Denied Weight-loss Surgery...

Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

Height: 5'5"
Current Weight: 240
Goal Weight: 140

100 pounds to go. Woo...
«1

Replies

  • tiptoethruthetulips
    tiptoethruthetulips Posts: 3,360 Member
    Is there an appeal process? I can't see that weight loss surgery could be considered cosmetic surgery - do you have any weight related health issues?
  • ronjsteele1
    ronjsteele1 Posts: 1,064 Member
    Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

    I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

    Height: 5'5"
    Current Weight: 240
    Goal Weight: 140

    100 pounds to go. Woo...

    I would encourage you to look into Blossom Bariatrics in Las Vegas, NV. They will check your out of network insurance coverage and give you a contracted rate that they will not go over. It allowed me to skip all of the pre-insurance in-network stuff they normally make you do to have VSG surgery (6 months of pre-op work ups). Their cash price (no insurance) is $15K total. That's your hotel, surgery, all lab work, etc. That is literally everything except your plane ticket. It's also transportation to and from airport, hotel, surgery center, etc. It was quite probably the best surgery experience I've ever had. Top notch care, excellent people to work with, etc. If you have out of network benefits, they will figure out how much they can get your insurance to pay out of network and subtract that from the $15K. Then you pay the difference. If your insurance refuses to pay, you never pay more then the amount they quoted you in the beginning. They guesstimated they could get my insurance to pay $5K of out of network benefits and so my contracted rate was $10K. And that's exactly what I paid. But if my insurance had not paid anything, I still would have only paid $10K. They have the system totally figured out.

    Look into Blossom Bariatrics. It's the best decision I ever made.
  • lynn_glenmont
    lynn_glenmont Posts: 9,959 Member
    Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

    I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

    Height: 5'5"
    Current Weight: 240
    Goal Weight: 140

    100 pounds to go. Woo...

    I would encourage you to look into Blossom Bariatrics in Las Vegas, NV. They will check your out of network insurance coverage and give you a contracted rate that they will not go over. It allowed me to skip all of the pre-insurance in-network stuff they normally make you do to have VSG surgery (6 months of pre-op work ups). Their cash price (no insurance) is $15K total. That's your hotel, surgery, all lab work, etc. That is literally everything except your plane ticket. It's also transportation to and from airport, hotel, surgery center, etc. It was quite probably the best surgery experience I've ever had. Top notch care, excellent people to work with, etc. If you have out of network benefits, they will figure out how much they can get your insurance to pay out of network and subtract that from the $15K. Then you pay the difference. If your insurance refuses to pay, you never pay more then the amount they quoted you in the beginning. They guesstimated they could get my insurance to pay $5K of out of network benefits and so my contracted rate was $10K. And that's exactly what I paid. But if my insurance had not paid anything, I still would have only paid $10K. They have the system totally figured out.

    Look into Blossom Bariatrics. It's the best decision I ever made.

    In-network v.out of network is a completely different issue from whether something is a covered procedure or not, unless someone is going to lie to the insurance company on the patient's behalf about the procedure that was performed, which would be insurance fraud.
  • hmaddpear
    hmaddpear Posts: 610 Member
    edited June 2020
    You have totally got this. 7 years ago, I started here at 5'5'', and 238lb. I lost 80lb by watching what are and walking. I've fallen of the wagon, and got back on, many times, but I'm still plodding along. It takes time, but set yourself a doable calorie goal (I picked 1640 kcal), and log everything. Work out what gets and keeps you full, and what you get to only have occasionally, and what is just not worth the calories. Read the forums, there's great advice on here, get yourself some friends to cheerlead and chivvy you. Make a commitment every day to do a little bit better. You don't have to be perfect from day one. And you don't fail if you pick yourself up and start again.

    Much luck to you.

    Edited to add a must read: https://community.myfitnesspal.com/en/discussion/1080242/a-guide-to-get-you-started-on-your-path-to-sexypants/p1
  • age_is_just_a_number
    age_is_just_a_number Posts: 630 Member
    As you can see from these replies, there is no quick fix to health and there are a lot of different people with different opinions. I’ve read really compelling studies that support vegan, vegetarian, high protein, low or even no carb diets. At the end of the day, you have to do what works for you. Everyone is different.
    Regarding wolf trucking08’s rules: they are from someone who has made a drastic change to their life and have had incredible success with that approach. If you are exactly like them, then that approach may work for you. If you are different, then you may need to act differently.
    1) I agree. This is a lifestyle change. But to change everything overnight is very drastic and can lead to not being sustainable. You may find making small realistic and sustainable changes every couple of weeks. At the end of a year, you will have made a big change to your lifestyle.
    2) I agree with calorie deficit. But I’ve never heard about training your body to operate on a caloric deficit.
    I agree with “ You must HONESTLY measure, weigh and log everything you eat and drink, including your exercise.”
    3) I agree. Water is your friend. Drink it all throughout the day.
    4) I’ve already addressed this. I agree with ditching the “SAD” or Standard American Diet. I support the new Canada Food Guide, which was developed without food marketing boards at the table, instead it was developed based on scientific evidence. The overall guideline is half your plate should be vegetables, a quarter of your plate should be complex carbohydrates and a quarter of your plate should be high quality lean protein.
    5) exercise: I agree, you need to add exercise to your day. You need to take it one step at a time. If you push yourself too much you increase your risk of injury, soreness and worst of all giving up. Listen to your body. Do what you can. But continue to increase what you can do.

    Caloric deficit will result in weight loss.
    Exercise, especially weight or resistance training, will result in muscle gain. You need to add muscle to your body.

    You can do it!

  • age_is_just_a_number
    age_is_just_a_number Posts: 630 Member
    I lost 100 lbs once the old fashioned way. I have a co-worker who got the surgery and while he lost a lot of weight he did it by eating a minuscule amount of food every day. Also his choices that I saw were poor. He was eating lots of junk food and he threw up quite a bit especially during meals. He's a lot younger than me and it wouldn't surprise me to ever hear that he had serious health issues or worse.

    You are in the right place.

    Congratulations!!
    Your friend sounds like my mom. She couldn’t eat regular food after the surgery. The surgery does not teach you how to eat properly. There is no quick fix. There is no magic pill. You can’t wish for it, you have to work for it. You’ve done it and now You are an inspiration for others.

  • jjlbrick
    jjlbrick Posts: 233 Member
    I have 12? Relatives several friends that have had weight loss surgery. Near as I can tell this surgery works because it forces you to change your diet. If you think that you can ever go back to your old habits you will gain weight.
    I went to a lecture to learn about lap band procedure. The doctor said that you wouldn’t be able to eat as much. But if you had a large sweetened, coffee drink every day. It would mess with your weight loss, same with alcohol.
    It should be a crime that insurance doesn’t pay for weight loss surgery. Or weight loss programs.

  • Diatonic12
    Diatonic12 Posts: 32,344 Member
    This. ^^ Cross-addiction.

    https://pubmed.ncbi.nlm.nih.gov/27400415/

    https://www.obesityaction.org/community/news/bariatric-surgery/transfer-addiction-following-bariatric-surgery/
    https://www.mdedge.com/psychiatry/article/126520/addiction-medicine/alcohol-use-disorders-after-bariatric-surgery-case

    The appetite control center is located in the brain and not the stomach. We can remove most of a stomach but it's the head that needs fixing. If WLS fixed the head no one would ever eat it all back.
  • paperpudding
    paperpudding Posts: 8,967 Member
    Well, yes - but one would hope part of the WLS process included counselling to address underlying issues.