I am here to ask for your help.

I've done everything that I know how to do to get gastric bypass surgery. I have a long and painful story, but I will try to be brief and to the point. I will leave my email address for anyone who is interested. My name is Paula Fullerton. I am 28 years old, 5' 3", and weigh 270 lbs. I have been obese all of my life. My first realization of this came in 4th grade when I weighed 145 lbs and attended Diet Workshop. My sisters and mother are overweight. In fact, 2 of my 5 sisters have had the surgery. I have 2 living children, a boy who is almost 4, and a girl, who is 18 months old. I also had a daughter who died July 18, 2002, at just 6 1/2 months old. We never had a chance to fully enjoy her because she never got to come home. In fact, her only adventure in life was going from St. John's Hospital, in Springfield, IL, to St. Louis Children's Hospital, in St. Louis, MO. During this time of great stress and sadness, I gained between 30 and 40 lbs. The week she died, I found out that I was 3 weeks pregnant with our 3rd child. I was told that I couldn't grieve the loss of my child, because it would harm the baby that I was pregnant with. Between the stress, the heartache, and the depression, I ate. What it boils down to is that over a period of about 4 years, first child, to last, I gained about 50 lbs on top of the 50 lbs that I gained in the 6 years prior, after graduating high school. I've spent the last 2 years, September 2002, to today, trying to gain knowledge and insurance approval for gastric bypass surgery. Our last child was born on March 10, 2003. Two weeks afterward I was in the surgeon's office. I had Cigna insurance through my husband's employer, Firestone. Thanks to the plant closure, I only had until October 31, 2003 to get approval and to get the sugery done. I didn't know if I would have any insurance after that or not. The surgeon submitted the documents. Without getting into great detail, I will just say that I was denied because as of September 2003, I did not have 6 months of MD Supervised Weight Loss Program within the last 12 months. Apparently, this requirement was just overlooked when I called in September 2002 to ask the requirements for gastric bypass surgery and was told all I needed was a letter of medical necessity. How convenient! That left me about 2 months to do a "6 month MD Supervised Weight Loss Program". Not possible! I, however, went ahead and started it. I wanted to show them and anyone else who was interested that I was determined to do what it took to get this surgery! Well, before the insurance with Cigna ran out, my husband started trying to get insurance from his current employer. BCBS is our current insurance and we have been with them since November 1, 2003. Right away, I called to ask their gastric bypass criteria. They were very upfront. The only thing that I lacked was 12 months of a MD Supervised Weight Loss Program within the last 24 months. I figured that I had already done everything else and if all I had to do over the coming month's was to try to lose weight and go to the doctor, I could do that. I already had about 2 months down any way. Every now and then, I'd send them my medical records, in hopes that they would approve it early, or at least not forget me and close the case. After about 3 letters, the last one dated September 2, 2004, I was told that the past year was basically a waste. The records they had did not show details of what I had done to try to lose weight. The supervisor that I spoke to said, "You can't just pop a pill and go weigh in every month and that be enough.". I feel that if they had explained what they meant by a MD Supervised Weight Loss Program, all the frustration, stress, and depression over the last year would not have happened. Now that I have bored you to death or confused you beyond imagination, I will get to the point. I have no means of paying for gastric bypass surgery. I have been to 3 surgeons, a psychologist, a therapist, a pulmonologist, cardiologist, a nutritionist, 2 doctors, and a nurse practitioner who feel I need this surgery. I have also been denied by 2 insurance complanies. I went to one of the surgeons in hopes that pulbic aid would hlep pay, but the surgeon and I had a falling out over his procedure for insurance approval. There are very few doctors who accept public aid. The closest doctors to me that I am aware of are in Chicago and some in St. Louis, but I have been told there is several year waiting list in St. Louis. After all this, I don't know how to get this surgery and I am so depressed. I'm embarrased to leave home, and I feel like crying all the time. I'm supposed to be on medicine for depression, but I don't feel like wasting my time taking it. I'm going to be miserable either way. I'm already on Social Security Disability for depression. The insurance doesn't care. I don't want to step on anyone's toes or make anyone angry, but I'm here today asking for help, either in information to get help paying for surgery or anyone who might be willing to help me pay for the surgery. I don't like doing this, but after 2 years, I don't feel like I have a choice. I have at least $1000 in medical bills related to trying to get this surgery that the insurance won't pay and we're stretched financially as tight as we can be. Th last surgeon that I went to, and who I would like to do the surgery, Dr. Sidney Roischibe (pardon the spelling - don't have his business card handy), in Clinton requires $4500 down and will take payments on the other $1000. This also doesn't include the hospital bill or any lab work. I hope no one takes offense to me asking, but I figure it can't hurt. If you have any questions, please email me. I'm not a fraud or a con. I just want to be able to do basic things, like play with my kids, perform basic personal hygiene, and enjoy life a little bit. Don't hesitate to email me and I will be completely upfront with you. I will even provide you with names and phone numbers of others who can confirm this. Thank you for your patience and time. Paula Fullerton [email protected] PS. You may have read a post from me back at the beginning of my QUEST for gastric bypass surgery! Thanks again!

Paula if your on public aid check out newhopesurgical.com they are in the river forest area near chicago now I know that is a drive for me I'm near st. louis but my life is on the line and I will do what I have to. New hope requires; Psych eval Upper GI Pulminary function test 1 year medical history Note to public aid asking for your approval Dietician visits copy of your medical card you have to also go to one of thier informational meetings. Information from the packet they will give you at the meeing There's more I will post to you tomorrow when I get to work to see my list If your tests are within the last year they will probably take them with no problems and if you have it all done give it to them when you go for th einformational meeting. If your on disability check with them i seem to recall there was something through them that will pay for this surgery also. And St. Alexian brothers in St. Louis takes the disability I THINK>>> Medicaid requires a note from your primary and they usually approve within 2 weeks. Good luck and I will get you more information tomorrow. Keep up hope you came to the right place for information!!! We're all here to help! And welcome to the AMOS family! Debby

Thank you so much for responding. I am on disability, but I don't have the medical insurance that goes with it. They take a portion of your checks to pay for the insurance. For me it would be like $58 per month and my husband already has $30 a week taken out for our BCBS coverage. As far as public aid goes, now I have to reapply for public aid. At the time that I was trying to get public aid to pay, I was on a spin down and I just had to submit a letter of medical necessity. Now I have to start all over and get approved for the medical card. It's so frustrating! One loop hole and then another. They are all trying to get out of paying for it!!! Thanks again. I really appreciate it. I printed your email out and will show it to my husband and find out if there is anything else I can do to get medicare to pay! Paula

Paula make sure when you go there you ask about Family Care which is part of the medicaid program they do not tell you about this you have to ask www familycareillinois com/

As long as your income is like you say it is, you should qualify for medicaid card. And this would be such a big help to you in many ways. Also, You CAN do this, it may not happen tomorrow but it CAN do not lose hope, do not fret. I was approved almost 2 years ago now through insurance only to have them stop taking my insurance, and now I am just starting the process all over again myself. I am 5'2" and over 300lbs with four children. I know it is quite frustrating, and upsetting, but you can do this Just continue to vent where needed, and each no or failure pick up again, it is all we can do. Blessings, Katie PS I am going to an informational meeting at newhopesurgical tomorrow. My road begins again, so I know all about picking up and trying again HUGS!!!!!!!!!!!!!!! Katie

Everyone has given you some good advice. I wish you luck. Dont give up! Joy 391/376/150

Everyone has given you some good advice. I wish you luck. Dont give up! Joy 391/376/150

Hi Paula, I wish that I could be of more assistance to you, however, what I and so many others here can do is offer you lots of support. It does look like you got some great leads and I hope they pan out for you! Hopefully everything will work out for you soon! Take care! huggzzz, Cathy

Thank you all for your words of encouragement and advice. I will take every piece of advice and do what I can to follow through with it. You are all so sweet and I am so glad that I decided to post the message. Even if all the advice leads nowhere, I know I have people who understand how I feel. I don't even have that in my husband. Again thank you all and God bless!! Paula Fullerton