Considering the Surgery
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| Wed, 06-09-2010 - 10:19am |
Just recently, after watching a documentary on MTV about two individuals who have both had gastric bypass surgery, I have considered weight loss surgery. I have tried and failed for the last two years to get this weight off. I have struggled my entire life with my weight and in college I had finally gotten down to 160 lbs and was very fit. I managed to go from 160 lbs to now 330 lbs within a years time--I know, absolutely ridiculous and out of control. I didn't change much about my diet but I had stopped exercising--big mistake. I do not have any issues with my thyroid (I am meeting with an Endocrinologist to make sure there aren't any other gland problems) but the weight is just stuck at 320 (my lowest) for the last two years. I work out now 5x's a week, 40 minutes a day..I eat consistently right..I drink lots of water and I am just stuck. My BMI is 53.3 (I am 5'6") and I am about 180 lbs over weight according to what I should weigh (around 150). I am sick of feeling trapped in my body! I am only 24, my husband and I have tried to get pregnant but have failed for almost a year, I couldn't even do hiking when we went hiking because the stairs were just too much. I am starting a new path in life on my way to getting my nursing degree and I do not want to be a very unhealthy, obese nurse who has trouble helping patients because of my own weight disability.
SO..I have some questions now :) I have United Healthcare for insurance..PPO..their best plan we could get under my husband's employer...has anyone else had them for insurance and gotten pre-approve for surgery? Does anyone know the requirements I'll have to meet? I sent an email to Barix Clinics because I am in Ohio and there is one just 20 minutes away. They said they keep current on insurance requirements, etc. I am hoping it will be covered by insurance since I am so obese and have been for so long while trying every diet under the sun and exercising. Has anyone else had theirs covered by insurance? If not, how did you go about affording it? Any suggestions for getting started on this journey? Any information, advice, stories, etc would be very welcomed!
Thanks :)
Heather

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Hi Heather!
Nowdays a lot of insurance companies cover weight loss surgery.
Alice,
You are like a light at the end of the tunnel :) My husband works for Nationwide Insurance LOL..they are huge on making sure people are healthy, etc..so I highly doubt they'd have a clause but THANK YOU..I did not know that--I will definitely have him check on that!!! :)
Also, I contacted Barix Clinics! We have one right here in Columbus, the lady said they even have their own United Healthcare representative that they keep on staff LOL..so I sent her my questions and we are going back and forth to figure things out and hopefully get my initial consultation set up! I remember when WLS wasn't covered by insurance and it was really frowned upon so I think my mind is still stuck in those days. I am praying this is covered--I have worked so incredibly hard and I am not seeing any success. I'd hate to have to do the 6 months of diet and exercise because that would delay my surgery out even more but really--I'd do anything to get approved. I don't have high bp or diabetes but I do have sleep apnea, had gallstones--had to even have my gallbladder removed, I have gastroparesis now..I've having to see a GI specialist..a whole mess of things, I've had so much bloodwork done it's insane! And I know it's all because of my weight.
CONGRATS on your weight loss--that is absolutely amazing, you should be incredibly proud of yourself. The procedure you had is the one I'd probably have based on how much weight I have to lose, etc. To be down 72 lbs since Feb. is amazing--you should be very proud of yourself!
I'll keep everyone posted..thank you, so much!
-H
-H
Hi Heather,
Welcome to the board. My weight height is similar to yours, so I know how hard it is to do things.
I'm fairly new to all of this so I don't know as much as some of the others. I started meeting with the bariatric team at my hospital a couple months ago and I am close to being approved. The way I started was to look into what hospitals offered it. Most will offer an information session. My hospital requires that you attend 2 of them as one of your approval requirements. After I attended my first one I filled out a form about myself and they called and set up the first appt. They are going to do all the work with the insurance company for me, so that is still in the works. I did call my insurance ahead of time to find out what they require, so that I wouldn't wast my time. My insurance is kind of strict and wanted 2 documented weight loss efforts that equaled 6 months each. Luckily I had that already met.
You could call your insurance company ahead of time and ask what their requirements are.
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Heather- an insurance notice just came in the mail and I realized I am wrong- I do have United Health care- but I always go by my plan name Oxford Liberty plan access, a PPO.
My pre-op requirements did NOT require a supervised diet.
Thanks everyone!! So much for your responses.
It would be great to not have to do the monitored diet to get approved but I have been consistently on diets since the age of 7! I even have medical documentation going back that far, so hopefully--if I have to do any of that, I already have it finished. But to hear that through United Healthcare (ours is known as the Nationwide Plan PPO lol) you didn't have to have the supervised diet is awesome! Not that I mind, I just don't want to delay this out months and months and months. I talked about it with my husband, who is in agreement that it is best for me and wouldn't hurt to at least have the consultation with the United Healthcare provider and find out the details, etc, and he was really encouraging b/c he said even if I had to do a supervised diet--it's worth it in the end for the surgery that could change my life. My mom worked with a woman who had it done along with her daughter--and they didn't have any complications either. All of those requirements are no problem for me--I've had complete bloodwork done recently for life insurance and with all of the health issues I've had recently (gallstones, gallbladder remove, I now have gastroparesis, etc).
The Barix lady called again, I am going to call back tomorrow and setup an appointment. She said they usually make appts. for Wednesdays so I'll let everyone know when my appt. is, etc! :)
Thanks again ladies!!!
-H
You will still need bloodwork done, besides the routine stuff they check a ton of vitamin levels for a baseline.
Bloodwork doesn't bother me LOL..you could draw blood from me all day and it doesn't phase me, I've had so much done in my lifetime so that'll be a small bump to get over :) Thank you so much for informing me on everything, you have been absolutely amazing! So informative and it has just been so helpful, it really makes me want to look into this more and take the appropriate steps to changing my life. You all are such great inspirations!
-H
Hi, Heather! Welcome to the board. My name is Melissa and I am the CL here. I'm sorry I've been gone for the last two days so I am late in welcoming you.
Our stories are a lot alike. What really stuck out at me while reading your post was you feeling "trapped" in your body. That is exactly how I feel and let me tell you NOT ANYMORE.
Also, my husband and I struggled with trying to pregnant for years (we've been married for 13 years now) and it was a major motivator in our decision to proceed with the surgery. After waiting 17 months after surgery and losing 130 pounds we got pregnant immediately. Literally the day after my husband returned home from a year long deployment to Afghanistan. Unfortunately, I had a m/c just 6 days after finding out I was pregnant. I got pregnant just 3 weeks after the m/c and am now 17 weeks pregnant with a healthy little baby so far. So I went from being infertile to VERY, very fertile which scares me for future babies, lol.
The bariatric clinics usually have an insurance specialist who just takes care of the ins. needs. I don't have any experience with United Healthcase but Alice is right that most ins. companies do cover the surgeries now. It makes sense because they can pay a one time fee for $15,000 (approx.) OR a lifetime of medicine, etc for us when we were morbidly obese.
I am so excited that you found the board as we have been quite active lately and will help you in any way we can!!!
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