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txmomof3

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Hello there! I am a new member, and wanted to say hi. I don't have a surgery date yet :( I am at 6 months into the process and very frustrated with doctors and insurance. I have a Hiatal Hernia and my doctor has suggested I do the bypass, 2 weeks ago my insurance changed and the new insurance has stricter restrictions and says I don't qualify!! So we are at a standstill while arguing with insurance to get things moving along again with the new insurance. I am hoping someone has words of wisdom?
 
Welcome to our group! Yikes, sounds like an insurance mess. Sorry you now have lost time in the process. I hope they can work things out for you. In the meantime some surgeries are being canceled due to Covid, depending on where you live and how bad it is. So you could have been postponed without even switching insurance companies. I just hope for your sake it doesn't take too long. Good luck!
 
The doctors office and your insurance will have to work that out. They're professionals. My only advice would be to make sure you are still seeing the doctor every month, otherwise they could use that as an excuse to make you start over. While waiting for my approval, my program suggested the same. Better safe than sorry. You've gotten this far, hopefully they can get it all straightened out. Good luck.
 
txmomof3 said:
Hello there! I am a new member, and wanted to say hi. I don't have a surgery date yet :( I am at 6 months into the process and very frustrated with doctors and insurance. I have a Hiatal Hernia and my doctor has suggested I do the bypass, 2 weeks ago my insurance changed and the new insurance has stricter restrictions and says I don't qualify!! So we are at a standstill while arguing with insurance to get things moving along again with the new insurance. I am hoping someone has words of wisdom?
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Hello a
txmomof3 said:
Hello there! I am a new member, and wanted to say hi. I don't have a surgery date yet :( I am at 6 months into the process and very frustrated with doctors and insurance. I have a Hiatal Hernia and my doctor has suggested I do the bypass, 2 weeks ago my insurance changed and the new insurance has stricter restrictions and says I don't qualify!! So we are at a standstill while arguing with insurance to get things moving along again with the new insurance. I am hoping someone has words of wisdom?
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Hello and welcome to the group. Do you have any obesity related conditions like high blood pressure, sleep apnea, diabetes, etc.? I have Aetna insurance and was approved right away because of my BMI, sleep apnea, and high blood pressure. My surgery center required a sleep study before I they submitted to my insurance carrier. I know that insurance companies are different and have many steps that we have to go through to get procedures covered.
 
Hi Team, I have a check list of clearances I need to get my surgery scheduled. The one that is holding me up is getting my A1C to <9.

I dropped from almost 13 A1C to 10 in about 3 weeks but it was done by eating on time, testing constantly , taking meds correctly, and generally being disciplined. A huge change but I must get it done. The past 2 days I have fallen back into my old habits and I could use some accountability to get me to under 9 (blood sugar A1C) by 2.15.21.

Any suggestions?
 
Oh, man that A1C is tricky. And you're absolutely right, you have to get and stay disciplined to get the number down. For me the only thing that worked was to eat the same amount of carbs each day and to divide them up equally throughout the day. And exercise. I am unsure how exercise lowers/regulates sugar, but exercise had a huge impact on my sugar levels. Since you know what your numbers should be and how to eat to get there, I will skip that advice and just offer these suggestions:
*Get the BARITASTIC app if you don't already have it. Aside from logging your food (important AF!) you can set meal reminders, telling you when you can eat. And you can track your activity.
*Get some exercise every single day. Walking is something almost everyone can do. If it is too cold where you are, there are exercise videos on YOUTUBE etc that can get you moving. Just do your best. I tried yoga yesterday and looked like a moron and felt like a failure. BUT, I'll be trying again today. Nike is 100% right. JUST DO IT!
I was diabetic for years before the surgery and now I am not. Another member on here was insulin dependent and is no longer diabetic. This month will be hard work but it is SO worth it and will improve your life in so many ways.
If the app alone is not enough to keep you accountable, text a friend your numbers (carb count, exercise minutes, etc) every evening before bed. If you do not have a friend you are comfortable doing that with, make a thread here or just DM me. Whatever you need to do to make this happen for yourself, you CAN do.
 
txmomof3 said:
Hello there! I am a new member, and wanted to say hi. I don't have a surgery date yet :( I am at 6 months into the process and very frustrated with doctors and insurance. I have a Hiatal Hernia and my doctor has suggested I do the bypass, 2 weeks ago my insurance changed and the new insurance has stricter restrictions and says I don't qualify!! So we are at a standstill while arguing with insurance to get things moving along again with the new insurance. I am hoping someone has words of wisdom?
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Keep up your thoughts. You will get there dont worry
 
eladams2015 said:
You can request an appeal from the insurance, and ask that they do a peer to peer review with your surgeon. This can take some time to coordinate, but can often get the process turned around and going in the right direction again.
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I have appealed with the peer to peer and then another medical review appeal - all denied. The new insurance states I must have multiple comorbidities for 36 months, which is a big change from the previous insurance. I have some good news today -- I am proceeding with my hernia surgery and paying for the sleeve. It is important enough to my husband and I to go ahead with the procedure. So I have a surfer date!!! yay. March 15!
 
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