Okay Steve, this is my story!

[Guest guest]

Babs,

I had a similar insurance experience as you have had so far. I went to a

popular RNY place (not knowing about DS) and applied for insurance coverage.

I had SelectCare PPO at the time. I got a general denial at first. The next

couple of denials said I didn't have enough co-morbidities. I hired Walter

Lindstrom and the final notice from the insurance company was that I needed

to try a weight loss program with a medical doctor. I was also told to

switch to Blue Cross PPO as they covered WLS with less hassle. All of that

took 1 year. I tried Xenical for 6 months and switched to Blue Cross PPO in

the mean time. At the end of the 6 months, I called the RNY place and they

told me that they no longer participated with my insurance. I was devastated

and felt like my only chance for surgery was taken away. After a few days of

feeling sorry for myself, I researched bariatric surgeons that took my

insurance. The first one I called told me they no longer did bariatric

surgery. The second was Dr. Hares and they sent me an information packet.

When I was reading the packet was when I learned a little about DS. I went

for a consultation and found out a lot more about the surgery. They told me

that my insurance should be no problem, but after all I had been through I

wasn't too positive. I had my pre-op exam on July 12 and they submitted to

my insurance the next day (Friday). That morning they also called me to say

that there was a cancellation for the 19th (6 days away) and they were trying

to get everything in order for me to have that date. All weekend I felt like

it wasn't really going to happen. I didn't want to get my hopes up and be

devastated again. All day Monday I waited and heard nothing. We had a

support meeting that night and when I got there the office manager was all

excited and told me my approval had come through at 4:45 that day! All of

the sudden it was real and I was really going to have surgery in 3 days! The

next day I had to tell my work and the following day was the bowel prep. The

best part was that I finally reached my out-of-pocket max for the year so I

haven't had much of a co-pay since. My insurance really didn't pay that

much, but since my surgeon participates they had to take what was approved.

Now I am almost 10 weeks out and feeling great.

I really wish you the best of luck and let us know how it goes with your

insurance.

Kathy M.

DS 7/19/01

213 pre-op

164 today

[Guest guest]

This is actually to the whole group, but Steve Goldstein being the

nice guy he is, pursuaded me to post my weight story because I stated

that I don't post because I didn't have anything to offer to the

group. I'm not an intravert, I just don't have any experience with

wls YET.

My story with obesity starts as a child. I was on amphetamines as a

child under doctors care of course. Remember when you were a kid you

always had to get in line according to you height, well, I'm not only

a porker, I'm a shortty too. So I always was the first in line. I

always was a " joke " because of being chubby.

Highschool days were not easy, but I seem to adapt to being chubby

and I developed a hell of a sense of humor. That is the only thing I

am thankful for obesity, my sense of humor. I can have people in

stitches in no time. Blah, Blah, Blah,

I'm a married to my " childhood sweetheart " I met him when I was 14,

47 year old woman, with two beautiful daughters who are now 22 and 24

yrs old and now I'm not chubby, I'm morbidly obese. This was no

surprise to me or anyone else who knew me growing up. I'm 5X5. I

have severe back pain due to a vertebrae that comes out of alignment,

despite the fact that I had surgery four years ago to fix it. I had a

lamenectomy with bone fusion. At 47, I had just finally learned to

love myself fat and all, but this back pain keeps me from having a

functional normal life. I was already denied RNY surgery from Optimum

Choice. I did three appeal processes and the last one was a

teleconference with OP CH and my PCP. She was brilliant. I'm

fortunate enough to be the office manager for my PCP so I was there

and she was great. I did not know about the DS at the time. I learned

of this on my own, not through the surgeon. Now I'm convinced DS is

the way to go. I'm waiting for open enrollment with BCBS and I'll pay

the extra premiums for insurance if I have to just to have wls.

I know I'm in for another fight for surgery, although I think my

weight history, hypertension and back problem speaks for themselves.

I was denied before, so I don't put anything past insurance

companies. I can't go on in this kind of incapacitating pain like I

do. They want to put rods and pins in my back and put me in a body

cast. NO WAY! I guess next would be my degenerative knees and then my

hips. My only fear is being denied once again with a new insurance.

If they will only approve a RNY I guess I'll have to settle, unless

the doctor would let me pay out of pocket for the difference. I'm

under the impression the RNY is less time in the OR, therefore I

assume pays less by insurances. Damn if you do, damn if you don't.

I apologize for posting such a lengthy composition. I actually

thought I cut it short. Aren't you glad I did.

Thanks Steve, once again for encouraging me to post.

Babs in Baltimore

Praying for a DS