a couple questions if you don't mind.

Hello all! If you don't mind, I have a couple questions to ask. (This might turn into a novel ) I just moved to a new county and with that comes changing my medicaid. I moved into a "managed care" county from a straight medicaid county. This means that I have to change my doctor as well, because my former doctor doesn't take the managed care policy. (Are you as confused as I am?) After calling around to doctors I found one that would take me, based on the fact that I was a former patient. And they recommended Mercy Health Care as their preferred policy. I called Mercy the second I got off the phone with them and asked the really nice older gentleman if they covered gastric bypass/bariatric surgery. He assured me that they did, if it was medically necessary. Question number one...is Mercy easy to deal with? Do they approve quickly...or are they pains in the rear? Now here's the deal. I'm 26 years old. Have been obese all of my life. Except for that brief period between birth and about a year. I now weigh 504 pounds. I've had diabetes testing done recently, a echo done on my heart, and several other tests that come back saying that I have no medical problems. I do have hip pain, and am on meds for that. I also have problems sleeping, I have to sleep upright, otherwise my back hurts and I can't breathe. I can't walk very far....standing up is an issue. Forget about shopping....I can't even do that without sitting down at least once. ..more often than not I just sit in the car or stay home. During my pregnancy my legs became swollen. My OB didn't think that was abnormal, and said that it would go away after I gave birth. My son is now 18 months old, and the swelling hasn't gone down. It's worse. It doesn't go down at night, or when I put my legs up....My legs, feet and ankles are at least twice, if not 3 times the size they should be. My doctors know about this, that's why I've had all the testing done. So far the only thing they can come up with is because I'm fat. Because I don't have diabetes, or heart problems, or any of that, do you think I would have a chance? My last two doctors have approached me asking if I had thought about this surgery. I also don't have any documented history of diets...am I wasting my time? Also, one more question. I have to make an appointment with my new doctor for early next month. What should I take with me to tell her how serious I am about getting this surgery done? If you made it this far...Thank you so much! Amanda

Amanda, Welcome to the Missouri board!! I don't know anything at all about Mercy insurance but, maybe someone does. If your last 2 doctors have mentioned having WLS then ask them NOW to write you letters. Ask them to explain why they think you need the surgery, and how they feel it will benefit you. Also, your sleeping upright and hip/joint pain are co-morbities. Don't forget that depression is also considered a co-morbity. You shouldn't have any problems proving the medical need for WLS. As for your diet history try having all of your doctors write letters that state your struggles with your weight and any diet attempts. You don't have to have insurance approval to call and have packets sent to you. There are several great doctors that do this surgery and, if I we're you I'd send off for at least 3 packets. Read everything over and take them to your appointment with you. If you do internet research about this surgery and have access to a printer...print some of the stuff off and take that to your appt as well. Let your new doctor know that you're serious and you have researched and know the risks and how your life will change following WLS. Good luck and let us know how things progress for you! Kelli

I dont know where this thread started but I had mercy a couple years ago when I had my surgery.. it was a fight all the way and the doctors office didn't help at all. I had to rebut it all the way.. the two things that they wanted to deny me on was the doctor supervised diet and the structured excerise attempts.. lucky I had the means to rebut it and still had to file a grievance with the insurance company to get them to reconsider.. get copies of all the medical records and test you can and send a copy to the insurance company with the request for reconsideration and if they say you have so long to respond don't let the time go by before sending a response.. it will keep it alive until you can get everything together and if you have to file a grievance with the insurance company through the state insurance board, or what ever it is called.. they can help you or should be able to help you.. insurances are out to save their money so be prepared for a fight.. good luck and let us know how things are going..

Here is a link that will provide you with a wealth of WLS information! http://www.obesityhelp.com/morbidobesity/profile.phtml?N=L1018634293

hIJACK ::: Sorry, kelly i just want to tell you you look wonderful ...

Thanks Sherry...and you look pretty snazzy yourself! I just wish my hair would come back. I'm not shedding anymore but, I don't like it so thin.

Amanda, Welcome to the board~! There are alot of wonderfull people on here with a wealth of info. As for the present.. I would say you need to ask your Dr to check you for fluid retention. I have the same problem in that if I don't take my dieuretic I swell, can't breath laying down, and am just miserable. You may also want to have him/her check your thyroid. I always am asked why the water pill, is it my heart, etc? I swell due to the thyroid disorder (Hypo). My Endocronologists sais this is one of the problems with a Hypo patient. I also agree that you should consider WLS. It is a huge step in making your life better for you, your son, congrats by the way on having a baby, better late than never to say congrats~!. And for everyone that is in your life. Start by checking with your INS co to see if they cover it, contact your Dr to get letters written and have them in a file. Also check with your PCP about Thyroid bloodwork and see if your levels are ok. Do everything in your power to make the Dr's work for you. You will have to allot of work, but my surgery is June 01, so the work is all worth it~!. I won't go on about how long it took me because I was extremely lucky time wise and every inurance is differnt to some degree. So again welcome and please please please ask all of the questions you want, or if you need a shoulder to cry on this is the place to do it. All of us here are going through or have gone through what your going through so ask ask ask.. Lots of luck in your journey and I hope this finds you well~!. Gevin Elder (Soon to be a loser~!) Hope you speak typo, LOL

Amanda, I agree with everything everyone has said so far. Document, document, document. Start now writing down every diet you have been on, supervised or unsupervised. I would think that your weight alone would get you approved for insurance. I started out at 430 about 6 years ago. I was retaining fluid and was diagnosed with congestive heart disease. The cardiologist said if I didn't lose weight, I'd be dead in 5 years. I was approved for WLS and then chickened out. I went on Atkins instead and lost 100 lbs. Everyone was happy and my heart was working fine. However, I slowly started gaining it back. When I had gained back 50 lbs, I realized I was headed to the same place again. So, then I decided to investigate the surgery again. The hospital that was where I was to go for my HMO no longer did the surgery and so I started on a trek to find one that would do it and would take my insurance. (Insurance is United Healthcare, not mercy). I finally found the right hospital, surgeon and had surgery on 9/27/04. I've lost 115 lbs and weigh 266 now. This is about halfway to my goal in 7 1/2 months. I know the next 115 will be harder than the first because I'm able to eat more now. But, the tool is still in place and I am determined to get there even if it takes me several years. I had no complications with my surgery but I know many people do have complications. Read everything you can. Realize that this is major surgery and all the complications of any major surgery apply. Anytime you go under anesthesia it is a big deal. There can be breathing, heart, lung problems just with that. Add to that the complications of bowel knicks, bowel obstructions and other bowel problems and well, you just have to be sure. I got to the point, though, where I could not do anything much at all. I'd send my son to the grocery store or take my daughter, give her a list and have her get what we needed. I just couldn't take the walking. I'd go to the smaller store and spend more money rather than going to a larger discount store and doing all the walking. Now, I can go to the discount store and even park away from the building. I don't have to have my husband drop me off at the door at church. I even went clothes shopping with my daughter for the first time in years. It made her so happy that I would do that with her. Something so simple that many moms and daughters do but I couldn't tolerate it before. I know after this surgery, I'm never going back to the old fat lifestyle. I'm 51 so I may not do a tummy tuck or any of the cosmetic surgeries, but just feeling better and being able to do things with my family is reward enough. I'm even contemplating a trip to Six Flags. Talk about gutsy, that would be a real breakthrough for me. Later. Teresa

I can't help with the insurance, but I wanted to tell you that not being able to sleep at night is a serious problem. Sounds like you have sleep apnea, and you really need to get tested for that (a lot of times, you have to be tested before surgery anyway). As for the swelling, has anyone ever considered that it could be lymphedema? I didn't know anything about that disease until I saw the MTV special...but they said that people over 500lbs tend to get that, and it's very hard to handle. Check out Amy Williams's profile...she has all kinds of information, and you can email her directly. It is also something serious that needs to be checked out. Good luck! Pamela -102

Thank you all so much for reading my novella. And for the wonderful answers. Someone asked me about thyroid problems...I was tested for a whole slew of problems about 2 or 3 months ago, thyroid included. Everything came back in the normal range. I need to get my family's medical history written down. Mom has congestive heart failure and many other breathing related problems, My dad has diabetes, degenerative disk disease, high blood pressure, high cholesterol....I really could go on. Thank you all for answering my questions and making me feel welcome. I'm glad that this board is here. No one else seems to know what I'm going through. Amanda