|
Post by kittykatkris on Sept 2, 2014 13:31:50 GMT -5
Hi everyone! I am new to the boards I actually had nomore b refer me to these forums from obesity help. I am 5'5" and weigh 224lbs I have PCOS and psuedo tumor ceribi and want the ds (duodenal switch surgery) I had healthfirst insurance thru medicaid ( I live on long island ny) but recently switched to unitedhealthcare community plan because I wanted to have Dr Roslin with lenox hill hospital do my surgery. I called like 3000 xs and finally got information from them that he is now accepting this insurance. I really wanted him because I know he is a firm believer that the choice should be the PATIENTS not the drs or the insurance. They will help you every step of the way with getting it approved with your insurance and he also will revise the ds surgery to fit the individual patients need, such as if you are a "light weight" making the common channel 125 instead of 100. Makes weight loss a little slower but malbsorption less over time and works well for those of us with a lower bmi.
So all this to say I really really do not want to wait 6 months to jump through hoops for the insurance company to approve me. The psuedotumor ceribi puts me at risk of losing my eye sight so I need to lose weight quick and I need to KEEP it off. Regaining actually can put me at higher risk, the PCOS makes this near impossible. And causes me to gain weight way easier then normal people and also makes it way harder to lose weight compared to the average person. It is also said that with pcos that at some point in your life you will more than likely develope type 2 diabetes. Has anyone had ds surgery approved by united healthcare community plan through medicaid for Dr Roslin, or in New York without having to go through the 6 month rigamarow? THANKS!
|
|
|
Post by Girlrocker on Sept 2, 2014 14:38:20 GMT -5
Hi there, and welcome! We have several Dr. Roslin patients here, and I know they'll drop in. I have UHC in California, a PPO through my very large corporately owned company, and was shocked beyond imagination at the speed in which I was approved for an RNY revision to DS (in 2012). Was 49 at time of surgery, 5'6 and 240lbs, so not much more than you. My approval, we're talking less than a month. Now, of course, this all varies from state to state, the policies within the same company differ. I think Dr. Roslin patients will be your best bet for some info, or other New Yorkers, we have a good contingent of NYC peeps on here, and they also do occasional get togethers for lunch/dinner in person. I can't speak to your specific health issues, but wanted to say hello and welcome.
|
|
|
Post by bboop on Sept 2, 2014 15:31:05 GMT -5
Can't help you with the insurance part of your question but I just wanted to welcome you to the forum. Hang in there sometimes it can take a while but what other choice do you have? I know when I found out about the DS I wanted it immediately, I think it took me maybe six months from start to finish...surgery and all.
I wish you the best and come back and ask questions - we love questions. I hope somebody with the same or very similar insurance will chime in.
|
|
|
Post by goodkel on Sept 2, 2014 23:55:30 GMT -5
Hi everyone! I am new to the boards I actually had nomore b refer me to these forums from obesity help. I am 5'5" and weigh 224lbs I have PCOS and psuedo tumor ceribi and want the ds (duodenal switch surgery) I had healthfirst insurance thru medicaid ( I live on long island ny) but recently switched to unitedhealthcare community plan because I wanted to have Dr Roslin with lenox hill hospital do my surgery. I called like 3000 xs and finally got information from them that he is now accepting this insurance. I really wanted him because I know he is a firm believer that the choice should be the PATIENTS not the drs or the insurance. They will help you every step of the way with getting it approved with your insurance and he also will revise the ds surgery to fit the individual patients need, such as if you are a "light weight" making the common channel 125 instead of 100. Makes weight loss a little slower but malbsorption less over time and works well for those of us with a lower bmi. So all this to say I really really do not want to wait 6 months to jump through hoops for the insurance company to approve me. The psuedotumor ceribi puts me at risk of losing my eye sight so I need to lose weight quick and I need to KEEP it off. Regaining actually can put me at higher risk, the PCOS makes this near impossible. And causes me to gain weight way easier then normal people and also makes it way harder to lose weight compared to the average person. It is also said that with pcos that at some point in your life you will more than likely develope type 2 diabetes. Has anyone had ds surgery approved by united healthcare community plan through medicaid for Dr Roslin, or in New York without having to go through the 6 month rigamarow? THANKS! Welcome! Unfortunately, I can't tell you whether Dr. Roslin or your insurance policy requires proof of six months of weight loss attempt prior to approval. But, you can read what your policy says yourself, make sure you have a copy of the complete policy, and you can call or email Dr. Roslin's office. If either of them does require it, I am sure that your urgent circumstances could convince them to make an exception for a medical emergency such as yours. You are a lightweight with a BMI of only 37.3. Do you have sleep apnea or high blood pressure? I ask because you usually need two co-morbidities to be approved for bariatric surgery (of any type) if your BMI is under 40. PCOS is not one, but your tumor, while not the norm, should be classified as one. But, first things first: 1. Read your insurance policy. 2. Call Dr. Roslin's office and ask whoever answers the phone what his pre-op requirements are. Have you made an appointment with him, yet, for a consultation? If not, you should and be sure to bring all your medical records about your tumor, including copies of scans, with you. You can get copies of everything from your doctor or hospital where scans took place. That is where you will get the ball rolling on this during this appointment. Please let us know how it goes.
|
|
|
Post by meq815 on Sept 3, 2014 8:24:22 GMT -5
Hi kitty and welcome!
I have nothing to add re: insurance, but wanted to let you know my cc is 125, and I quickly far surpassed my goal in less than a year.
Good luck to you'
|
|
|
Post by kittykatkris on Sept 3, 2014 11:23:33 GMT -5
Hi everyone I just wanted to say thank you for the responses. I did some digging and as far as I can tell except for Maryland they do not require the 6 months. However they do require the 40 bmi OR 35 and higher with a co morbidity Now to answer the tumor comment I do not have a tumor it is called psudotumor ceribi. It is swelling and so it makes your body ACT like it has a tumor in the brain but it actually do not. Not too much is actually known about it and what causes it. They just know if you loose weight and keep it off you are less likely to have complications or lose sight.
ALSO I forgot to mention in July 2012 I was diagnosed with Atrial Tachycardia and am on metoprolol. Does that qualify as heart disease? because if it does then it is a co morbidity.
I actually have a sleep test scheduled for mid october because my endocrinologist was concerned I may have it. But according to unitedhealth care community it has to be obstructed sleep apnea and have numbers higher then something lol I forgot I read ALOT of stuff last night.
I also found out I have Lyme disease yesterday!! Talk about OMG!! I am only 31 I am just holding on and laughing, you gotta laugh geesh you got to.
So with the PCOS, psuedo tumor ceribi, atrial tachycardia, and possible sleep apnea although If I do have it I dont believe it is severe or obstructive. Do you think this would meet the 35 to 39.9 with a co morbidity?
THANKS EVERYONE!
|
|
|
Post by kittykatkris on Sept 3, 2014 11:31:22 GMT -5
Attachments:
|
|
|
Post by goodkel on Sept 3, 2014 12:08:40 GMT -5
That is awesome that your insurance allows for "one or more" comorbidities. I believe your Atrial Tachycardia would indeed qualify you with them. Now, just to convince Dr. Roslin, though I doubt that you'll have any problems there. From here: 1.Get your files together that provide the diagnosis for both the Atrial Tachycardis and the Pseudotumor cerebri. 2. Make an appointment with Dr. Roslin. 3. Bring those reports with you to the appointment. 4. If there is a pre-screening by his office before they will make an appointment and you are asked if you have two comorbidities the answer is "yes." 5. Let us know how it goes. 6. Stop communing with wildlife and keep laughing.
|
|
|
Post by kittykatkris on Sept 3, 2014 13:40:24 GMT -5
Oh my goodness! you just made me so happy! I seriously have hope they will consider it co morbidities. I have paper work I can bring to prove both plus my actually medications that I take. And I have to go to a seminar in NYC at lenox hill hospital on Sept 9/2014 once I do that I can call Dr Roslin and set up a one on one. I changed my insurance from Health First to United Health Care Community yesterday so that I can see Dr Roslin, that doesnt kick in til Oct 1/14 so I do have to wait til then. But I doubt that he will be able to see me til then or after anyway. SOOOOO I am so hopeful. So very hopeful. Any tidbits or info, advice, anything you guys can think of just let me know I greatly appreciate everyone!
|
|
|
Post by west4thavenue on Sept 3, 2014 13:49:22 GMT -5
Welcome, Kitty.
Read the posts here and ask lots of questions. Be open and prepared for a slow post-surgery recovery and for the many substantial changes the DS will make to your life.
|
|
|
Post by goodkel on Sept 3, 2014 14:06:27 GMT -5
Atrial tachycardia is a heart condition. That one should be easy.
Pseudotumor cerebri is a swelling in your brain that could lead to blindness. Weight loss is one of the treatments for it. While probably not fatal, there is a high risk of vision loss. Sounds serious enough to me.
How's your blood pressure?
|
|
|
Post by aa on Sept 3, 2014 15:08:36 GMT -5
Oh my goodness! you just made me so happy! I seriously have hope they will consider it co morbidities. I have paper work I can bring to prove both plus my actually medications that I take. And I have to go to a seminar in NYC at lenox hill hospital on Sept 9/2014 once I do that I can call Dr Roslin and set up a one on one. I changed my insurance from Health First to United Health Care Community yesterday so that I can see Dr Roslin, that doesnt kick in til Oct 1/14 so I do have to wait til then. But I doubt that he will be able to see me til then or after anyway. SOOOOO I am so hopeful. So very hopeful. Any tidbits or info, advice, anything you guys can think of just let me know I greatly appreciate everyone! Welcome. The group at Lenox Hill is usually pretty good. It's one of the few that often has several DSers there.
|
|
|
Post by Joanne on Sept 3, 2014 16:53:45 GMT -5
Hi I'm the one on Obesity Help that directed you over here. I changed my name to "NoMore" when I left there years ago.
I cant answer your insurance question, but want to let you know I had my DS at Lenox Hill in 2009 and am very happy with the decision, the surgeon, and the hospital.
I found dealing with Dr Roslin's staff a little difficult. They're a very busy practice, so you may have to be pushy. They do seminars, I think every week, and you can sign up online. He says in the seminar that he doesn't answer individual questions, but it's a good way to meet him afterwards because he'll stay and mingle, and his insurance coordinator is usually there, too. The seminar will give you a good feel for him, the hospital, and what to expect - plus your insurance will probably require it too, so you'll be a step ahead.
|
|
|
Post by Joanne on Sept 3, 2014 16:54:58 GMT -5
|
|
|
Post by goodkel on Sept 3, 2014 19:46:44 GMT -5
Hi I'm the one on Obesity Help that directed you over here. I changed my name to "NoMore" when I left there years ago. I cant answer your insurance question, but want to let you know I had my DS at Lenox Hill in 2009 and am very happy with the decision, the surgeon, and the hospital. I found dealing with Dr Roslin's staff a little difficult. They're a very busy practice, so you may have to be pushy. They do seminars, I think every week, and you can sign up online. He says in the seminar that he doesn't answer individual questions, but it's a good way to meet him afterwards because he'll stay and mingle, and his insurance coordinator is usually there, too. The seminar will give you a good feel for him, the hospital, and what to expect - plus your insurance will probably require it too, so you'll be a step ahead. Just who I was hoping would join in...
|
|
|
Post by kittykatkris on Sept 4, 2014 8:54:08 GMT -5
Hi joanne!!! thanks so much for sending me over here u were right lot of ds'ers over here. I have a scheduled seminar the 9th of Sept i have to wait till ive attended and its on record before I can call and setup a 1 on 1 with doctor roslin but that's okay because united healthcare community plan insurance doesn't kick in for me until october first.
I know this is a very silly thing to worry about but my brother and sister in law and niece and nephew basically a family tradition we go to Wolf Lodge indoor water park every December if I happen to get my surgery end of October do you think I could still make that trip?
Here's hoping!
|
|
|
Post by goodkel on Sept 4, 2014 22:34:18 GMT -5
You can immerse yourself in water as soon as your stitches come out. You won't be able to eat much and you probably won't have the energy to do much more than float along in the lazy river. But, it is definitely doable.
|
|
|
Post by kittykatkris on Sept 5, 2014 16:23:02 GMT -5
Ok I just didnt want to go and be absolutely miserable. Its about a 6 hour drive there. Plus I dont wanna be a debbie downer. So I guess I will just have to wait and see. When I had surgery on my ovary to remove a 9.7 cm cyst inside of it (which burst during removal and they had to clean all my organs so it was way more complicated then it should have been) I recovered quite quickly.
I mean it was quite miserable and hellish for the first week to 2 weeks but then about a month out I was ok as long as I did not bend a certain way. It was a quick reminder of hey take it easy there you were just through a major surgery.
I guess I will just have to wait and see! I am so excited guys and gals! I am sorry if I am annoying, badgering, or bothering anyone I just have only been at a NORMAL bmi once in my adult weight and that was 10 years ago!
THANKS FOR ALL THE ADVICE AND PATIENCE!
|
|
|
Post by goodkel on Sept 5, 2014 17:18:55 GMT -5
If it is normally a six hour drive, add a couple of hours on to that to account for your frequent pit stops. That early out, when your body tells you that you have to go, you need to be heading towards the nearest bathroom immediately.
There is no,"Well can you hold it? The next rest stop is only 7 miles away." Nope.
It is, "Get off at this exit. NOW."
In fact, I would plot out all the public bathrooms available along the way. But, I like to be prepared.
|
|
|
Post by kittykatkris on Sept 5, 2014 23:26:14 GMT -5
Oh no lol!! That makes me nervous haha. Ok we will see how it goes.
|
|
|
Post by goodkel on Sept 6, 2014 0:12:57 GMT -5
If it is something you can decide at the last minute, that would be best. There is no way to predict where you will be in the healing process as everyone is different.
|
|