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Post by lwtg1369 on Apr 5, 2012 12:08:48 GMT -5
Hello all. I am new here, and in the process of obtaining approval for gastric bypass. I have been researching WLS for years, and finally started the official process. Unfortunately I have met nothing but issues with getting the surgery approved. I meet the requirements set forth by Anthem Blue Cross, but apparently my employer has stipulations about approving for Bariatric surgery. Today, we finally had a breakthrough with the employer side of it, and I will find out in about 48 hours if I am approved. Even the patient advocate for the Center of Excellence that will perform my surgery said he has never come across the issues I have had to go through with the approval process. And that I will have to do it all again once the doctors begin their testing and approval prior to surgery. But luckily for me, I am one persistent pain in the butt, and will continue on until I am post-op. I'm 30, my husband and I want to start a family, I have tried Everything, and I'm not giving up!
Thank you for all the threads and information I have found thus far on this site, and I'm looking forward to making some friends in this community.
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Post by So Blessed on Apr 5, 2012 15:21:48 GMT -5
Welcome! You'll find that there are a lot of people who have to jump through hoops to get approval, but it does eventually happen. Hang in there and keep posting.
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Post by Peggy on Apr 5, 2012 15:38:14 GMT -5
Please don't give up it i will so worth to you down the road .. I know it is hard and seems never ending but it is so worth it..
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Post by lwtg1369 on Apr 5, 2012 19:54:32 GMT -5
We did make some breakthroughs today, so I am hopeful. I have been researching and educating myselg on WLS for about 2 years.....so I am definitely not going to give up!
Question though: I do know a whole lot about duodenal switch sugery.......just in what I have read, it seems better than the gastric bypass.....but it seems alot harder to find surgeons in the CT area that perform the surgery. Is there a reason why it appears to be less common than the bypass? Looks like I would have to go to NYC or Boston if I go that route.
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Post by Joanne on Apr 5, 2012 19:57:54 GMT -5
There are no DS surgeons in CT, and there aren't any in Boston, either. NYC is your best bet. There are also a few DS surgeons in NJ. The closest to you would probably be Dr Roslin's office in Westchester at Northern Westchester Hospital in Mt Kisco, NY.
I know a few DS'ers in CT that don't post here but are on Facebook. If you're on Facebook you can send me a PM and I can put you in touch with them, if you would like.
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Post by Joanne on Apr 5, 2012 19:58:16 GMT -5
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Post by lwtg1369 on Apr 5, 2012 20:44:29 GMT -5
Thank you for the info! :-)
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formerlyfluffy
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Join me on my journey to become.........Formerly Fluffy!
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Post by formerlyfluffy on Apr 5, 2012 21:05:53 GMT -5
Hugs! Isn't it frustrating the B.S. most insurances make you go through when clearly you are doing this to get healthy?! And yet they seem to have no problem just automatically authorizing rehab for someone that doesn't even want to go, and is just doing it b/c of a court date! :-( They don't tell them their blood alcohol level isn't high enough, or there's not enough meth in their system, come back when your your levels are higher! But for some reason......they think it's acceptable to fuck with someone trying to get bariatric surgery that is sincere about improving their health. :-(
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formerlyfluffy
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Join me on my journey to become.........Formerly Fluffy!
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Post by formerlyfluffy on Apr 5, 2012 21:11:30 GMT -5
Actually I did a post about this previously: Weight Loss Surgery: Did Your Insurance Require You to Jump Through Hoops? Posted on April 29, 2011 by MariaFitzpatrick This is a rant pet peeve of mine. Now I didn’t have insurance, and paid cash for my surgery, which would have been fine had the WLS actually worked! (Ask me about my CRAP BAND Lap-Band!), but I just hate to see the runaround that so many insurance companies give their patients that are seeking Weight Loss Surgery! You know………….the mountains of paperwork. The jumping through hoops. Through all the road blocks. Sometimes only to get denied?! Now what’s up with weight requirement? I feel that should be lower. I just don’t believe that they should require someone to get fatter and sicker and increase their BMI before they will help them! And the 6 months supervised diet. Do they honestly think that all those fluffy people have never tried to diet? Do they really think that if they require a 6 month diet that those people will suddenly diet and lose all their weight and not need WLS??? Now the insurance companies requiring all these things wouldn’t be so much of an issue were it not for the fact of how they handle other addictions. Alcoholic? They’ll send them straight to rehab! Junkie? Straight to rehab! So why should someone with a food addiction not be entitled to the same quick response when seeking treatment for their condition? Especially since those obese and morbidly obese individuals have sought out treatment on their own to help improve their life. How many alcoholics or junkies have we heard of that go to rehab but didn’t even want the help? They were just going because it was court ordered, or because they thought it would look favorable to the courts during their court date for whatever alcohol or drug related offense they are facing charges on at the moment. How likely is it that these individuals that enter rehab under these circumstances will take an active interest in doing what they need to do as far as lifestyle changes to get well??? Now as far as a time limit, I have never know of an insurance company to deny anyone from rehab telling them “you haven’t been a crackhead long enough! Come back when you have evidence that you have been a crackhead for at least 5 years and then we can put you on a 6 mos. supervised crack diet……….then you can submit you request for rehab”. Do they tell an alcoholic “I’m sorry but your blood alcohol level is not quite high enough. You’ll have to start drinking more before we will help you out with rehab. Now I’m NOT saying that insurance companies should not help alcoholics and drug addicts if THEY are the ones that want treatment to improve their health. I just object to the double standard that is there, since I am not aware of them having so many requirements and waiting periods for any for surgeries other than organ transplants. It just really seems as though alcoholics and drug addicts are given preferential treatment over the morbidly obese. Did you insurance company require you to jump through hoops to get your WLS covered??? www.formerlyfluffy.com/weight-loss-surgery-did-your-insurance-require-you-to-jump-through-hoops/
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Post by lwtg1369 on Apr 5, 2012 22:15:17 GMT -5
It's kinda funny because the one thing I was told today was 'if you had heart disease or diabetes, you would be all set'........really! Well, I'm sorry but I am 30, with a strong family history of all that can go wrong with your body due to obesity, and I am trying to make a permanent change that will prevent heart disease or diabetes.....ya know, which would cost my insurance company more to treat! The guy chuckled because even he realized how dumb some of these stipulations are.
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Post by So Blessed on Apr 6, 2012 8:11:19 GMT -5
We did make some breakthroughs today, so I am hopeful. I have been researching and educating myselg on WLS for about 2 years.....so I am definitely not going to give up! Question though: I do know a whole lot about duodenal switch sugery.......just in what I have read, it seems better than the gastric bypass.....but it seems alot harder to find surgeons in the CT area that perform the surgery. Is there a reason why it appears to be less common than the bypass? Looks like I would have to go to NYC or Boston if I go that route. The procedure is more complicated to perform than RNY and there just aren't as many surgeons who have the expertise to do it. The DS vets can point you to the good surgeons.
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Post by lwtg1369 on Apr 8, 2012 10:54:10 GMT -5
We did make some breakthroughs today, so I am hopeful. I have been researching and educating myselg on WLS for about 2 years.....so I am definitely not going to give up! Question though: I do know a whole lot about duodenal switch sugery.......just in what I have read, it seems better than the gastric bypass.....but it seems alot harder to find surgeons in the CT area that perform the surgery. Is there a reason why it appears to be less common than the bypass? Looks like I would have to go to NYC or Boston if I go that route. The procedure is more complicated to perform than RNY and there just aren't as many surgeons who have the expertise to do it. The DS vets can point you to the good surgeons. I looked into Dr. Roslin. I registered for one of his Seminars. I know this was a requirement for the Surgeon I am in contact with in CT (not for DS)......Trying to find out if it is a requirement to go to Dr. Roslin's seminar if I have already been to another seminar and could bring a referral. It would just be a pain to drive 2.5 hours for a 1 hour seminar and drive 2.5 hours back....but I'll definitely do it if they require their particular seminar. Got the call back from the Employer end of things and the Advisor said he expects to be calling me tomorrow (monday) with my Approval!!!!!!! Yay! And my therapists who has been treating me for depression (no medication though....don't want it) offered to write a letter of recommendation for the surgery! :-)
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Post by larra on Apr 8, 2012 12:38:59 GMT -5
I hope that you will continue to research the DS while working through your approval problems (which as you know by now are all too common). You would need to travel, but NYC isn't too far, and the results of the DS are better than for gastric bypass for percentage excess weight loss, maintainence of that weight loss, and resolution of almost all comorbidities. My heart goes out to Carnie and all the other people who thought RNY would resolve their MO problem for life, who made a sincere committment to it, and who tried their best to comply with the post-op dietary and lifestyle requirements and STILL never lost enough weight, or regained significant amounts of weight. While there are certainly some people who are very successful and happy with RNY, the failure rate is substantial (30%) and not emphasized enough to pre-ops. Keep an open mind to the DS. The extra effort will be well worth it.
Larra
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Post by lwtg1369 on Apr 8, 2012 14:58:02 GMT -5
My only concern with the DS is that they won't approve me for that particular surgery. I keep reading how many people's insurance companies say they have to have a BMI of over 50 or even 60. Mine is 42.4.........................and I am definitely not going to intentionally gain weight for DS. But the more I look into RYN, the more I worry about the adverse effects. I know several people who have had it and swear by it, just wondering if it is the right choice for me. I am definitely keeping my options open and will continue to talk to the Dr's for the best route.
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Post by pktwatch on Apr 8, 2012 22:39:20 GMT -5
If you qualify for the gastric bypass you qualify for the DS. Do your research and make sure that you get the surgery that will work best for your lifestyle.
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Post by So Blessed on Apr 9, 2012 8:34:33 GMT -5
My only concern with the DS is that they won't approve me for that particular surgery. I keep reading how many people's insurance companies say they have to have a BMI of over 50 or even 60. Mine is 42.4.........................and I am definitely not going to intentionally gain weight for DS. But the more I look into RYN, the more I worry about the adverse effects. I know several people who have had it and swear by it, just wondering if it is the right choice for me. I am definitely keeping my options open and will continue to talk to the Dr's for the best route. There are some light weights on this board who had the DS.
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Post by lwtg1369 on Apr 11, 2012 9:04:34 GMT -5
Got the Approval from the Employer yesterday!!!!!!!!!!!!!!!!!!!!!!!!!! :-) So excited! So everything has been passed along to Anthem and the ball is officially rolling! Appointment with PCP on 17th to get my letter of recommendation from him, appt on 20th and get letter of recommendation from my therapist, and my general surgeon in MA said he will order and rush along any testing Athem requires and squeeze me in to ensure we meet any time restraints they put in place. The light at the end of the tunnel is getting bigger and brighter!!! Yay!
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Post by SLVinNorCA on Apr 11, 2012 9:43:26 GMT -5
Please be careful about WHICH Dr. you consult. A Dr who only performs the RnY is NOT going to give you unbiased information about the DS because they don't do the DS.
Only YOU can or should decide on which surgery you need. That is NOT a Dr. decision.
You don't call a plumber when you need to have your house re-wired, you call an electrician.
Choose your surgery, THEN choose your surgeon.
Best of Luck to you.
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Post by lwtg1369 on Apr 11, 2012 22:29:21 GMT -5
Please be careful about WHICH Dr. you consult. A Dr who only performs the RnY is NOT going to give you unbiased information about the DS because they don't do the DS. Only YOU can or should decide on which surgery you need. That is NOT a Dr. decision. You don't call a plumber when you need to have your house re-wired, you call an electrician. Choose your surgery, THEN choose your dr Best of Luck to you. Thank you! I am between the VSG and DS. If I go with the VSG, then I'll be using my surgeon here in CT, but if I go with the DS then I'll be using Dr Roslin in NY.
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Post by So Blessed on Apr 12, 2012 10:09:59 GMT -5
I'm glad things are starting to move along for you. Congrats!
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Post by lwtg1369 on Apr 18, 2012 8:57:09 GMT -5
UPDATE: Anthem BCBS is trying to deny all coverage of the surgery.....BUT, same day got a phone call from an RN from Anthem who supposedly mailed me out a packet of information on their Bariatric Program and congratulated me on my Approval!!! Insurance companies are ridiculous...it's like the right hand has no idea what the left one is doing. But on the bright side, my company has taken over the fight on my behalf....they reviewed my benefits and the fact that I was approved and said they will have my approval code for the Surgeons office within 48 hours. Went to the PCP yesterday....had my EKG, reviewed my blood work (everything looks great).....but he said I would have to have a sleep apnea test. Why would I have to do this test if I show no signs of sleep apnea, and have never had any issues with my sleep? Is it just always required? I thought this was only a requirement if you had a history of issues with your sleep or breathing.......
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Deleted
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Post by Deleted on Apr 18, 2012 9:29:24 GMT -5
My only concern with the DS is that they won't approve me for that particular surgery. I keep reading how many people's insurance companies say they have to have a BMI of over 50 or even 60. Mine is 42.4.........................and I am definitely not going to intentionally gain weight for DS. But the more I look into RYN, the more I worry about the adverse effects. I know several people who have had it and swear by it, just wondering if it is the right choice for me. I am definitely keeping my options open and will continue to talk to the Dr's for the best route. I am a lightweight and have had the DS! BEST decision I MADE. My dh is also a lightweight (his pre-op BMI was 39) and he had a DS too. My BMI pre-op was ONLY 35.2, just barely squeaked in. Its mainly how your employer wrote the policy that matters...BCBS here in TN approved me easily for my DS (they follow the Medicare rules and if you qualify for the RNY you also qualify for the DS regardless of BMI, as long as it's over 35 with comorbids or 40 without). Liz
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Post by So Blessed on Apr 18, 2012 10:55:27 GMT -5
UPDATE: Anthem BCBS is trying to deny all coverage of the surgery.....BUT, same day got a phone call from an RN from Anthem who supposedly mailed me out a packet of information on their Bariatric Program and congratulated me on my Approval!!! Insurance companies are ridiculous...it's like the right hand has no idea what the left one is doing. But on the bright side, my company has taken over the fight on my behalf....they reviewed my benefits and the fact that I was approved and said they will have my approval code for the Surgeons office within 48 hours. Went to the PCP yesterday....had my EKG, reviewed my blood work (everything looks great).....but he said I would have to have a sleep apnea test. Why would I have to do this test if I show no signs of sleep apnea, and have never had any issues with my sleep? Is it just always required? I thought this was only a requirement if you had a history of issues with your sleep or breathing....... I just posted a couple of articles that might answer your questions.
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Post by hala2215 on May 30, 2012 17:05:54 GMT -5
Hi, I had RNY 10 years ago. Lost 110 pounds and was quite happy for about 6 years then slowley I have put back on 60 pounds. It is not uncommon. The DS was not an option for me in 2002. In fact I did not even know it existied. It would have been my choice. It really has the best long term success. I am not bashing the RNY. I never reached goal but I was thin. I got complacent then after the death of both parents I reverted back to what felt good. There are lots and lots of people on this site and who do what they are suposed to do. Follow the plan forever and have long term success.. I was not one of them. Look at all your options and consider it carefully as you do not want to be considering a revision in 10 years. Good Luck. Whit Follow the plan forever and have long term success.. I was not one of them. If we could be on permanant diet - most of us would not need WLS... RNY is Ok to lose weight - maintnace - not so much.. The reactive hypoglycemia with the foods restrictions due to pouch (i.e some can't tolerate veggies, get very sensitive to other foods) makes it very difficult to mainatain. You are partially to blame, RNY did the rest.
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Post by hala2215 on May 30, 2012 17:09:22 GMT -5
Please be careful about WHICH Dr. you consult. A Dr who only performs the RnY is NOT going to give you unbiased information about the DS because they don't do the DS. Only YOU can or should decide on which surgery you need. That is NOT a Dr. decision. You don't call a plumber when you need to have your house re-wired, you call an electrician. Choose your surgery, THEN choose your dr Best of Luck to you. Thank you! I am between the VSG and DS. If I go with the VSG, then I'll be using my surgeon here in CT, but if I go with the DS then I'll be using Dr Roslin in NY. Great, I had RNY 4 years ago. I would not recommend that to anyone. why? because I don't hate anyone enough to recommend that surgery. VSG or DS - sure... I would love to have one or the other... RNY - not so much..
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