Denied Weight-loss Surgery...
HealthyChubbyMe
Posts: 2 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'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...
19
Replies
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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?1
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It's very surprising what you learn when you start tracking. Portion control for me was what I needed to do. I was hungry for the first week or so but eventually your body adjusts. I just kept telling myself it's okay to feel hungry; I've eaten enough. Some good days, some not so good, but overall slowly starting to do this! Good luck with your journey! Perhaps pick a 10 or 20 lbs goal to start?5
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HealthyChubbyMe wrote: »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.4 -
Hello! I'm 5'4 and started at 235. I'm now down to 197 since January doing nothing more than maintaining a calorie deficit slowly moving in to cycling. Please have faith and confidence that you CAN do this without surgery, you just have to start making small changes and stick with it. If I can do it, I know you can too. 😁14
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ronjsteele1 wrote: »HealthyChubbyMe wrote: »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.3 -
I wouldnt persue bariatric surgery for that amount of weight loss anyway after seeing my cousins experience.
It's an entire lifestyle change with potemtially huge life long side effects for a small amount of weight in comparison to someone who is actually morbidly, life threateningly obese. I've been through a lot of major surgeries and I tend to be pretty flippant about them, but the side effects I've seen arent worth it for that amount of weight loss.
I am 5'4ish and started at 235lbs. My goal is about the same as yours. My lowest is 156lbs a month or two after giving birth and honestly, it wasnt excruciagingly difficult. I didnt have to deprive myself. I just ate at a calorie deficit and found exercise I enjoyed and tracked it all. Took only about 9 months to get from 235lbs to 175lbs when I got pregnant. I was 185ish when I was 40 weeks pregnant
173lbs when I left the hospital and within a couple months of just walking my dogs 5km per day with my baby in a carrier on my back, still tracking everything etc,.I was about 156lbs.
You can do it!13 -
My sister has a sleeve. It did help her lose weight, but she has had some other issues related to the sleeve. She can only eat small meals now and does not eat regularly. That leads to low blood sugar and fainting episodes. I had the pleasure of an ambulance ride with her when she passed out in a department store last summer.
As others have noted here, you can lose the weight without surgery. Please make a serous effort to do this on your own. You will get lots of support and encouragement here from others who have done it.10 -
OP you totally got this! My starting weight was 225. Goal weight is 135-140. So 90 lbs to lose. I've lost 21 lbs since joining MFP. I focus on being mindful of my calories, and setting small goals. My first goal is to get under 200 and at 203.8 I'm almost there. On here I've also joined a daily and a couple weekly weigh in threads. They help keep me motivated and accountable.
Lots of good luck on your journey.6 -
I 100% agree with great white north. My mom had gastric bypass surgery when she was 250. Initially she was rejected because she was not heavy enough to qualify. I was 16 when she had it done. I’m not sure how she got it approved. But honestly, it ruined her life. She was 44 when she had the surgery. She had post surgery complications with an infection. Then she really was never able to eat regular food ever again. Even decades later, if she didn’t chew her food to a pulp, it would come back up.
In the first year post surgery she did lose weight. Probably got down to about 150. But then a few years later she was back at 210. After a few more years, she decided to start to eat differently and got back to 150 with making better food choices. She joined TOPS (take off pounds sensibly). I think it is kind of like weight watchers. In other words, it look support from others and a lifestyle change to get to and maintain her weight.
She did have some excess skin that she wanted to have removed, but it was a lower priority when she was diagnosed with bladder cancer. Depending on how old you are and how long you’ve been at 240, your skin may retract naturally.
Don’t do the surgery. Surgery is not a guarantee to success, especially in the long term.
Embrace a new lifestyle of healthy food choices, tracking what you eat, and when you are ready adding some exercise.
You can do it!!!
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"...had the pleasure of an ambulance ride with her when she passed out in a department store last summer.
As others have noted here, you can lose the weight without surgery. Please make a serous effort to do this on your own. You will get lots of support and encouragement here from others who have done it."
Understood and appreciated.
I have more than a handful of relatives who've opted for WLS. Not one has maintained their weight loss. They ate it all back. One died from surgery complications. Her young children came home from school in the afternoon and found her deceased. They're still suffering without their mother.
Some of their surgeons prescribed the pre-op dieting phase to see if they were mentally prepared. That only worked until after the surgery. After the first year, they all started eating it back. Some went bald but all had complications within 5 years of the surgeries. Dumping, ulcers, low blood sugar. The radical drop in weight without doing any exercise aged them. Any thoughts for an easy fix became imaginary thinking.
If you can conduct the pre-op dieting phase then keep on going. Learn how to moderate yourself with foods and portions. Rebound weight gain with friends happens to the WLS patient just like the yo-yo dieter. I refuse to start over and over and over again.
There is a honeymoon phase with any WLS, weight loss surgery. Talk to them at the 5 year mark and you'll get a truer picture of their struggles. Long term weight stability requires the ability to focus on what's really important.
The best diet is the one that improves your health.5 -
OP is 5' 5" and weighs 240 lb.
Her starting calorie allowance would be well over 1200 calories - and that is net, eat back at least some excercise calories on top of that.
OP I am bit shorter than you and probably older - and I started at about 160lb - and my calorie allowance was 1460.
Don't make this harder than it needs to be by incorrectly aiming at 1200.
and dont make it uneccesarily harder by any of the rules in wolftrucking's post.
Just put your stats in to MFP and then aim for that many net calories.
( for health sake also aim for a reasonably nutritious diet - but this does not have to be precise and certainly does not have to be keto.)
Do whatever excercise you like - or none if you really don't want to.
Of course be sensible about it - if you have not been doing any regular excercise start with walking or gym for beginners or some other beginner level activity. Common sense.6 -
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/p13 -
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.6 -
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!
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Hagensieker wrote: »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.
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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.
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Surgery DOESN'T change the reason why you got 100lbs overweight. Many people who do have bariatric surgeries, never addressed issue of wny they did and turned their food addicition, to another. Example would be, now that they can't eat as much, they may turn to gambling, alcohol, drugs, etc.
A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition
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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.
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Well, yes - but one would hope part of the WLS process included counselling to address underlying issues.0
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I am so sick of multiple people here judging for someone, or stopping someone from getting Weight Loss Surgery. Believe me, its not the easy way out! and some people cant just lose it the old fashion way. I am 460lbs and I am 29 years old. For anyone that is interested in WLS, I support you completely! it's your body and your life, after all. I had to do three months of intense classes and seeing a nutritionist as well that went over the whole procedure and what food looks like for post-opp. I will most likely be getting the Gastric Sleeve in September after I lose 10% of my body fat.
I'm nervous of course because it is surgery but I am also excited to begin my new life. I have been big my entire life and I have struggled with diets, left and right. This surgery is not just surgery, its not going to solve every problem. It's a tool to help those that get the surgery maintain a healthy balance in life. I've spoken to others that have had the surgery and from what I have gathered, its difficult in the beginning of course but what isn't? Nobody has told me though that they regret the surgery because it give them back their life. I'm young. If I was going to do it, now would be the time
For those that are considering WLS, add me! lets talk and support each other on this journey! 7
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