these forums but still awaiting surgery.
My previous Blue Cross/Blue Shield plan (a large insuror in the US) would not cover the surgery, even if a life-and-death matter. My current one, also BC/BS but a different plan, will cover it grudgingly. So I am at the end of month two of qualifying for the surgery.
With so very many insurance companies in the US, there are no hard and fast rules. It can depend on what policy your employer buys into, not just what insuror you have. And it varies throughout the nation. Some companies want more proof of eligibility than others, and some just seem to hope if you are not willing to jump through the hoops, you will forget it altogether. They don't want to get stuck paying for reversal procedures or having people who are not fully prepared for the surgery end up back in the hospital with complications from not being compliant. It's all a waiting game, I suppose.
I tell myself I did not put the weight on overnight (I'm nearly 59, BMI of 42), but it will practically come off overnight when I finally get the surgery. For now, I am preparing in all sorts of other ways to be ready for the incredible changes ahead. If you can't make peace with the process, you'll go crazy waiting to get started! At least that's what keeps me on track and looking forward to the day when I can finally control the hunger permanently.

Godsblessedme · 05-19-2008, 12:59 PM

Quote:

but it will practically come off overnight when I finally get the surgery.

i'm telling you right now, do NOT think like that because even at 5 months out i'm struggling to loose 2-4 pounds A MONTH everyone is different, maybe you will loose it really fast, but then again you may not. just wanted to tell you that

Quote:

At least that's what keeps me on track and looking forward to the day when I can finally control the hunger permanently.

and this also is a misconception. This is a tool, i still get "hungry" but have to resist the urge to stuff my face even with the GBS

Lady Greyhound · 05-19-2008, 01:11 PM

I am sorry you are struggling so much...believe me, even 2-4 pounds a month will seem like a miracle for me after all these years of being so overweight. Of course, we all hope it will go faster than that, but I am being realistic.
I don't expect a silver bullet or magic cure - just a good fighting chance. I'm off to a good start, getting the head in the right place so that the body will follow. Sure, I'll get hungry, but I will not be able to consume the quantity of food I can now. To me, that in itself will be such a relief, knowing a reasonable portion will satisfy me.
For many of us, the "hunger" is really in the brain, and we have to figure out some other way to feed it. I started exercise classes for the first time in my life, am reading books on WLS and going to the support groups before surgery (and will after).
I will be able to control my hunger permanently, with God's support and with my own determination to figure out what's been eating me all these years...it's not always about what we eat. A lifetime of insecurities won't change overnight, but I am making small steps toward banishing them, learning not to push them down with food. It's a lesson I've learned repeatedly over the years, but this time something has clicked in my brain and I'm at peace with my choices. Having a very, very close friend just go through quadruple heart bypass and a husband with terminal health conditions related to his weight that cannot be changed now, I have plenty of motivation.
Wishing you the best on your journey - hang in there! Time is relative, and what seems like forever to us is just a twinkling in God's eyes. We'll get there.

EasyRider · 05-22-2008, 09:42 PM

I have been breezing through my preop stuff. Only took a week for BC/BS to approve mine. I have several health issues which helped my case. I also have a fabulous PCP and wrote a great referral. I am scheduled for surgery June 30 and I am so excited.

Have a great holiday weekend.

Lady Greyhound · 05-23-2008, 09:08 AM

You are to be congratulated! I am awaiting my turn patiently, but I'm OK with that. I too have several health issues, but none so pressing that I'll be a shoe-in. But it will happen. Until then, I go to my aqua exercises and am very slowly losing the downpayment (5-10 pounds) before my surgery. We'll get there, and it will be worth every trial along the way.
Happy holiday weekend!

Native2u · 05-23-2008, 12:03 PM

Quote:

Originally Posted by Snow-Belle

It sounds like your insurance ROCKS!!!!

I have awful Aetna.... when I called (twice, talked to two different people) I was told there was no "waiting' period as look as it was recommended by my doctor and I was over a certain BMI. It wasn't until I actually got started in the process that all of a sudden I to be on a supervised diet, get an mental health evaluation, see a physical therapist, etc., etc., etc.

I wouldn't had a problem with all this if any of the Aetna customer service people had a clue as to what is going on with my insurance for this procedure.

I still haven't been 'officially' approved....I have another 30 days of supervised diet.

My major concern is my company has been heavily hinting at layoffs for the past three months- I'd be SOOOO upset if I lose my job right before I am approved for my surgery. That would make it twice as hard to get it approved at a future job/company as it would be a 'pre-existing' condition.

I'm glad for you--be thankful you do NOT have awful Aetna.

What kind of Aetna do you have? I have Aetna too. They just denied me...and I'm appealing it.