New Kid on the Block! Karen Lawrenceville, Ga.

Hello all, This is an awesome crew of people! I have been looking into having this surgery for some time now, and was told about this web site. I am totally impressed. I have a few questions about this insurance thing. I have BCBS HMO through Gwinnett Co. Schools. I think our renewal date is in July. I have heard that they are going to discontinue paying for this surgery and I am just wondering if you all think I have time to get it through? My sister-in-law had this done almost 2 yrs ago and is doing great. She went from 302 to 124!!! Looks great! I also am worried about the part where they want you to have 3 different times you have tried to lose weight for 6 months at a time. I don't have that! Not documented anyway. I have arthritis in my knees and lower back pain, and my feet hurt....you know all the signs. I also took phen-phen for almost one year, but I don't have records of that either. The place I went was in Kentucky and they are long gone out of business. I have called several places to try to get ideas on where to get this info, and no one can give me any help. I didn't complete 6 months of weigh****chers, I may have gone 12 wks or so last year. What do you all think? Do I have a chance at all of doing this? I went to the seminar that Dr. Appell gave. It was very informative, and he requires alot of stuff. Does my copay pay for all those appointments to the phsyco dr, and the nutritionist? I am going through a divorce and have no extra money! I really need to do this, but I am afraid I won't get an approval over the documented weight loss thing! Also, what Dr. in Atlanta gets you in quicker? Let me know what you guys think! Thanks for all your input! Karen

Hi Karen, may I make a suggestion as you begin this journey. If you think your insurance company may require the 6-month doctor supervised diet, make an appt. Get in to see your doc asap, be put on a plan, almost any plan will do, and start going in for regular weigh-ins. As for what doctor gets you in quicker........not to be harsh, but that is not a good way to pick a doctor for this surgery. You want an experienced doctor who has done many gastric by-pass surgeries. You want a doctor that is available to you, one who will follow you throughout this process. Not one who moves you along conveyor belt style. May I suggest you contact Dr. John Daly or Dr. Christoper Hart. Neither of the before mentioned docs are paid subscribers to ObesityHelp, so their information is not in the forefront on this site, but is available if you search. Good Luck to you Debbie J Duncan patient 01-14-02 lap-rny 01-15-02 leak repair surgery (non smoker, non steroid taker) 01-29-02 surgery to see if I had another leak, NO thank goodness SEVERE COMPLICATIONS!! 45 days in ICU, 33 days kept alive via ventilator 30 days in a rehab hosptital, had to learn to walk again Now one happy girl.........LUCKY to be alive

Hi Debbie, Thank you for your reply. I am so glad to hear you are doing good. Man, you are so lucky to be alive. I am certainly looking for an experienced Dr. Dr. Appell has lots of experience in this field, and his seminars are very informative. I have procrastinated thinking I won't have a chance because of my weight loss history. I will call BCBS to see if they are going to stop paying in July. I will also call my benefits department. Thank you so much for your help. Karen

Karen, Welcome! If I were you, I would go to the doctor asap and get on a diet plan. The whole Ins process can sometimes take a while, sometimes it could take weeks just to get a appt with the doctor. If you are going to have to do a diet, start now. If your coverage does indeed end in July, you don't have a day to waste. Cathy Martin

Thanks Cathy, I will get busy this week. I really want this surgery and need it, but I don't want to go through all the required steps to be turned down! I will check into it further and see what happens. You look great, how much have you lost? Karen

Karen, I had my 2 year post op Anniversery on 10/22/02. I have lost a total of 133lbs. I stopped losing around March of 03, my surgeon said that my body has found a comfortable weight. I can go up and down a few lbs, but I stay pretty steady at 135. My next hurdle is plastics. I was denied by my Ins co last fall, and am slowly but surely trying to get the energy to fight them. I do want more surgery, so that my body will look somewhat "normal", but, I have two small boys, and my previous surgeries were quite difficult on them, so I am in no hurry. Be careful when asking me questions, I tend to go on and on and on.........(he,he,he) Well I must get back to my Saturday cleaning.. Cathy

Hi, Karen, I would go to my PCP ASAP to start documenting your weight loss. I had been on many medication for weight loss in the past, but had to use a "new" one per insurance for three months. I think my other years of attempts were included in the six month requirement. I was also a Phen Fen girl. Your doc whould have record of your Phen-Fen attempt. Write up your weight loss history before you go to the PCP, and maybe you will have all or some of the six months required already behind you. I also have BCBS HMO through the school system. They reimbursed me for the psych eval. (I had prior approval because I had to go out of network for this.) All other appointments required my co-payment. I do think you can get this done in six months, but you will need to be Pro-active to insure efficiency. Since you already have a surgeon in mind, start going through their process as well. Unfortunately, I have also heard that WLS will not be covered in the future by BCBS HMO through the school systems. I am interested in finding out what I can do to be an advocate for WLS.

Becky, Thanks for your response. I will go to my PCP this week and see if I can get things moving. I had already talked to her about it and she wanted me to write the weight loss history and fax back to her. I just haven't been able to find out what will work for me. I can no longer get in touch with the Dr. who gave me Phen-phen. He is out of business and can't be found! I have tried all kinds of weight loss, but I don't have documentation from a dr. I tried weigh****chers last year and I lost 15 lousy pounds. I dropped out because of my divorce and all that was going on with it. I am going to make calls to everyone I can this week to try and get things started. Just pray I can get it done in ample time! Are you from gwinnett co.? Our director of human resources just had this surgery, but she hasn't come back to work yet. Can't wait to see her! She is doing great. Thanks for your help.

Sounds like you are on the right track. My PCP took my weight loss history, and put it on her letter head. I'll be happy to share mine, and you can edit it. My format came from Dr. Duncan. Send your e-mail to me, and I will attach it. When you see it, you are going to laugh really hard! I tried everything! I also had to have several echo-cardiograms to prove that my heart was not adversely affected. I knew it wasn't since I didn't lose weight! I teach in the Cherokee County School System - kindergarten teacher for 25 years. I was a parapro for two years prior in the same school - Woodstock Elementary...been here most of my life. LOL Hugs, Becky

Hi Karen, I wish I could answer some of your questions but I can't. I just wanted to say welcome to the GA board. Shon