Going for ARS

Hi all... I've exhausted other options and about to make and appt with Arkansas rehabilitation services in the morning to see what it would take to get them to pay for it. There are a number of people on the insurance list who listed ARS but not one of them responded to my questions - most had their surgeries in 2002 and 2003. Maybe their emails have changed since then. So here is my situation, and after are my questions. Anyone that can answer or even give an opinion about anything will be welcomed! My husband and I are 51 and 45, respectively, and we both want wls. He is a nurse at a hospital but the insurance excludes 'surgery for weight loss.' There is a $25K cap on what they'll pay for ANYTHING related to weight loss, which isn't enough to cover surgery even if I horsewhipped them into relenting. DH has sleep apnea and has even had surgery for it. He probably has sugar issues, as we have a glucometer here and have watched it for a while, but he didn't want to get it treated (documented) while we still had some insurance questions. He also has Crohn's disease which will limit him to either a band or vertical gastroplasty procedure. I haven't worked in the system in 15 years. The kids are just now grown and I'd go back to work again, but I just can't. After a half day on my feet as it is I can barely walk. A half day in front of the computer is only marginally better. I have very little documented as I'd rather take a beating than complain to the doc, only to hear that my problem is my weight and I need to lose it to fix the problem. However, I have lots of stuff I COULD complain about- the not being able to walk sometimes is a pretty big one and DH is pretty sure I have sleep apnea too. We definitely have to get moving on documenting our co-morbs and making sure that they aren't diminished on paper, but look as bad as they honestly can look. DH's BMI is about 43 and mine is 47. ARS require 55 and yet there are several people on the insurance list whose BMIs are below 55, so there must be some discretion. I do not want the RNY procedure. Period. My preference is for the duodenal switch. If I can't have that, I want the vertical gastroplasty, which makes the stomach smaller but leaves the pyloric valve intact, and also removes the hunger-hormone ghrelin producing tissue. We realize that DH's Crohn's could come into play here, however my research supports that while he would not be a candidate for any malabsorption procedure, VG is a good option for a Crohn's patient. Now, for the questions: What kinds of things are required to get them to help pay for the surgery? Does anyone know anyone who has used ARS to pay but their BMI is lower than 55? Would that person talk to me? There are no DS surgeons in Arkansas - has anyone ever gone out of state for treament and how difficult is it to get a treatment covered that is unavailable in Ark? Where does the fact that I haven't worked while the kids were home factor into all of this? I'm willing to go to work but it'd be hard to find a job because employers don't like to hire people like me. And until I get some weight off and get over this constant pain, I probably couldn't do much anyway. But - once I dropped 50 or 75 lbs, I could be out there NO HOLDS BARRED. Denise in Fort Smith

Dear Denise, I am so sorry about all the trouble you are having.I can't help you with these questions either but just wanted to let you know that I do hope some one can help you on the main board. I will be comming to Clarksville Ar. Aug 13th for a family reunion. Keep fighting for this it will be worth it. pat memaw199554

Denise, I am sorry for all the frustration you are facing. I was one of the fortunate ones who had WLS paid for by insurance, so I can't help you from personal experience. But it seems that the best course of action is to find a doctor that will perform the type of surgery you seek who has office staff devoted to helping you through the financial hurdles. They will have done this many more times than any of us and will know the documentation hoops to jump through. I wish you and your husband the very best of luck on this journey. Joy