new and need help!

Hello all, I'm Buffy. I've been lurking on and off for 6 months now and I am hoping that you all can give me some insight. I am apre-op patient of Dr. Aranows, hoping for open RNY ASAP!!! I have completed my pre-op check list with the exception of still needing to attend 2 more support group meetings and still working on losing my pre-op 10 lbs. I have BC/BS of Mass for now but am out of work on a workers comp claim, broke my ankle the day after Christmas 2005 and it's not healing. Its my right ankle and I can't drive because of it. I am still out of work but my ortho doc cleared me to go back once WC fits my Jeep with hand controls....but he's only cleared me for part time. If I'm not making 30 hrs/week I lose my medical insurance!!! I need this surgery to live, you can all relate to that! And I dont feel my ankle will allow me to work yet...Im most likely going to lose my job I'm looking into state insurance because I have no where else to turn. Do any of you know if state ins covers RNY? Do you have any advice for me? Someone Please Help! ANY advice would be appreciated! Buffy

hi buffy, most of the time the state will pay if surgery is deemed medically necessary,dr.A is certainly qualified to make that decision.most of the time the medical providers office handles the insurance part of it,another thing is that the state likes to pay for surgery at only hospitals that are "centers of excellence" feel very secure,,,middletown is one of those.And everyone thats been a patient of his that I have ever spoke to are very happy with the results..Good luck to you on your journey and keep posting.....cyndee

Hello Buffy, There is only one type of state insurance that Dr Aranow accepts and that one DOES cover it 100%. Best of luck on the healing of your ankle and also with the surgery. Lisa

Thanx Cyndee, I KNOW it is medically necessary. I am 26, 388, 5'6" have sleep apnea, HBP, GERD, Depression, Asthma, Migraines, joint pain..... I qualify, no doubt about it. Dr. A would probably go to bat for me on that too. Middlesex IS a center of excellence for anyone who was wondering. Thanx again...

Hello Beth, I wish I had good advice for you, but I dont know much about that insurance, but your in good hands with Dr A, he has been alot of my friends here on the boards as his patients and he is well respected and loved by all. Good luck in your journey and I wish you all the best. Welcome to the family and good luck sweetie. Hugs KimC

Okay- my advice is to get a good workers comp lawyer- YOU CANNOT BE FIRED YOU ARE ON WORKERS COMP IT'S THEIR FAULT YOU CAN'T WORK- The MOST they can do is settle the claim, and even so you are not "fired" and you are entitled to continue your present health insurance under COBRA - this allows you to stay in your employer's group coverage for up to 18 mos following the end of your employment. MEANWHILE get thy buttocks to a lawyer.....get your meetings and your pre-op weight loss DONE so you can move it along with Dr Aranow, but don't fret, you CANNOT be fired while out on comp- no way no how can they just fire you....

I already do have a lawyer and he has told me that they CAN terminate me at this point. NOT because I filed a WC claim but because they need to fill the position. Also my lawyer is impressed with the company because they COULD have terminated my insurance the day of the accident....catch 22 any way you look at it. And the cobra isn't an option...after 10 months of only making 60% of my salary ....savings is depleted and there IS no $ to pay for cobra....like I said catch 22. I've discussed it with Lois who seems genuinly concerned but theres nothing she can do to speed up the process...I am really not a pessimist but I am having trouble seeing a way through this one!!

Hi Beth, Can you stall having the hand controls put in? Tell your ortho doc that you cannot work full time and will lose all insurance if you go back part time. In the meantime...go on the South Beach Diet first stage and lost that ten pounds! You can do it within a month. Get the last two meetings done in the next two weeks. If all goes well, I'm sure Dr Aranow will clear your chart and pass it to Lois to schedule a date while you're still 100% covered. He expidited my husband's surgery this past June and my husband did all of his pre op testing, visits, support groups, meetings, etc. in just 5 weeks! I think he broke the record! Can you get into a pool for some exercise? Is there a YMCA near you? You'll lose faster if you can kick with a kick board up and back to get your heart rate going and you'll lose. Drink tons of water...flush your system...Try to drink a gallon a day. Eat lots of protein and start protein shakes now. It'll help to lose, too. Go to: www.southbeach-diet-plan.com to read more on South Beach. Dr A had me do this pre op and I lost 18 lbs in a short time prior to surgery. I know about ankle breaks. My sister completly chattered her ankle a year ago in April due to a dog pushing her down and she is having the toughest time with the recovery of it. She's in litigation now with the homeowner's ins company for a settlement. She will have lifelong suffering from this. She had to have a chair lift installed in her house so she could get upstairs. She's got plates and pins and tons of screws holding both sides of her ankle together. Have you ever gone to www.mybrokenleg.com ?? She finds good support there for that issue. Get motivated to get your RNY stuff done so Dr A can do the surgery soon. Try to stall going back to work so you're still covered. I think a new ins company will make you wait, or possibly make you do the six month nutrition counseling, so it will set you back another half year. You're in great hands with Dr Aranow. He's such a caring man and surgeon. Lois and the staff is great too and will help you out as much as possible. But, be patient, ins submittals take a couple days or more sometimes...A friendly check in to Stacy or Lois from time to time to find out what's going on is ok. Good luck, and keep us posted. paula

Well Workers Comp doesn't realise it but they have just done me a favor. Their independant Medical examiner says that I'm faking it...ok..all this pain is in my head, my ankle simply stopping working is a figment of my immagination....the doc is a moron. Theyre cutting off my bennefits and sending me back to work full time no restrictions, and refusing to pay for the hand controls for my Jeep......my lawyer is appealing that. By appealing we have to go through a hearing with the WC Commissioner and get a 3rd opinion which will decide the final verdict. This does however gain me precious time to go for WLS. They must keep paying me untill the case is resolved. Although the WC checks arent nearly enough it's better than nothing!!! I'm already 2 weeks on South Beach and am hoping to go to the office and weigh in on thursday.....my scale broke, gotta have Hubby look at it! So, I have been super duper strict on the South beach, as far as the info Liz gave me, and have ordred the book to get more info. Low carb diets HAVE shown results in the past so I'm pretty hopefull!!! Thanks for all the support and advice guys! I'll keep you posted and will see some of you at Mondays meeting!

Buffy, If you are out of work on workmans comp, that should mean you got hurt at work. It would be really, really stupid if your employer lets you go and/or refuses to cover your insurance if it a work related injury. I think it's time to talk to a lawyer, not state medical. You have rights and they cannot force you out. Let us know how it goes Tee