Lotus28

Gallbladder Removed 19 years ago

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If my gallbladder was removed 19 years ago, is THAT still considered a comorbidity?  I'm not trying to split hairs, I'm just trying to figure out how to malinger through this insurance stuff. I want to be thoroughly prepared and not drag this out once I see a new Doctor (I tried getting approved when I was a 35 bmi, but wasn't approved. Right after that  (well not too long after), I had  to have emergency gallbladder removal surgery. 

Now I'm at a 39.7 bmi and I don't WANT a comorbidity, but this is ridiculous!

I've gained and lost for nearly 30 years! I've tried everything!  I've even been on Phentermine for over a year this time!!

Nothing's working now, so I'm seriously considering surgery before I'm larger and cannot get around.

My joints hurt, my back, legs AND ARMS are killing me. My neck even hurts, my heals hurt.... I've has it. I'm 46. I'll be 47 in October. I really cannot take this anymore.

Thanks for your help,

Kelly 

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They look for BMI of 40 or above with out comorbidity.  

Do you have diabetes, high blood pressure, sleep apnea?  Gall bladder removal is not one.  Nor do they (insurance) care about joint or back pain.  

Have you been in for a consult yet?  If not, I would wear the heaviest clothing you have, make appointment later in the day,  (I've heard of people on the border doing this).  They take your initial weight for beginning...

 

if if you are at 248 you will have a bmi of 40.1

Edited by Cheesehead

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No, I have no comorbidities. I've had high blood pressure once or twice in my life. 

I wasn't sure about the gallbladder thing because mine is already out, but it says "gallbladder disease" is one of the comorbidities. 

Actually I've read that osteoarthritis is considered a comorbidity for WLS. This isn't true?

Thanks

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Gain a bit of weight before you go in ;)...you're almost there. 

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Cheesehead,

Thanks for all your help. I really appreciate it. Can you tell me what's next after all the labs, tests, metabolic test, etc.? I've been medically supervised the past 1 1/2 years with Phentermine, and prior to that as well on different occasions since I was in my 20s. 

Am I going to be required to "supervised weight loss/gain" again for ANOTHER 6 MONTHS?!! :(

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Thanks Valerie :)

That definitely seems to be the easiest way :ph34r:

 

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As long as it is documented supervised diet it should be ok.  Osteo arthritis  was not on my list.  But each insurance is different.  I put a call in to mine when I began the process so I knew what was expected and if I qualified.  I had 3 comorbidities (took 18 pills a day) so I knew I was ok being a little under a 40 bmi.  

A friend said she was close and when she went in to be weighed she didn't take keys or her cell phone out of her pockets she also layered her clothes that day.  Lol!  

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On June 21, 2016 at 5:32 PM, Cheesehead said:

 

A friend said she was close and when she went in to be weighed she didn't take keys or her cell phone out of her pockets she also layered her clothes that day.  Lol!  

This! I was thinking blue jeans and heavy jacket and when the measure your height slouch a littleB)

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Hahahaha!  Thanks y'all!  I was thinkin rolls of quarters in my bra cups!! Crazy what I'd do to be able to have this surgery I know, but I went through the testing n stuff years back and I qualified weight wise THEN, but no comorbidities so I couldn't get approved. I've lost and gained so much weight, that's actually how I ended up with the gallbladder surgery the Dr said. High fat low carb, low fat, low calorie... the body doesn't like all that change and instability. :/ 

Just please tell me what to do, and I'll do it, whatever it takes. Please 

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6 hours ago, Lotus28 said:

I was thinkin rolls of quarters in my bra cups!! 

Just please tell me what to do, and I'll do it, whatever it takes. Please 

One member here who I haven't seen around in a while put rolls of quarters in her pockets for her first weigh-in. :P

Here's my "what I would do if I were Kelly" list: 

1) Call my insurance company and find out their requirements for coverage of bariatric surgery. Do they cover it? What are the clinical requirements (BMI, etc.)? Do they have restrictions on where you can go (e.g., exclude coverage at certain hospitals require going to a Bariatric Center of Excellence)? 

2) What do they require that you do before they will approve you? Is there a weight management requirement? Is it 90 days? Is it six months? If you don't have an appointment during a calendar month, does your clock reset to the beginning? 

3) Specifically confirm that they qualify you surgery based on your initial weigh-in with the bariatric practice and losing weight while preparing for surgery won't disqualify you for coverage. Almost all do, but it's best to confirm.

4) Find a bariatric practice or two that you like and attend their informational seminars.

Based on what your insurance says (requirements , timelines, etc.), the process for the practice you select, whether having your insurance deductible reset in January is a consideration, and any preparation you need to do (e.g., gain a few pounds, start when the weather is cooler so you can wear heavier clothes), pick your start date, and start preparing.

This is a lifetime commitment. A few months getting your shot lined up is a drop in the bucket.

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On 6/25/2016 at 11:44 AM, WendyH said:

One member here who I haven't seen around in a while put rolls of quarters in her pockets for her first weigh-in. :P

Here's my "what I would do if I were Kelly" list: 

1) Call my insurance company and find out their requirements for coverage of bariatric surgery. Do they cover it? What are the clinical requirements (BMI, etc.)? Do they have restrictions on where you can go (e.g., exclude coverage at certain hospitals require going to a Bariatric Center of Excellence)? 

2) What do they require that you do before they will approve you? Is there a weight management requirement? Is it 90 days? Is it six months? If you don't have an appointment during a calendar month, does your clock reset to the beginning? 

3) Specifically confirm that they qualify you surgery based on your initial weigh-in with the bariatric practice and losing weight while preparing for surgery won't disqualify you for coverage. Almost all do, but it's best to confirm.

4) Find a bariatric practice or two that you like and attend their informational seminars.

Based on what your insurance says (requirements , timelines, etc.), the process for the practice you select, whether having your insurance deductible reset in January is a consideration, and any preparation you need to do (e.g., gain a few pounds, start when the weather is cooler so you can wear heavier clothes), pick your start date, and start preparing.

This is a lifetime commitment. A few months getting your shot lined up is a drop in the bucket.

You're absolutely right! Thank you for your help Wendy! :D

I know what my insurance (Medicare) requirements are, I'm just really nervous and haven't ever weighed this much before :(

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