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  1. #16
    Gastric Sleeve Member rhill2901's Avatar
    I have had a gastric sleeve.
    Join Date
    Feb 2014
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    328
    Said "Thanks" 11 Times
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    Said "Welcome to Gastric Sleeve" 43 Times

    Default Re: Light At The End Of The Tunnel

    Quote Originally Posted by attaylor View Post
    I can understand the hassle! In having my 6 month diet, I was on the fence of my 40 BMI, and I wasn't allowed to lose anything. And wouldn't you know, since I wasn't trying, I would lose a few pounds here and there. Luckily, it was never too much for that BMI to fall under 40 (insurance requirements, yayyy). The day the insurance coordinator called to say I was apporved, which was a shock honestly (it was way too easy!), I asked things about what meds I couldn't take, etc. So we set the date Aug 19th, my mom had taken off a week to take care of me and help with my two toddlers. My husband was off and so were my in-laws, vacation scheduled - everything was in place.

    I get a call about 2.5 weeks before the surgery date, saying there is a diet class I am required to attend and there is only one available. Frustrated, I told them to put me down and I would just have to leave work (3 days notice mindyou) because this wasn't going to be the snag that set me back. So I called my dr office back just to quadruplecheck everything was scheduled and in line; I didn't want anything standing in the way of this date! She goes on to say that I've got to get my nicotine test done with results back or they wont be able to do anything. She could tell my frustration as I thought this was done with my pe-op so she says we can do that with pre-op, and assume it will come back ok (which it would have). She schedules my pre-op labwork, and again I ask, "Is there anything else I need to do or NOT do???" At this point, if I didn't ask, they didn't tell; which is extremely frustrating. She goes on to ask if I took any daily meds, just my birth control... She immediately says, "Oh no, we will have postpone your surgery, you can't take any meds at all."

    why didn't you say that the other 100 times I asked????? I was pissed, crying, frustrated.

    So I accepted the fact, stopped taking it that day, and am rescheduled for 9/2. Then the games begin again. I call to make sure there is NOTHING that I need to do other than my consult and my pre-op. Well turns out, this time I have to do the nicotine seperate, and can't do anything else until that's back. So I have gone and done that. With the date creeping up on me, I am so nervous they are going to throw something else in my path. Everyone has rescheduled vacations and time off, and I feel like I might blow my top if this 'lady' doesn't straighten up.

    Whoever said this was the easy way out; has never been through it obviously. And this is only the beginning. I wish you the best of luck!!!
    Isn't it crazy how insurance companies act like your payments to them is their money and any payments they make on your behalf, well, is their money.... Go figure...



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  3. Gastric Sleeve Surgery With Weight Loss Agents
  4. #17
    Gastric Sleeve Member attaylor's Avatar
    I have had a gastric sleeve.
    Name
    Ashton
    Surgery date
    09/02/2014
    Surgeon
    Dr. Nwanguma
    Join Date
    Mar 2014
    Last Activity
    01-31-2015 04:26 AM
    Location
    Kentucky
    Posts
    8
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    Was Thanked 1 Time in 1 Post
    Said "Welcome to Gastric Sleeve" 6 Times

    Default Re: Light At The End Of The Tunnel

    Quote Originally Posted by rhill2901 View Post
    Isn't it crazy how insurance companies act like your payments to them is their money and any payments they make on your behalf, well, is their money.... Go figure...
    I was actually referring to the lady in the office, never had any issues with the insurance company at all.


  5. #18
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
    Said "Welcome to Gastric Sleeve" 20 Times
    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    Thank you Ema!! Hopefully we'll see soon


  6. #19
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
    Said "Welcome to Gastric Sleeve" 20 Times
    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    rhill2901,

    You have managed to scare the piss outta me(In my most Tennessean accent LOL)!!! A huge fright is to have completed this journey to this point, only to be denied by an insurance nazi! Especially after seeing a friend of mine, who at the time had gov't insurance[dead beat dad left her with two children and no support.], be approved immediately and have her surgery a month after the seminar we attended. Here's to hoping that in a about a week and a half, I will know the verdict.

    Quote Originally Posted by rhill2901 View Post
    Yea!!! Another Tennessean

    Thanks for the gut wrenching story. Its amazing when others reach out to us for their story. Its put personality to a face and causes us all to feel your pain and identify with you. You will fit in really well Be ready for denials from the insurance companies. It may not happen, but its highly doubtful that your insurance company will cough up 15k without denying it a couple of times. Just be persistent and ask them how long should it be before you expect an answer and call them when that time has lapsed. If they deny, go back to your doctor and have them resubmit.

    In my case, with Mexican doctors doing the same exact procedure for $4,500, its very tempting to just cough up the money and just do it there. Its completely safe, the dr's have alot of experience, and 1000s have gone there before you. My DR was a professional, very good at it, probably done more gastric sleeve's than any other doctor in the world.

    Good luck with the insurance, your going to need it :/


  7. #20
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
    Said "Welcome to Gastric Sleeve" 20 Times
    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    attaylor,

    I feel you!!! The weight issue was a big deal for me! I could not understand why I was being told one thing just to find out they were wrong! I honestly thought of switching, but the fact of having to redo what I had already accomplished just wouldn't cut it. I remember telling the nurse when I weighed last week that if there was something they had forgotten to tell me, then they were going to have to fudge the records. I would not be rehashing what I had went through. LOL!!! Best of luck to ya!! Please keep me posted on your surgery in the coming days I'm so happy for you!!!!

    Quote Originally Posted by attaylor View Post
    I can understand the hassle! In having my 6 month diet, I was on the fence of my 40 BMI, and I wasn't allowed to lose anything. And wouldn't you know, since I wasn't trying, I would lose a few pounds here and there. Luckily, it was never too much for that BMI to fall under 40 (insurance requirements, yayyy). The day the insurance coordinator called to say I was apporved, which was a shock honestly (it was way too easy!), I asked things about what meds I couldn't take, etc. So we set the date Aug 19th, my mom had taken off a week to take care of me and help with my two toddlers. My husband was off and so were my in-laws, vacation scheduled - everything was in place.

    I get a call about 2.5 weeks before the surgery date, saying there is a diet class I am required to attend and there is only one available. Frustrated, I told them to put me down and I would just have to leave work (3 days notice mindyou) because this wasn't going to be the snag that set me back. So I called my dr office back just to quadruplecheck everything was scheduled and in line; I didn't want anything standing in the way of this date! She goes on to say that I've got to get my nicotine test done with results back or they wont be able to do anything. She could tell my frustration as I thought this was done with my pe-op so she says we can do that with pre-op, and assume it will come back ok (which it would have). She schedules my pre-op labwork, and again I ask, "Is there anything else I need to do or NOT do???" At this point, if I didn't ask, they didn't tell; which is extremely frustrating. She goes on to ask if I took any daily meds, just my birth control... She immediately says, "Oh no, we will have postpone your surgery, you can't take any meds at all."

    why didn't you say that the other 100 times I asked????? I was pissed, crying, frustrated.

    So I accepted the fact, stopped taking it that day, and am rescheduled for 9/2. Then the games begin again. I call to make sure there is NOTHING that I need to do other than my consult and my pre-op. Well turns out, this time I have to do the nicotine seperate, and can't do anything else until that's back. So I have gone and done that. With the date creeping up on me, I am so nervous they are going to throw something else in my path. Everyone has rescheduled vacations and time off, and I feel like I might blow my top if this 'lady' doesn't straighten up.

    Whoever said this was the easy way out; has never been through it obviously. And this is only the beginning. I wish you the best of luck!!!


  8. Gastric Sleeve Surgery With Weight Loss Agents
  9. #21
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
    Said "Welcome to Gastric Sleeve" 20 Times
    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    Welp... It happened. My insurance denied me! Ugh. I'm almost over this whole ordeal. When talking with her over the phone, I asked for the reasons. I was informed that I was missing years 2010 & 2011 of my medical history and that I had lost over 15% of my body weight.. Um.. I was suppose to lose 10% and was told more was best, PLUS... I have gained back up to 3lbs over my goal.. So now what?? It's really hard not to throw in the towel right now and just be fat the rest of my life.


  10. #22
    Gastric Sleeve Member Ann2's Avatar
    I have had a gastric sleeve.
    Name
    Ann2
    Surgery date
    08/18/2014
    Surgeon
    n.a.
    Join Date
    Oct 2013
    Location
    Missouri
    Posts
    6,630
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    Default Re: Light At The End Of The Tunnel

    I'm so, so sorry. But as tough as you are -- and it's SO CLEAR how tough you are! -- I expect you will get right back up and make this happen. These insurance company appeals happen, and they succeed. There are numerous stories on here of people going through those hoops and winning the coverage approval.

    My own surgeon's office has a coordinator who wrangles all the insurance issues for us, and she is gooooood! I hope you can find that kind of support for your appeal.

    Again, I wish it had turned out differently the first time. Just get your breath back now. Then ... next steps.



    Consult: 235 lbs
    My and doc's preop diet: 216 -19 lbs
    M1 postop 205 -30
    M2 193 -42
    M3 184 -51
    M4 174 -61
    M5 167 -68
    M6 162 -73
    M7 156 -79
    M8 151 -84
    M9 148 -87
    M10 146 -89
    M11 144 -91
    M12 143 -92
    M13 142 -93
    M14 140 -95
    M15 139 -96
    M16 137 -98
    M17 135 -100

    First Surgiversary post

    Second Surgiversary post

    Third Surgiversary post

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  12. #23
    Gastric Sleeve Member nmgirl's Avatar
    I have had a gastric sleeve.
    Surgery date
    09/04/2014
    Surgeon
    Dr Almanza
    Join Date
    Jul 2014
    Last Activity
    03-31-2015 10:52 PM
    Posts
    56
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    Was Thanked 7 Times in 6 Posts
    Said "Welcome to Gastric Sleeve" 5 Times

    Default Re: Light At The End Of The Tunnel

    MEXICO, girl! It is only $4500 in Tijuana. Get Dr Almanza, he does excellent work! Had mine done almost 1 month ago and have lost 25 lbs so far.



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  14. #24
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
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    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    Ann2,

    Thank you so much for calling me tough. With everything else going on, aside for the insurance issues, I guess I lost sight of exactly what I have already gone through and over come. As for getting back up, I already have. After losing it with my insurance company, I began to think things out. 1) in order to have lost 15% of my body weight they had to be going by my highest weight, not my start weight. 2) my doctors office verified they faxed all required documentation, but to be on the safe side I have found another provider that has the missing 2 years and have faxed the records. 3) my surgeon was infuriated after being told I was not suppose to lose weight. He got on the phone to assure me that he was appealing the decision based on my insurance provider not notifying them of a change in their policy[the whole not suppose to lose weight as opposed to the 10% they use to require] and that I have, in fact, gained 6 lbs back.

    After looking at all of this, I finally see it is a set back and only a set back. There is a reason for it. I was panicky over making sure I have enough time for 2 entire weeks off work(had to burn 4 days for pneumonia this month). It will work out. I will work it out. LOL

    Thanks again!

    Quote Originally Posted by Ann2 View Post
    I'm so, so sorry. But as tough as you are -- and it's SO CLEAR how tough you are! -- I expect you will get right back up and make this happen. These insurance company appeals happen, and they succeed. There are numerous stories on here of people going through those hoops and winning the coverage approval.

    My own surgeon's office has a coordinator who wrangles all the insurance issues for us, and she is gooooood! I hope you can find that kind of support for your appeal.

    Again, I wish it had turned out differently the first time. Just get your breath back now. Then ... next steps.


  15. #25
    Gastric Sleeve Member MissersK's Avatar
    I have not had a gastric sleeve.
    Surgeon
    Dr. Chris Huddleston
    Join Date
    Aug 2013
    Last Activity
    06-30-2015 09:54 PM
    Location
    Tennessee
    Posts
    23
    Said "Thanks" 21 Times
    Was Thanked 2 Times in 2 Posts
    Said "Welcome to Gastric Sleeve" 20 Times
    Blog Entries
    1

    Default Re: Light At The End Of The Tunnel

    nmgirl,

    CONGRATULATIONS!!!! 25lbs is no easy feat! I cannot imagine how elated you must be As for going to Mexico, it is an option. I am going to try one more time to get the insurance company to pay(I've already met my deductible so it wouldn't cost anything). If they don't, I will be booking a flight after the first of the year

    Again, CONGRATULATIONS Keep up the hard work!!!!

    Quote Originally Posted by nmgirl View Post
    MEXICO, girl! It is only $4500 in Tijuana. Get Dr Almanza, he does excellent work! Had mine done almost 1 month ago and have lost 25 lbs so far.


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