Monicaw1127

Submitted to Insurance

32 posts in this topic

I will start off by saying that I AM SO SCARED!!!!!!!!!!!!!!!!   Not one bit am I scared of the surgery.  I want this more than anything, but I am scared that insurance will deny me.  I don't have the major co-morbilities that Aetna require.  The only thing that I do have is what they are calling pre-diabetic and have been on Metformin for over a year now due to my A1C being high.  But with the metformin its controllable.  I have an autoimmune thyroid disease which makes it impossible for me to loose any weight, I have asthma and retain fluid.  I have been on EVERY WEIGHTLOSS PRESCRIPTION DRUG THERE IS AND STILL COULDNT LOOSE ANY WEIGHT!!!!!  I followed a strict diet, herbalife with the 2 shakes and a salad, atkins, weight watchers, joined a gym and purchased a treadmill................STILL NOTHING!!!!!!!!!!!!  Why me??!!  I finished my 4 months of supervised weight loss visits yesterday and the coordinator said she submitted it to insurance this morning.  I asked what Co-morbility she was using and she said Diabetic (scratching my head bc no one has ever said you have Type 1 or you have type 2) but she said it shouldn't be an issue bc the insurance company will see metformin (2000 mg) and should approve it.

Has anyone had the same experience?  Been on Metformin and got approved?  I am 5'8 238 pounds and my BMI is 36.2

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12 minutes ago, Monicaw1127 said:

I will start off by saying that I AM SO SCARED!!!!!!!!!!!!!!!!   Not one bit am I scared of the surgery.  I want this more than anything, but I am scared that insurance will deny me.  I don't have the major co-morbilities that Aetna require.  The only thing that I do have is what they are calling pre-diabetic and have been on Metformin for over a year now due to my A1C being high.  But with the metformin its controllable.  I have an autoimmune thyroid disease which makes it impossible for me to loose any weight, I have asthma and retain fluid.  I have been on EVERY WEIGHTLOSS PRESCRIPTION DRUG THERE IS AND STILL COULDNT LOOSE ANY WEIGHT!!!!!  I followed a strict diet, herbalife with the 2 shakes and a salad, atkins, weight watchers, joined a gym and purchased a treadmill................STILL NOTHING!!!!!!!!!!!!  Why me??!!  I finished my 4 months of supervised weight loss visits yesterday and the coordinator said she submitted it to insurance this morning.  I asked what Co-morbility she was using and she said Diabetic (scratching my head bc no one has ever said you have Type 1 or you have type 2) but she said it shouldn't be an issue bc the insurance company will see metformin (2000 mg) and should approve it.

Has anyone had the same experience?  Been on Metformin and got approved?  I am 5'8 238 pounds and my BMI is 36.2

Hi and welcome!

I could be wrong...  but I'm pretty sure you're not "pre" diabetic, if you're on Metformin. Basically there are no drugs approved by the FDA to treat "prediabetes". If you're on Metformin to control blood sugar numbers, then just about any institution is going to look at you as Type 2 diabetic.

Congrats on your impending surgery!! Mine is right around the corner.

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Posted (edited)

I sure hope thats it correct and I get approved.  This will be the longest 14 days I believe in my life. (atleast that's what she said it will take 14 days for them to make a decision).  I have been on the Metformin for over a year and I hope it gets me approved for surgery.  Congrats on your surgery coming up, wishing you the best of luck!!!  Did you have any co-morbilities?

Edited by Monicaw1127

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Welcome to Thinner Times Monica!

Can I ask why you chose the duodenal switch over a RNY or VSG? 

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4 minutes ago, Monicaw1127 said:

I sure hope thats it correct and I get approved.  This will be the longest 14 days I believe in my life. (atleast that's what she said it will take 14 days for them to make a decision).  I have been on the Metformin for over a year and I hope it gets me approved for surgery.  Congrats on your surgery coming up, wishing you the best of luck!!!  Did you have any co-morbilities?

High BMI, Type 2 diabetes, sleep apnea...

Today is my 5th (out of 6) monthly pre-op appointments with my surgeon. The day after next month's appointment, they submit to insurance and then they have 7 days to approve it or deny it. I've followed the insurance requirements to the letter though, so I'm not expecting a denial.

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5 minutes ago, cinwa said:

Welcome to Thinner Times Monica!

Can I ask why you chose the duodenal switch over a RNY or VSG? 

When I started the process the Dr suggested the DS, but after the 3rd month he switched to the Sleeve sue to Insurance supposes.

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4 minutes ago, Michael_A said:

High BMI, Type 2 diabetes, sleep apnea...

Today is my 5th (out of 6) monthly pre-op appointments with my surgeon. The day after next month's appointment, they submit to insurance and then they have 7 days to approve it or deny it. I've followed the insurance requirements to the letter though, so I'm not expecting a denial.

My Sleep apnea wasn't high enough to do anything about.  With Aetna you have to have 1 co-morbility if your BMI is between 35-40 and if its above 40 then you don't have to have any co-morbs.

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1 minute ago, Monicaw1127 said:

When I started the process the Dr suggested the DS, but after the 3rd month he switched to the Sleeve sue to Insurance supposes.

The duodenal switch is pretty severe, I think. The sleeve or bypass sounds more appropriate for you looking at your weight stats, but that's just my humble opinion :-)

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9 minutes ago, Monicaw1127 said:

When I started the process the Dr suggested the DS, but after the 3rd month he switched to the Sleeve sue to Insurance supposes.

Your profile shows your Surgery Type as a  Duodenal Switch.  You can change that by going to your home page and clicking on Edit Profile (upper right of the page).

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I just updated it to show the sleeve.  Sorry... Wasn even paying attention that it had the old recommendation on it.

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Welcome, @Monicaw1127! Fingers crossed for your insurance approval!

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40 minutes ago, Gretta said:

Welcome, @Monicaw1127! Fingers crossed for your insurance approval!

Thank You!!!!!!  My fingers are crossed too!!!!!!!!!!!

 

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Did you hear anything back yet or get approved for surgery, monicaw1127? Wishing you the best of luck!

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I GOT THE CALL FRIDAY THAT I WAS APPROVED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  IM SO EXCITED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  I go back to my Dr. tomorrow and find out the surgery date and what all I have to do.  I don't know what to expect to be honest.  Not to sure about the pre-op liquid diet being that im not a fan of protein drinks other than the slim fast chocolate that I did a few years ago.  Does anyone have any good protein drinks they use and would recommend?

 

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Congratulations Monica!

Protein shakes are very much a personal thing and don't bank on like the same ones you drank pre-op after your surgery so don't buy too much of anything.

Personally, I have always like Syntrax Nectar - the shake type flavours, not the fruity ones.

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I will try some of that.  Thanks!!

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2 hours ago, Monicaw1127 said:

I GOT THE CALL FRIDAY THAT I WAS APPROVED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  IM SO EXCITED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  I go back to my Dr. tomorrow and find out the surgery date and what all I have to do.  I don't know what to expect to be honest.  Not to sure about the pre-op liquid diet being that im not a fan of protein drinks other than the slim fast chocolate that I did a few years ago.  Does anyone have any good protein drinks they use and would recommend?

 

What great news!

Not much of a fan of the majority of protein drinks either - so many are sugared up. Have heard good things about the Syntax Nectar that @cinwa suggests. I use the premier Protein high protein drinks - you can buy a few to try at many places. Now I buy them by the case of 18 at Costco - I drink a vanilla every morning in a blueberry shake, and drink a chocolate about every other day as my recovery fluid after a bike ride or swim. Flavorful without being over the top or artificial tasting, lots of protein, and a good base for when I make a fruit smoothie. There are some other threads here on protein drinks as well...

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Congratulations on your approval! So exciting!!!

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Congrats on getting approved for your surgery!!! My BMI was 54, I'm type 2 diabetic, I have high blood pressure and high cholesterol, and I was still worried about getting approved, lol. Now you can rest easy about the insurance, and focus on your pre op program, and learn as much as you can about what life will be like for you post op. 

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9 hours ago, Monicaw1127 said:

I GOT THE CALL FRIDAY THAT I WAS APPROVED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  IM SO EXCITED!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  I go back to my Dr. tomorrow and find out the surgery date and what all I have to do.  I don't know what to expect to be honest.  Not to sure about the pre-op liquid diet being that im not a fan of protein drinks other than the slim fast chocolate that I did a few years ago.  Does anyone have any good protein drinks they use and would recommend?

 

Be sure to post your surgery date in the calendar so you can be flooded with well-wishes. :D

@Trish1967's post reminds me how weird a lot of this is... if ever there was a person whose circumstances SHOUTED that she needed surgery it was her and yet she was worried about approval. LOL. We all have pretty strong reasons for our WLS and yet are worried about approval. Last time I checked only about 1% of people who would benefit had actually had the surgery.... A shout out to her for her braving lots of post-op stuff and keeping her nose to the grind to get the pounds off. As she says you can now learn about what your life will be like after surgery.

Post op life? Tonight, not quite 4 months out, I had duck breast, radish/feta cheese salad, and maybe (just maybe) a glass of very fine Burgundy wine with the company of an old and beloved friend. And I wore new pants that are 6 inches smaller in the waist, woo-hoo. Anyone who tells you that life is  bad after WLS is ... not telling the truth as I am experiencing it. Freedom. I am thinking of Kundera's 1984 book The Unbearable Lightness of Being. The title describes what so many of us experience. 

Congrats on your insurance approval and the door opening to the next chapter of your life. There is a lot of joy and pleasure in your life ahead. 

 

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9 minutes ago, BurgundyBoy said:

 

@Trish1967's post reminds me how weird a lot of this is... if ever there was a person whose circumstances SHOUTED that she needed surgery it was her and yet she was worried about approval. LOL.

Amen to that! Someone in my position should have never had to worry about insurance approval...but I think part of the stress and worry comes from the fact that the doctors wait until the end of your pre op program to submit the claim to insurance. Who wants to jump through all the hoops only to find out they aren't approved in the end! And thanks for the shout out, @BurgundyBoy! It means a lot :) (I'm in a stall, btw...ugh...first one...but at least I'm staying steady and not gaining!) 

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1 minute ago, Trish1967 said:

Amen to that! Someone in my position should have never had to worry about insurance approval...but I think part of the stress and worry comes from the fact that the doctors wait until the end of your pre op program to submit the claim to insurance. Who wants to jump through all the hoops only to find out they aren't approved in the end! And thanks for the shout out, @BurgundyBoy! It means a lot :) (I'm in a stall, btw...ugh...first one...but at least I'm staying steady and not gaining!) 

Pfft. First stall? I suppose I should say lucky you, but Ouch and sympathy. Keep the spirits up and keep doing the drill. I must be in my third or fourth stall now and ha ha ha ha I just laugh at these (or try not to go insane, depends on when you talk to me during the day). 

FYI I do weigh myself every day but have started to track my weight going back 2 weeks at a time. So far I have always lost weight if I look back far enough. <_< This only goes to show the wisdom of people who only measure once a month. I remain in awe of those stalwart souls. Maybe if you go back a few weeks you will see progress and not the stall. How we choose to see the world is so important...

You are right, especially in this thread started by @Monicaw1127 to point out how crazy it is to have us all apply for approval only after going through the program. My two cents is that there should be some kind of pre-approval approval where people can be clearly told what they have to do to qualify so they can diligently work towards that goal. But well this is a WLS site not an insurance complaint site (although we could probably fill it with these stories). 

@Michael_A are you still awaiting approval too? You are close the end of your 6-month gig...

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Posted (edited)

I love reading all the comments and post.  I am still in shock, because reading a lot of the other threads I was 100% expecting to get denied.  But then again reading some of the success stories of WLS and the hoops they have gone through helps.  I agree, I think that everyone goes through it, the doubt that is, of ... OK I'VE GOT TO DO X-AMOUNT OF MONTHS SUPERVISED WEIGHTLOSS VISITS, ALL THE TESTING, MONTHLY APPOINTMENTS AND THEN TO PLAY THE WAITING GAME.................THATS THE HARDEST PART IS THE WAIT TO SEE IF INSURANCE ACCEPTS WHAT WAS SUBMITTED AND APPROVE YOU OR DENY YOU.  Then worry sets in, what if Im denied, how do I appeal, will I have to or my Dr.  All this played in my head EVERY SINGLE DAY!!!!  And now...... im in shock, but IM SO HAPPYYYYYYYYYYYYYYYYY!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!  3:00 can not get here fast enough today.  I go see the surgeon for my "results visit" and get a surgery date. 

I WANT TO BE HEALTHY AGAIN!!!!!

Edited by Monicaw1127
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Oooh, I can't wait until you're on the calendar!

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me either............... I am patiently waiting on 3:00!!!!!!!!!!!!!!!!

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