Susanvmallory

Members
  • Content count

    25
  • Joined

  • Last visited

3 Followers

About Susanvmallory

  • Rank
    Member
  • Birthday 09/29/1973

Profile Information

  • Gender
    Female
  • Location
    Louisville
  • Age
    44

Information

  • Hospital
    Norton Audubon
  • Height (ft-in)
    5-09
  • Start Weight
    248
  • Current Weight
    248
  • Goal Weight
    165
  • Body Mass Index (BMI)
    36.6
  • Surgery Date
    Pending
  • Surgery Type
    Vertical Sleeve

Recent Profile Visitors

172 profile views
  1. @Stephtay thank you! I truly enjoyed reading your reply so much. Awesome, it make me think, it made me laugh and it made me blush. I appreciate everyone’s advice so much.
  2. At our first discussion regarding WLS my spouse was quick to say, what about the elliptical you were wanting to get, you’ve been losing weight here lately. I quickly explained to him that I have been battling with the Numbers on the scale for eight years and asked if he could recall when we were dating and I was a size 4 and I am now a size 16 to 18. I explained to him how depressed I am and how I don’t feel attractive and it is the main reason why our intimacy has become less and less over the years. My spouse goes on to jokingly explain that being intimate can burn a lot of calories. This absolutely infuriated me. Maybe I’m being sensitive but I felt like he was mocking me when I felt like was being honest and expressing my raw emotion. If he could only understand how disgusted I get when I look in the mirror especially because for so many years I was very thin but once I hit 36 it all changed and I started packing on the weight. My husband is 5 foot 10 and literally eats about 5000 calories in his once daily meal. This is not an exaggeration my brother Thomas who went through weight-loss surgery and is also a member on this site can vouch for me. My hubby is a thin fat man with a metabolism like I have never seen before in my life. I really hope by taking him to the weight-loss seminar will help him to really understand the importance of my decision and the need for his his support during this process. I feel like if he’s going to expect me to cook him dinner he’s out of his mind because it can’t happen The children are mainly grown and out of the house except for one who is pretty self-sufficient. I don’t believe it would be in my best interest to continue to have to cook him his dinner and sit with him while he eats 3 pounds of chili or 5 pounds of cottage pie! I don’t know how to tell him that I won’t be cooking for him once I have surgery! Ugh....maybe I should stop cooking for him after we attend the seminar. I know how angry I get sometimes because he can eat so much food in one sitting and never gain weight. If I think I’m being hateful then maybe I am but honestly should I stop cooking for him or continue to cook for him while explaining that I cannot sit at the dinner table with him while he eats. I literally spend hours preparing his meal then I sit at the dinner table and eat a salad or a plate of vegetables and am completely disgusted by the amount he eats because I guess I’m jealous.
  3. Susanvmallory

    Someone Please read this insurance info and help me

    @ReadytobemeYeah when I called yesterday to the weight loss center I messed up and said I had BCBC of CA so they told me if my BMI was not over 40 or at 40 i had to have two comorbidities but I it’s actually anthem Blue Cross Blue Shield PPO of California so today through the I surqnc chat I was able to Get the proper information and as it stands I have two options. A my BMI has to be 40 or B a BMI of 35 to 39.9 Iand only one comorbidity. So currently my BMI is 36.9 however my doctors office has my height as 5 foot 8 1/2 also as 5 foot 9 in another visit. If I am only 5 foot 8 I could technically qualify at 263 pounds with no comorbities So in the unlikely event that I do not have sleep apnea I have just resolved to the fact that I am not going to try to lose weight anymore and I will most definitely gain weight. I have such large fluctuations in my water weight and I can literally be 10 pounds heavier at any given day if I eat foods high in sodium.
  4. Susanvmallory

    Someone Please read this insurance info and help me

    Oh thank goodness I am having a sleep study soon and scheduled my sleep conso for the 11th. I snore like a wilder beast and wake myself up I am sadly praying I have severe sleep apnea. I also would wear a cpap because I never feel rested.
  5. I was able to get this from a chat online with the insurance company Here is what you need: Gastric bypass and gastric restrictive procedures with a Roux-en-Y procedure up to 150 cm, laparoscopic adjustable gastric banding (for example, the Lap-Band® System or the REALIZE™ Adjustable Gastric Band), vertical banded gastroplasty, biliopancreatic bypass with duodenal switch, and sleeve gastrectomy (open or laparoscopic) are considered medically necessary for the treatment of clinically severe obesity for selected adults (18 years and older) who meet ALL the following criteria (A, B, and C): BMI of 40 or greater, or BMI of 35 or greater with an obesity-related co-morbid condition including, but not limited to: diabetes mellitus; or cardiovascular disease; or hypertension; or life threatening cardio-pulmonary problems, (for example, severe obstructive sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy); and The individual must have serially documented active participation in a non-surgical weight reduction regimen for at least 6 continuous months, in the 2 years prior to surgery, to enable both behavioral changes and adequate assessment of anticipated postoperative dietary maintenance. These efforts must be fully appraised and documented by the physician requesting authorization for surgery; and The physician requesting authorization for the surgery must provide documentation of ALL of the following (1 through 7): The individual's psychiatric profile is such that the candidate is able to understand, tolerate and comply with all phases of care and is committed to long-term follow-up requirements; and The candidate's post-operative expectations have been addressed; and The individual has undergone a preoperative medical consultation and is felt to be an acceptable surgical candidate; and The individual has undergone a preoperative mental health assessment and is felt to be an acceptable candidate; and The individual has received a thorough explanation of the risks, benefits, and uncertainties of the procedure; and The candidate's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling; and The candidate's treatment plan includes counseling regarding exercise, psychological issues and the availability of supportive resources when needed. So is this saying I could be approved with a BMI of 35-39.9 with only 1 comorbidity?
  6. Susanvmallory

    Very discouraged with Insurance

    @TammyP I called them and as you can see by my other post they were the most unhelpful people in the world and told me that I would have to be seen by bariatric surgery center of excellence and they were the ones who make the decisions and I know well and clear they have a set of specific provisions to cover weight-loss surgery depending on BMI and comorbidities they will not tell me if I have to have one or two comorbidities and what comorbidities they except I cannot find the information anywhere. So frustrating I will gladly give anyone the phone number to call to see how incompetent these people are and how they cannot answer a direct question and give me the information I am requesting.
  7. Does anyone have Blue Cross Blue Shield PPO of California and was approved for bariatric surgery with a BMI under 40 with only one comorbidity such a sleep apnea? I called to speak with my insurance company they were very unhelpful I asked them for a document stating what the requirements for gastric surgery were and I was informed that I would have to be seen by a bariatric surgical center of excellence and they would either recommend or not. My Insurance company cannot give me a straight answer on what the requirements are even when I specifically asked for this. I guess I’m going to have to have my husband go to his human resources department today and ask them.
  8. Susanvmallory

    Very discouraged with Insurance

    @TammyPdid you have to have two comorbidities if your BMI was under 40 because I am ready to just let the weight take over and qualify with my BMI. I have literally been struggling with my weight for over eight years and 23 pounds is going to prevent me from having a life changing necessary surgery it is so ridiculous to me. I’m a nurse I know the health risk involved eventually I will have life-threatening illnesses and eventually my BMI will be well above 40 if I continue on this path it is sickening to me.... all the hoops the insurance company requires you to jump through when you’re asking for help.
  9. Susanvmallory

    Very discouraged with Insurance

    @athenarose so basically you needed to gain some weight for the initial weight submission to qualify you but after this you were fine?
  10. Susanvmallory

    Very discouraged with Insurance

    I need two so I’m going to have the sleep study done and maybe with some luck that will work but it has to be severe sleep apnea. The insurance website is so confusing but the surgeon seems to think I need two comorbidities not one. Maybe I should call the insurance ?
  11. Susanvmallory

    Very discouraged with Insurance

    So annoying but I cannot change these insurance required stipulations! I guess for now I’ll make certain to get my sleep study done and wait for either another chronic life threatening disease or gain weight!
  12. Spoke to my weight loss surgery center a few minutes ago, they are very familiar with my insurance and unfortunately my BMI is not 40 and though It is over 35 I do not qualify because I do not have any of the two comorbidities that Anthem BCBC PPO of CA would require!! So my 8 year weight struggle will continue...very upset feel like I could cry!! I am 5 foot 9 and as of this morning weigh 248 lbs. Guess I have to wait until I develop a few life threatening diseases or save up and pay cash. Feeling defeated today.....
  13. Susanvmallory

    BCBS CA PPO BMI Question

    @athenarose I looked at my policy, had hubby send me info as I’m in NY visit g my parents and you are correct I basically need a BMI of 40 or 35-39.9 with two comorbidities and do not have them to qualify!! My weight loss seminar is March 17th. Where I live in Kentucky they give you a massive packet to fill out then you take it to your primary care physicians office so they Complete the portion regarding your health history, diagnosis and your current weight as height then you mail the completed packet to the surgeons office they schedule a consultation and discuss options. The surgeon submits to insurance based off the first weight entry log from your PCP when they completed their portion of your packet of paperwork that was mailed in prior, they are are all in the same healthcare network, Norton’s Healthcare System. I only know that part since my brother went through his weight loss surgery at the same healthcare system; and attended the same seminar; however his BMI was well above 40. Ugh if I was only 5 foot 8 and 15lbs heavier or I’d need about 20 more pounds on me!!! This makes me seriously consider ankle weights, salty foods, heavy clothing and a ton of water!! I’m 5 foot 9 and currently at this moment 248.3 any advice???
  14. Susanvmallory

    BCBS CA PPO BMI Question

    Awesome thank you. BMI is under 40 but I officially know I have sleep apnea. I’m actually calling tomorrow to schedule my sleep study to have it documented because my snoring and gasping awakens my husband and myself at times.
  15. Susanvmallory

    Newbie

    @BurgundyBoy I am extremely lactose intolerant I avoid dairy products especially milk at all cost.....will this maybe change afterwards to allow me to use a milk based protein drink or do you think I could just drink vegetable broth with egg whites??