Hello! New Here!

Just wanted to introduce myself. My name is Shawn, I am a 35 yr old mother to six (yes, I said 6). I jusr recently started considering WLS, but have known about it for some time. I never really thought my weight would get to the point it is, and then when it did, I was in denial for some time. My BMI is 44.3 now. It is hard when I can't do things with my younger kids that I used to be able to somewhat do with my older kids. I was overweight as a teen and as I entered my 20's, but with each child it got worse and with each diet I tried I would gain back more than I lost. My last attempt I thought was going pretty good, I lost 41 pounds, but then in a matter of one month it was all back on. I have various medical conditions now and everytime I see a doctor for something I hear the famous "you know if you lost weight...." or "you should really try to lose some weight". The latest comment was from a knee surgeon saying "until you show an honest attempt at a significant weight loss, don't come back". I had just lost 40 pounds too. So with my history and family history I can see now that WLS may very well be my only solution at this point to achieve a healthier lifestyle so I can be around for my kids and my family. I have called my primary insurance already (BlueCard PPO - Premer out of Washington), and they have an exlusion for the surgery. "Treatment of obesity, including surgery and it's complications, services and supplies connected with weight loss or weight control. This exclusion applies even if you also have an illness or injury which might be helped by weight loss." I was shocked that even if it is medically necessary they won't cover it. However I do have Medicare and then Medicaid too. The thing I don't know and would like to find out is will Medicare pay for the surgery if the primary insurance states that it is not a covered benefit? I am pretty sure that Medicare covers 80% from what I found out on the phone, but they couldn't tell me about how it works if the primary won't cover the services. Can anyone help me with this question? Thanks! Shawn

Shawn - I can't help you with your insurance questions, but I just wanted to say HI and Welcome to the Michigan board. I too have SIX childre, with the oldest one graduating this year and my youngest being 9 years old. Your story sounds all too familiar!!!! I hope you get some insurance answers quickly!!! Hugs, Laurie

Hi Laurie! Thanks for the welcome. My oldest SHOULD graduate next year, but that remains to be seen, and my youngest is two. He has so much energy and it is virtually impossible to keep up with him. Especially with my knee problems on top of the weight issues. I tore my right ACL a little over a year ago, then had a tendon transplan to fix it in June of last year. Then in December I tore my left ACL, MCL, lateral meniscus and damaged the cartilage behind my kneecap. I still need the surgery on that knee. I meet with a different surgeon this Tuesday about my knee, the one that did my right knee. Not the jerk that was so rude to me with the weight comments (I will never go back to him again, well, maybe when I am 150 pounds lol). I am confident with the surgeon that did my other knee. I initially couldn't go to him because of insurance, but we had yet another insurance change and now I can go back to him... woohoo!!! Now I just hope I can get insurance and surgeon stuff to work out for WLS and then I am all set. Well, I am good at rambling as you can tell, so I will shut up now.. thanks again for the welcome! Hugs back, Shawn 289

Well Shawn let me encourage you with my little story. Last May I weighed 262 at 5'5" I was told I would soon have to be in a wheelchair because of constant problems with my feet/knees. I had surgery and I've lost 136 pounds. Went from a size 24W to a size 4!!!! I have had NO problems with my feet or knees in a year now. I can walk, ride bike, do anything my kids want to do. I don't have to sit on the sidelines anymore. I am really enjoying life now!!!! It will happen for you to!! Just keep working on the insurance (that's a stressful fight I know) and this time next year, you will just be amazed at the transfermation. Hugs, Laurie

Hello Shawn, I am relatively new, too... Don't fret about your Insurance. It seems that things always have a way of working themselves out. In the mean time... I am speaking from experience when I tell you that the OH Michigan Group is an awesome group. Welcome aboard! Brandee Surgery Date: June 26