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Insurance Discuss insurance topics for the gastric bypass and Lap Band® operations.

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Old 04-04-2008, 04:38 PM   #1 (permalink)
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Default My biggest fear ..

I have rolled around the thought of bypass surgery for quite some time. I never took it passed thinking until January, because I figured that I was not "sick" enough. So even though I have had problems with Sleep Apena, Gastro Reflux, borderline cholesterol, high triglycerides, and in 1996 my BMI was 59.9, after using the Phen Phen drugs my BMI was 35.2 and currently it's 47.8. For my height (5'3"), "normal" is 107 - 135 lbs. Are you freaking kidding me? With my bone structure, I would be thrilled and screaming from roof tops if I managed to get to 150 lbs.

Anyway I am afraid that once I am done with this nutrition program that the insurance company requires (I have 4 more appointments to make until I am done), that I will not get the referral to the Bariatric Center and not be approved for the surgery. Then what do I do? Give up? Since I was 12, I have been on and off diets, health programs and exercise programs. I have been called names, picked on, poked at and been accused of trying to kill myself with food. Even after the drugs, I still was 199 lbs. Which was the lowest I had been up till then since I was in high school.

I am so afraid that this is another thing that will not work out in my favor. OMG, what am I going to do. I can totally understand why people gain weight during this time. The stress of wondering if the insurance company will see what I have done and authorize the procedure. What am I going to do???

My PA at the PCP office told, no problem! She will write up the documents and I will be good. The nutritionist said that the insurance company is looking for weight loss and/or stablized weight during this program. But I wonder what is in that file they have. OMG, that file is an inch thick and I have only had 13 visits completed (3 scheduled and as I said 4 left to schedule). What is in that darn file? Who of us that have gained and carried this much weight have not had an emotional issue of two? I am much better than I was several years ago. Now I can see and feel the trigger. Sometimes I am better than others at containing it.

I think it would be so much easier to go through this whole process, if the insurance company said, "OK you are approved", unless you do not complete the following program(s). That way you would know, OK here is the list of things I need to do and if I don't, than I will be disqualified.

I am just so scared that I will never be able to escape this prison.......
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Type: Lap RNY
surgery date - 10/31/08 -BOO-
Highest weights:
340 (1995) & 320 (2001)
12/07 - pre-op - current - my goal
285 - 245 - 138 - 135
Onederland 1/9/09
Unofficial Century 2/8/09
Post-Surgery Century Club - 6/26/09

"What you think of me is none of my business." - Terry Cole-Whittaker
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Old 04-05-2008, 10:20 AM   #2 (permalink)
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you are totally normal. I think most of us with insurance were skeptical. I personally was denied after doing all thier requirements. But then got an approval after appealing it. DONT GIVE UP Never! If you really want this then there is no need to ever give in or quit. You stay positive and focused and you will be on that recovery room gurney in no time. Keep up the good workd with the preop diet plan
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Old 04-05-2008, 10:31 AM   #3 (permalink)
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If they deny you, all you do is appeal. You have the history of obesity. Dont sweat it... everything will go in your favor. You may or may not have to work extra hard at it, but the outcome will be the same!
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"People will argue with you that getting what you want in life isn’t something you can learn, if you’re destined to be one of the worlds winners as opposed to one of its perpetual whiners, its because you have been born with the right talents and temperament and have a big dose of self-esteem, ambition, and good judgment." Kate White
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Old 04-05-2008, 11:19 AM   #4 (permalink)
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Default

Your feelings are normal and expected. Just keep plugging away, and if they deny you - appeal appeal appeal...the squeeky wheel gets the grease
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Old 04-05-2008, 02:10 PM   #5 (permalink)
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Start Weight: 245
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Default Thanks...

I know that I was whinning ... just seems sooo long.

I was really hoping to have a bit of the summer to enjoy being on the road to thinner ..

Thanks for the support
__________________

Type: Lap RNY
surgery date - 10/31/08 -BOO-
Highest weights:
340 (1995) & 320 (2001)
12/07 - pre-op - current - my goal
285 - 245 - 138 - 135
Onederland 1/9/09
Unofficial Century 2/8/09
Post-Surgery Century Club - 6/26/09

"What you think of me is none of my business." - Terry Cole-Whittaker
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Old 04-05-2008, 06:20 PM   #6 (permalink)
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Start Weight: 270
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Goal Weight: 135
Surgery Date: 12/18/2007
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Default

Quote:
I know that I was whinning ... just seems sooo long
wow that was me about 1 1/2 years ago just begining the process and i thought "oh the time will drag by" but ya know what ... i'm 3 1/2 months post op and the time really flew by
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Surgery Date: 12/18/07 Lap RNY
Current Loss: However far this journey will take me Current Weight:175 (10/26/09) and finally a SIZE 12
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Old 04-06-2008, 12:04 AM   #7 (permalink)
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It IS tough to wait. But the UPSIDE is that you can begin to do the things that you'll have to do (and deal with) after WLS. There are a lot of them, and they can help you to not only prepare for the possible surgery, but also deal with some of the reasons you're MO.
From experience, I'd encourage you to try some of these and see if you find they help:
Eat slow and chew your food until it's mush. You'll eat less because you'll give your body time to tell you it's full.
Start journaling or seeing a counselor to figure out what food is for you, how you feel about it, what your relationship with food is, and start to get real with the stuff INSIDE you that contributes to being obese.

I had to wait awhile. It ended up being the best thing that helped me succeed...so maybe you're not in such a bad spot after all? Think of it as getting a jumpstart on success for permanent weight loss. The things above will be part of losing weight, either with our without surgery.
Good luck and be strong. It's not easy, but it IS possible!
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Total weight lost after Roux-en-Y gastric bypass: 160 lbs. POUNDS!
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Old 04-06-2008, 12:19 AM   #8 (permalink)
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i think that it is safe to say that we have all been there! me personaly.. i flew through everything.. ive been seeing a nutritionist since the time that i was 10... it just so happened to be the same nutritionist that was assigned to me when i was going through the beginning steps of the preop stages... so i was able to bipass most of the nutritionist classes.. considering how i had already been taking them for TEN years... my doctors flew at the chance to get me the surgery! they wrote numerous letters to the insurance company(i have GREAT medical insurance and was IMMEDIATELY approved!) but before i had decided to do WLS i had played competitive soccer from the time that i was 5 till i was 18... i did blood work monthly to check if i was diabetic or if i had thiroid problems... nothing ever came out wrong.... but i couldnt sleep i was always tired.. finally the doctor decided to send me to have a sleep apnia test... turns out that i stopped breathing over 210 times for longer than 10 seconds each time!! i was AMAZED! that was the last straw... ive done all the diets... been active... been to a nutritionist for 10years...took over the counter pillls and just continued to grow...

everybodys body is different.. evrybodys insurance is different... your not alone... you have all of us.. we know how you feel...

just keep up the good work and JOIN US!
i know that my message is long and im sorry... but i just wanted to let you know that its a process...
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Old 04-08-2008, 07:56 PM   #9 (permalink)
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Join Date: Mar 2008
Location: East Rochester, NY
Surgeon: Dr. O'Malley
Start Weight: 245
Current Weight: 138
Goal Weight: 135
Surgery Date: 10/31/2008
Age: 48
Posts: 624
Blog Entries: 48
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Default In my small corner of the world

I may be alone is my small corner of the world....

But it's so nice to know that I am not really alone, I have all of you!

Thank you.
__________________

Type: Lap RNY
surgery date - 10/31/08 -BOO-
Highest weights:
340 (1995) & 320 (2001)
12/07 - pre-op - current - my goal
285 - 245 - 138 - 135
Onederland 1/9/09
Unofficial Century 2/8/09
Post-Surgery Century Club - 6/26/09

"What you think of me is none of my business." - Terry Cole-Whittaker
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