Recent Posts

penthilisea
on 7/27/19 8:04 pm - Milford, NJ
Topic: Message of hope - Horizon NJ Health Revision Approved!

I know we get a lot of people here asking about this insurance or that insurance.

I had my RNY in 2006 when I had a different insurance plan entirely. Now I have Horizon NJ Health (NJ Medicaid).

It took me 4-5 months to jump through all the hoops (nutritionist appointments, psych eval, cardiologist, pulmonologist, and more), but in less than two weeks from submission, my revision to the DS was approved.

I ended up trying three different surgeons before I found one I trusted- finding a revision doc covered by HNJH was a serious challenge!

Surgery date is 8/20. Wish me luck!

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Mal: "Well, my days of taking you seriously are certainly coming to a middle." "Everything was beautiful and nothing hurt" Kurt Vonnegut Jr.

penthilisea
on 3/8/19 8:38 am - Milford, NJ
Topic: RE: RNY to Distal RNY? Any success

Can I ask which doc offered r n y to r n y in no bc I can't find one! ???

glitter graphicsglitter graphicsglitter graphics
 
Mal: "Well, my days of taking you seriously are certainly coming to a middle." "Everything was beautiful and nothing hurt" Kurt Vonnegut Jr.

Sheri A.
on 1/29/19 4:28 am
Topic: UNION COUNTY SUPPORT GROUP-Peer to Peer
Hi First Saturday Support! I'm looking forward to our next meeting on Saturday, February 2nd. Our featured presenter will be Deborah Hall from Nordstroms who will chat with us about wardrobe choices as we go through this journey. I need to ask for RSVP's as our guest is bringing goodies and asked for a headcount. Hope you can attend! 10:30 am at Robert Wood Johnson Fitness Center. Please RSVP through our FB page.

NOTE: First Saturday Support Group is the only peer to peer group known in the Union County area, began in 2008, starting our 11th year of support, friendship, guidance and help for the bariatric community. Visit our FB page for admittance. The group meets the first Saturday of each month from September-June at the RWJ Fitness and Wellness Center, Conference Room, kitchen side from 10:30-noon. Please join us!!!!
hectorc1087
on 10/2/18 12:04 pm
Topic: 3 month nutritionist

I am in the beginning process of this journey, I am required to meet with the nutritionist for 3 months and my BMI is currently at the qualifying range of 35.5. My question is if they put my on a meal plan for the next 3 months and my BMI falls below 35 will I be not eligible for bariatric surgery or do I need to try to keep my BMI at 35 during this 3 month process?

hectorc1087
on 9/30/18 9:51 am
Topic: Psych Evaluation for Bariatric Surgery

I met with a bariatric surgeon last week and based on my BMI and Sleep Apena he told me that I was an eligible candidate. He provided me with information and referrals to see a dietitian for 3 months and a psychologist both within the practice. My question is do I have to go to the psychologist that he referred me to or can I choose to look else where as long as they specialize in bariatric surgery exams and are able to send him the report.

Kathy S.
on 9/27/18 9:00 am - InTheBurbs, XX
RNY on 08/29/04 with
Topic: RE: Medicare Requirements/ List of full comorbid conditions for bariatric surgery

Hello Hector,

Here is what we found for you.

Medicare covers certain types of bariatric surgery if you have certain factors related to morbid obesity. To be eligible, you must:

  • Have a body mass index (BMI) of at least 35 kg/m2.
  • Have at least one obesity-related medical condition, such as diabetes type 2.
  • Have tried other treatments for obesity and been unsuccessful.
  • Get the surgical procedure at a hospital or facility that has been certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center or as a Bariatric Surgery Center of Excellence.

Here are additional medical conditions.

Have at least ONE of the following diagnosed health conditions

  • Type II diabetes mellitus (by American Diabetes Association diagnostic criteria).
  • Refractory hypertension (defined as blood pressure of 140 mmHg systolic and/or 90 mmHg diastolic despite medical treatment with maximal doses of three antihypertensive medications).
  • Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).
  • Obesity-induced cardiomyopathy.
  • Clinically significant obstructive sleep apnea.
  • Obesity-related hypoventilation.
  • Pseudotumor cerebri (documented idiopathic intracerebral hypertension).
  • Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity).
  • Hepatic steatosis without evidence of active inflammation.

When you are ready let us know if you need any further assistance like finding a surgeon.

Take care,

Kathy

Member Services

HW:330 - GW:150 - MW:118-125

RW:190 - CW:130

hectorc1087
on 9/26/18 3:38 pm
Topic: Medicare Requirements/ List of full comorbid conditions for bariatric surgery

Hello my name is Hector I little about me, I am 30 years old 5"7 227 lbs BMI 35.5, I suffer from GERD, High liver enzymes and I also have High cholesterol levels.I am interested in bariatric surgery I have tried on my own to lose this weight have tried diet programs such as slim fast, nutrisystem, joining gyms and medication and have been unsuccessful. I would like to know if anyone knows what are Medicare's requirements to have bariatric surgery covered and a full list of comorbid conditions that are associated with obesity. I have tried to get the information directly from Medicare but they are vague with the information they provided. Only conditions that I am aware of is Sleep Apnea and Hypertention in which I do not have. If anyone has anyone any information I would really much appreciate it. Thank you.

Northside
on 1/11/18 6:22 pm
VSG on 04/01/16
Topic: RE: Horizon NJ Health

Try Dr. James McCaughan in Toms River 732 577 8558

CarolineHalifax
on 8/29/17 2:44 pm
Topic: United Healthcare Community Plan surgeons in or near Union City?

I'm in Hudson County and I'm having trouble finding a surgeon who accepts this insurance. My pcp is ready to sign off on whatever needs to be done, but I can't find a surgeon! Does anyone have any recommendations for a doctor in or around the Union City/Jersey City/North Bergen/Hoboken area? Or even within a reasonable driving distance? I'm at my wits end with research and making phone calls and if anyone has any advice I would greatly appreciate it.

Mirandia
on 6/12/17 11:14 am
VSG on 03/14/17
Topic: RE: MEDICAID AND MEDICARE SURGEONS LIST!

Dr. Foreman

I had Medicaid - Paramount advantage

(419) 251-8760

Mercy Weight Management Center

3930 Sunforest Ct #100, Toledo, OH 43623

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