Denied by insurance for gastric sleeve today :(

becoming_a_new_me

I got the call today. I was denied by my insurance company the coverage for the gastric sleeve. The reason? I've lost too much weight during the 3-moth process in which I had to attend a class once a month that educates you on the lifestyle change you will be embarking on. This was required by my insurance company in order to attain their coverage.

Despite being told by the doctor, nutritionist, and insurance lady that weight-loss BEFORE surgery is preferred and even some-what mandatory, in some cases. And, despite being reassured not once, but three times that it wasn't going to be possible to lose too much weight before surgery, I seemed to have achieved this task.

I did everything I was supposed to. I did what I was told and I started taking charge of my life. Now they're telling me I took too much charge and I no longer have the privilege of their services.

It's bitter-sweet. I mean, who can't be a little proud of losing nearly fifty pounds? At the same time though, I was REALLY looking forward to having another weapon in my arsenal for when my Will Power gun was running low.

I can't say I'm ready to just give up or anything pathetic like that. The thought of launching myself into a downward spiral seems rather annoying and self-mutilating.

Has this happened to anyone else? Can someone share their story with me? I still feel strong....almost like this is a sign I should be doing this on my own....or a sign that surgery might lead to something far worse.

I'm sorry honey :frown: I ended up paying out of pocket for my surgery 9 years ago (roux-en-y). While I don't regret the surgery (I started at 450#), I would have loved to do it on my own.

Look at how far you have come!! You are nearly a third of the way there without the surgery. You can do this...don't let it get you down, use it to fuel yourself! Prove to yourself that it can be done. Hugs!!

UsedToBeHusky

Congrats on what I consider a super-awesome NSV!!!

Rocking_Robin

I am sorry you got denied, I think you should be proud that you did exactly what was expected of you and you lost amazing pounds!!!!! It just stinks that you did what you were told and then they didnt approve your surgery. Please dont give up, you can do this!! MFP people totally ROCK, we are all here to lend you support.

angeldaae

Had you ever even really tried to lose weight on your own before? Cripes. I'm horrified that you were approved to begin with.

ArtemisMoon

I honestly believe one day you will be glad this happened. Being strong enough to do this on your own is something you can obviously achieve, and know that one day when you weigh less, you won't be weighed back down by additional health problems caused by the surgery as so many people are. I have known people to get these surgeries, they are usually just used as crutches so they don't have to put in as much effort themselves. It usually backfires and they still manage to be obese and in terrible physical condition because they ended up relying on the surgery too much. I have never met a happy, physically well off person who has had surgery to try to fix their weight problems.

Congrats on the weight loss, and I can't wait to hear about your next big success!

suziecue66

You're too good for those quick fix solutions. You've proved you've got what it takes without needing surgery.

Besides she did her own quick fix in 3 months without surgery!! With that kind of results and some determination that goal weight will be a reality.

htolen

Well, I understand why you would be confused and massively frustrated by your insurance company's decision. However, I have to echo what everyone else here is saying: you have proven that you can do this without the surgery. And that's something to feel really proud of. I'm wondering if you were thinking that it would be easier with the gastric sleeve? Nothing is ever easier with surgery. No matter how "routine" or "common" a surgery is supposed to be, the fact is that bodies don't like to be cut, mucked about with, and sutured together. Such a thing would change your lifestyle completely, and not necessarily in the "quick and easy weight loss" way that you might be imagining. I wish there was a magic fix for my weight loss goals, but I have learned that the only way is exactly what you have been doing. Exercise, count your calories, watch your diet, and LIVE. You don't need to hide behind a surgical procedure to achieve success. If it means enough to you, you'll keep going exactly as you have been. Feel proud of yourself--you avoided the need for surgery! Celebrate you!

purpleipod

Well obviously you can accomplish this process without it so I'm glad you were denied. No need for something so drastic if you can do it without it.

sem41278

Blessing in disguise! Do you really want to have your insides rearranged???? You can do this with hour own weapon arsenal! !!!

fullofsmiles04

Don't let this news stop you. You've lost FIFTY POUNDS by YOURSELF. That's AMAZING and you should be SO PROUD! Keep up the great work that you've been doing and before you know it the next fifty pounds will be gone too. You dont need surgery. You need motivation and strength and self-control and it sounds like you have all of these already. You CAN do it! We are ALL here for you when you need that extra motivation.

tuffytuffy1

I understand the disappointment. But as someone who is friends with two people with the band, it is definitely very difficult to even eat now for them. They eat more than a few bites, they throw up. It's not easy, not easy at all. I think your hard work is incredible and I would also, like the others, take it as a blessing in disguise. You can do it!!!

Barbellsandthimbles

I understand being somewhat disappointed because you had a plan in your head that got derailed. BUT...50lbs in 3 months? That is awesome! It's taken me 2 years to lose 55. You can do this without surgery...you just proved it!

AlicynH

You've lost 48 lbs in three months. That's amazing!!! I had gastric bypass just over 6 years ago and luckily my insurance did help. When I had mine, the doctor told me that it would help me with the first 100-150 lbs. I did loose 160 initially but ended up gaining back 60 of it because I didn't make the lifestyle change. Once I made that commitment to make that change, I lost the 60 I gained back plus a little more. I still have about 65 lbs to go. Good luck. We're here for you.

Papillon22

I'm sorry you're disappointed, but I think it's a sign too! In 3 months, you've lost what I have been trying to lose for a year. You are doing this, because you are capable. If you can't look in the mirror and tell yourself that, at least look at the undeniable results. You rock and you don't need the surgery! :flowerforyou:

KenDubya74

I am sorry for your denial from the insurance company, but I would say take this as a blessing in disguise.

My first wife had a Roux-En-Y Gastric Bypass in 2001. She had problems with it for the first few weeks after the surgery, she ended up having to have another procedure done just so she could keep food down. She did lose about 80lbs before falling back to her old ways. We separated in 2002, from what I was told is she didnt stick to doctors instructions and later died from her stomach rupturing in 2004.

My wife now just had the gastric sleeve done at the end of April. I wasnt thrilled with the idea of her doing that but supported her regardless. She tried several times to convince me to have the procedure done and I refused every time. I figured at the age of 38 and at 405lbs that I could still get around good and that I could do this without the surgery. So on 01/16/12 of this year I started with the mindset of "I'd rather die on my feet fighting this battle than to die in a hospital bed from unseen complications." I haven't looked back. Now not even 5 months later I'm down 61lbs and convinced now more than ever that I didn't need the surgery.

My point is this. I see the surgery as a cop-out (There are exceptions I think for those with medical or physical limitations that prevent them from exercising or moving in general) . If you are healthy enough to walk and move period then you can do it on your own. In my opinion it's a mindset. You have to look at yourself and see what keeps you from your goal. Once you see that you can come up with a plan of attack. If a 38 year old 405lb guy with bad knees and back can do this then I would think a healthy looking 22 year old such as yourself can do this too. You have to have faith in yourself, even if no one else does. If you have that faith in yourself you can do it. Determination can move mountains. I know you can do this....YOU KNOW YOU CAN TOO. You've proven that by losing 50lbs, that's a huge first step I'd say... in 3 months no less!

Do yourself a favor, go to the mirror, look yourself in the eye and say "I can do this. I WILL DO THIS."

I believe in you.

Lozze

Take this moment as not bittersweet but as a very proud moment.

Exactly! To me he surgery should be a last resort not a 'tool'. You've shown you can do it so your insurance company has made he right decision. Even if you'd had it done there are no guarantees you'll not put it back on or find ways to cheat.

A girl I work with had WLS (not sure which) She was 20kg lighter than me. I started a month before she had it done. Ten months later we've lost the same ampunt of weight. I can still drink when I choose, have decent sized meals and not grow up if I slip up. She's happy with the weight loss but regrets having it done.

taso42

I hope you look back upon this day as one of the luckiest in your life. Keep losing weight the old fashioned (and permanent) way.

lalapurple62

To many people perceive gastric banding as an easy fix, its not, there are major risks in having the surgery, but particularly bariatric surgery. Banding does not teach you to eat correctly or exercise and from friends that have it done, its so much easier to eat all the bad stuff because it is full of fat and fat melts and slips straight thru the band, very easy to not lose, you still need to be disciplined and focused and WOW look what you have done all on your own, what a star, your young and focused and i am sure have learnt what works for you in the last 3 months or you would not have lost nearly 50 lb. Stay focused, lose that weight and then hit your insurance company up for a tummy tuck after you have lost all your weight, that will teach them!!
Keep at it, you have done an amazing job....:flowerforyou:

dmaz99

Bittersweet ALWAYS means a blessing in disguise! I believe that now that you have your final answer, you'll push your self towards your goal! Count me in for support sweetie! xoxo

pants77

It's better for you to do it without the surgery and you've proven to yourself that you're capable. Plus you'll have less loose skin if you do it the hard way and take a little longer.

Jay_Jay_

I hope this may hold some more weight (heh, weight!) because I started at 469 lbs. I was denied for bariatric surgery when I was 19, for no reason at all but they found it to be a risky procedure. At the time, it wasn't as big as it is now. At that time I was crushed, and in the years to come I put on more weight. But today I am down 156 lbs, about to hit the 200's, and let me tell you, I thank that stupid cheap uncaring insurance company everyday for denying me, because the entire time I could do it on my own. It wasn't the physical aspect, it was the mental, I wasn't ready to lose weight then. It seems like you are! Don't make the mistake of irrevocably changing your body, you are young and you have all the time in the world to lose this weight. Do it slowly, change your body as you change your mind. If you had two choices, lose all of your weight now and gain it back in five years, or take 1-2 years to lose all of your weight and then never gain it back again, what would you choose? I know which one I chose.

ambitious01

Well, clearly you don't need surgery then.

You're 22 for christs sake. You can achieve anything you want if you put in the work. You don't need shortcuts like that. It's a good thing you were rejected in my opinion. You have the strength to do this without medical intervention.

Well not as harshly, but yeah ^^^^

pam6870

I know it's bittersweet, but look what you have already accomplished on your own. You know now that you can do it!!

jjnt007

I am sorry for your news but I have complete faith that if you can lose 50 pounds you can lose 50 more. I hope your weight loss journey goes well throughout the remainder of the year.

jenilla1

I still feel strong....almost like this is a sign I should be doing this on my own....

This is the only voice you need to listen to. Say it. Loud.

mom2mozart

You are capable of doing this without surgery. You are young, and you are on your way to health. Surgery is not a miracle.
There are considerable risks involved with any surgery - including DEATH. Don't look at this as a missed opportunity,
keep up the good work. You will achieve your goal without risking your health along the way. It may take longer, but then you
can say you did it my sheer will power and hard work.

gypsybree

I still feel strong....almost like this is a sign I should be doing this on my own....or a sign that surgery might lead to something far worse.

I don't know what the gastric sleeve is but my mother had gastric bypass, I'll never have surgery to lose weight, life is to be enjoyed so much more than that, I believe.

Athena413

Obviously you don't actually need the surgery...save your money and just finish this on your own.

lour441

This should be under success stories for losing 50 lbs in 3 months. You will look back on this day and be happy things worked out the way they did.

jlreser

If you have the strength and discipline to lose 50 lbs in 3 months then you got the answer you really NEEDED, not wanted. You've already proven you can do it on your own, the hard way, not the easy way out so rejoice in that. In the end, you'll be GLAD you did it on your own without a quick fix!