Angry Moderators - Very Long Post

[Guest guest]

Wow, I belong to another WLS group who I guess also

include RNYers. I'll post the emails (without names).

1. A man posted this, addressing it to the moderator:

{Moderator's name}, I've read where you say don't let

much time go by without calling the insurance company

and be a thorn in their side. Give me a little input

here. After my last appeal was denied, the next

step/coarse of action is to file a grievance with the

Department of Managed Health Care. Ok,that is being

done.

Now what might I say to B/C when I call to be a thorn

as they pretty much have closed the discussion with

me, by sending me on to the DMHC. I'd like to start

dialogue with them to rationalize surgery and I'm

curious how they can approve others (that are

self-insured)while calling the OP

experimental/investigative? Thanks for some input.

**************

2. Then the moderator replied:

Moderator's Note: What operation are you trying to

get them to approve... If its a RNY it is considered

the gold standard and information on this as being an

effective treatment for morbid obesity is on

www.nih.gov. Make sure you are not talking to an entry

level clerk in customer service but ask to speak with

their medical director and find out the

qualifications. You may find out their so called

" medical director " is nothing more than a LPN or a

RN... you would be surprised at who is reviewing

claims at some companies. Keep us informed on what is

going on. Again if you are dealing with the fact that

its a question that the surgery is experimental....

that is not the case for RNY.. but may be for other

procedures. Things are so different in insurance

companies depending on who is reviewing the claims. Do

you know of any others who have the same policy with

the same exclusions that have been approved for

gastric bypass surgery?

***************

3. So, the original poster wrote back saying he's had

three denials from BC for a DS.

***********

4. The moderator posted this:

Moderator's Note: It is my opinion that you should

be seeking approval for the RNY and not the duodenal

switch which they could have the right to deny.

Give that up and go for the RNY which is a great

operation, has severed the masses very well. I lost

150 pounds on it and am a normal 142 pounds now. If

you policy covers the surgery and you put in for the

RNY I bet it would cover it.. As far as getting

approved for the Duodenal switch... I can't help you

cause it is beyond the coverage and the insurance

company does have the right to deny cause it is NOT

the gold standard operation. So either put in for

the RNY or give it up. If you want to improve your

health and life... the handwriting is on the wall..

the quicker you realize it the quicker you can have

a RNY and the faster your life will change for the

better.

**********

5. So then I popped in with:

{Moderator's name}, I don't mean to butt in but since

this was posted to the entire list...

I'm glad your RNY went well but I have read so many

things about the RNY vs the DS that, personally, I

would rather have the DS and don't blame {Original

Poster} for wanting it to. I would want to live

post-surgery by eating whatever I want (within

moderation!) and not have to worry about the side

effects of dumping.

Also, some RNYers have to drink meat tenderizer with

water to digest meat unlike those with DS.

I am fighting for the DS, having been approved for the

RNY, because of the possible side effects from RNY.

As for the DS, the side effects are possible smelly

poops and diarrhea, which from what I've read on the

DS list, doesn't last forever.

Please don't misunderstand me, I'm not saying the RNY

is a terrible thing - it has saved many lives - but I

can understand why some would rather have the DS.

**************

6. The moderator disagreed with me:

Moderator's Note: I think you have the WRONG

impression of a RNY. I have never dumped, I CAN eat

ANYTHING I want to eat within moderation as to portion

size and have NEVER had any dumping syndrome. In

fact, my bedtime snack is Hershey's Nuggets with

Almonds every single night and if I wake up during the

night I have a few of those candies. I have NEVER had

to drink meat tenderorizer or any thing like it. I

have never had diarrhea except when a normal person

would have it or smelly poops worse than normal. Some

people do dump after surgery but they soon learn that

they no longer dump in the long term. There are

exceptions to every rule but most part it is not true

what you have said. You also have to remember there

is a psychological component to this surgery. Before

I had surgery I decided that this surgery would be

portion control for me and not limit the types or

varieties of food I eat. To tell you folks the truth,

I am now free to chose what I want to eat rather than

what will give me the largest portion size in a

restaurant to fill me up. I look for quality vs.

quantity of food and couldn't be happier.

I would say that you should go back and do your

research instead of hanging on a FEW negative

comments. and if you truly wanted to get healthy you

would have the RNY and stop fighting for something the

insurance company is not going to approve. I would

not advise anyone to remain morbidly obese and bypass

a RNY surgery. How could any of us know and make an

intelligent decision as to which surgery MIGHT be best

when the person that is telling you what you should

have is the one who is performing that procedure and

stands to benefit financially from your going with

his/her procedure.

Always remember that this surgery is not something

doctors do do without making a sizeable living. If

doctors were doing this surgery on a humanitarism

basis you would not see doctors charging so much for

people without insurance. For your information

doctors may get about 1,700 for performing this

surgery or LESS from an approved insurance company and

may feel justified in charging 10K in surgeon's fees

from a patient without insurance. Doesn't this tell

you that their hearts and heads are in their wallets?

So beware that this is as much of a business to a

doctor as a plastic surgeon who doesn't accept any

insurance and wants only private pay patients...

But again consider, the facts, not the rumors.. and

for every bad story.. there are a hundred good ones.

I would rather have this surgery than be morbidly

obese which limited my life to no end. Life is

wonderful at 140 pounds and will get much better after

the excess skin is removed.

****************

8. After someone else posted their thoughts that the

Original Poster's desire for a DS was their biz, and

they shouldn't be criticized... that the DS is a good

type of surgergy etc., the Moderator posted this:

Moderator's Note: If you were only to help people and

have the knowledge rather than this baloney. You

folks do not know about RNY's and it is NOT an

inferior surgery. People lose more than 55 percent..

like any surgery it is a tool and those who want to

bypass that tool can graze and eat and do whatever and

make any surgery ineffective. I was 300 pounds and

now weigh 142 pounds and will probably weight about

130 after plastic surgery.. so you tell me if the

surgery works and I'm 5'6 by the way..... so I stan by

what I said...

I don't know if the surgery is more or less

expensive.. The rates that the insurance companies pay

doesn't matter cause they get away cheap cheap cheap.

I do not personally think that is the answer. THere

is much risk of malnutrition and other deficiencies

problems with the procedure you are suggesting and NOT

the RNY, but then again it boils down to with a RNY

with WHAT you put in your mouth.. You can be

malnutritioned on any surgery living on potatoe chips

and peanuts rather than protein. and personally..;

whether it is a good procedure or not you have

attacked what I have said and another surgery. If you

do your research, GOD FORBID.. you will know that

rny's are recommended by the National Institute of

Health,, it is your STUPIDITY to say it is doctors who

can't perform any other surgery.

If you put as much effort into helping others as you

have here in attacking what I said and running your

fingers on the keyboard this might be a more helpful

place. BUT.. as I said I feel that the insurance

companies is justified and I would never do something

as drastic as what you are speaking of when I eat

totally normally, feel totally normal and look

awesome.. Good enough to win equitation classes on

horseback at horseshows. I am soon to get back to

riding jumpers and competition in that area as well on

my other horse.... I will do 3 day eventing again

perhaps.. but you know what this RNY surgery worked

for me and alot of other people I know...

If you just had surgery the end of August.. you can't

speak first hand for what you are experiencing as far

as weight loss is concerned. I had my surgery 19

months ago and am at goal weight. Can you say the

same??

********

Wow, I'm glad OUR moderators are nothing like this

person. I'm thankful for moderators who put in time

to keep their lists running but to have one who is so

one-sided and critical... and close-minded... wow.

=====

Dee

Waiting for Ins. Co. Approval

313/Want to be 165

__________________________________________________

[Guest guest]

Wow! I can't believe how close minded some people can be. I know for me the DS

surgery was the right choice, but I would never lash out at anyone for choosing

RNY. It didn't sound like anyone else did, but the moderator sure was touchy

about the whole thing. It wasn't all that long ago that RNY was considered

" experimental " by insurance companies and they wouldn't cover it either. It is

people like us who fight for the surgery we think is best that allow future

patients an easier time getting surgery.

As far as dumping, I thought that RNY surgeons were pleased with that result.

Maybe I am all wrong here, but I thought the idea was to keep you from eating

fats and sweets. I saw an RNY surgeon and they seemed to act as if dumping was

a way to keep your diet on track. This is all just my opinion and I have no

medical background to back it up.

Kathy M.

DS 7/19/01

213 pre-op

164 today

[Guest guest]

In a message dated 9/25/01 4:27:19 AM Pacific Daylight Time, andem4@...

writes:

> . It didn't sound like anyone else did, but the moderator sure was touchy

> about the whole thing

Maybe she started out as many of us did...looking for the DS only to not be

allowed to get it. Its wrong of her to tell people to forget the fight and

just settle for the RNY...that is not giving balanced information. One thing

I've learned as I've made my way thru this journey is whatever surgery we

each decide on...we're passionate about it....nothing wrong with that....as

long as we dont forget our compassion and respect each others choices. I

would have not had surgery if I'd only been able to get the RNY....it just

wasn't how I wanted to live and while that is my opinion, I respect anyone

that does do it if its the only thing they can do. We each have to make the

choices and live with them...but I'd never tell someone not to do something

simply because I wouldnt.!

~~* AJ *~~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 415.1

08/06/01 BMI 59 390.2 -24.9 lbs! -10.75 inches

08/16/01 BMI 58 387.0 -28.1 lbs! -11.25 inches

08/24/01 BMI 58 386.5 -28.6 lbs! -15.5 inches

08/30/01 BMI 58 378.3 -36.8 lbs! -21.25 inches

09/10/01 BMI 57 373.0 -42.1 lbs!

09/24/01 BMI 55 367.1 -48.0 lbs!

My personal website: www.WLS4AJ.homestead.com

Check out the Bellingham Support Group at WWW.WLSBellingham.homestead.com