Is there anything I can do NOW?

I was very interested in the WLS about 3 years ago but my Doc was anti WLS. I went on Atkins and lost a bit of weight (again) but as always put it back on. We lost our health insurance shortly thereafter so surgery was not an option. Now after almost 2 full years without insurance (hence no doctor appts or anything) our new insurance will kick in in April (its Anthem BC/BS.) I want this surgery! I can not go thru another 100# loss just to gain it back as soon as I eat a single carb. My BMI is 40.3 and although I don't have any real comorbidities like HBP or Diabetes I hurt all the time. You see I am small framed my wrists are as small as my 12 year old neices! My legs and back hurt constantly and at least once every cpl of months I strain my lower back and can not move for days at a time. I also have horrendous heel spurs some days Its all I can do to walk! I lost my job a few months ago as a restaurant manager simply because I was in pain so often I couldn't do the job I needed to do. I think they just thought I had gotten lazy!!! I am on the verge of being a shut in! It is so embarassing to have to do walmart in a wheelchair because my feet, legs and back hurt so bad.My husband has a great job and is very supportive. We have discussed doing atkins again (no other diet works for me in the least) but I just feel like I am getting back on the hamster wheel and I will never really get anywhere with it! Since we don't have insurance yet, is there anything I can do now to get a head start on the approval? Any advice will be greatly appreciated! Thank you all so much!

Kimberly, First of all, don't give up! My pcp was exactly like yours, she refused to accept that I wanted wls, and was very anti-wls. I asked her five years ago if she would accept this option for me and she refused immediately. Well, again I dieted and lost and gained and developed even more pain each time I gained. I have an eleven year history with this doctor of weight loss and gain, and again she refused me this option. At the end of my rope, I approached her last May with wls, and agian she refused to agree with this option. I simply told her that if I keep up this way that I would certainly die at a younger age, and that I respected her opinion but I want to live and if she wouldn't agree to wls that I would be forced to find a new pcp. She realized that I was very passionate about wls and she agreed to support me 100%. I had my wls surgery on Oct 11, 2005. By the way, when my pcp said that she would support me 100%-- she didn't. She tried her best to stale me throughout this process. Her letter to my insurance was ridiculous, she tried to say that I didn't try to lose weight once, but my records showed otherwise and I'm happy that insurance saw through that. I also have Anthem, my policy is blue hmo federal. I had absolutely no problems with them covering wls. Within 6 months from start to finish I was approved and in surgery. How long were you at your old pcp? And do you have on record at your pcp the ups and downs of your weight? I tried on several attempts to get my pcp to offer me somekind of diet to help me, but she would just say- exercise! Honestly, I walked all the time and would occasionly do aerobics. I did weigh****chers, slim fast, walk away the pounds, richard simmons, you name the diet and I tried it. I would lose 40 and gain 50 time after time and this was all on record at my pcp by my weight lose and weight gain not because my pcp put on record that I was dieting. So don't give up! Needless to say I am in the process of finding a new pcp because of the way she has treated me throughout this process. I kinda feel like my pcp has been the one that has held me back all along. I did all the work on my own without her support.

Are you cover by any insurance now?? The problem that you might run into with BCBS (or any other insurance for that matter) is what they term Preexisting conditions. If you aren't covered by any insurance when you start with them, they will make you wait 1 year before they will let you apply for WLS. If you apply for it before then, they will say that your weight problems are pre-existing. If you are covered by another policy, or even Medicaid and it covers you till your BCBS policy begins, then you can avoid this. This is the same problem I encountered with BCBS.

I bypassed my pcp. First of all I didn't need her approval and second she was dead set against the WLS. I do have to have my heart doctor's approval and a stress test. He has already approved it as long as the stress test is ok. I also have anthem BC/BS. You might check into the preexisting thing. My WLS told me BC/BS was one of the easiest insurances to work with.

I am currently NOT covered by any insurance. However I also don't have any real medical history of trying to lsoe wright. My old Doc just always brushed it off when Id start in about weight loss. One time he perscribed me some astronomically expensive "fat absorber" that about killed me with the pain due to IBS. I worry that this will be harder for me for several reasons. The lack of comorbidities as well as the lack of documented weight loss programs. I can not go back to my old PCP for several reasons, we left him right before we lost our insurance due to incompetence. He misdiagnosed an injury my hubby had and prescribed him meds he was allergic to. Arent most folks that are morbidly obese subject to the preexisting condition thing? Ive been fat for year!

I didn't make the rules--I just know what BCBS told me when I started under thier coverage. They told me I would have to wait 1 year from my coverage date before I could submit for approval. I was also told that after I submitted for approval, that they would most likely ask me to do a doctor supervised diet since I didn't have any documented weight loss attempts. Is there any way you are eligible for state coverage like Medicaid. If you are covered by it when you start thier coverage with no lapse in coverage, you would have no problem. This is what I was told my the director of HR at the company my husband worked for...She called the provider and spent hours on the phone to try to get them to bend the policy for me (lucky for me she is my Sister In Law--but it didn't help)...You may want to call BCBS or HR at your husbands employer and find out for sure, as I know that many of the BCBS carriers changed thier guidelines at the first of the year.

I have BCBS of SC and it is been a real pain in the butt!!!!! I have been at this since June 04 and have received the last denial from them and now we have to go to the state insurance board. I ran into the pre-existing clause cause I did not have insurance for 1 full yr prior to being enrolled into the plan so they would not cover anything till that period was up. They had me go through all the hoops and approved the surgery as long as it was done before 1/1/05 because at that time they put it as an exclusion to the policy...WELL....get this .... I went through all of the crap that they required me to just to have them approve me BUT to inform me that it was UNFORTUNATE for me that they would not pay for it cause my pre-existing condition clause was not up till 1/1/05 and at that time it would be an exclusion. So make sure that you do not have the pre-existing clause like the others had said and then make sure that it is not an exclusion to the policy. That is begining to be the popular thing for these insurance companies so that they do not have to cover it. If you only have the pre-existing thing then you could use the time to get a head start on the documented diet. Good luck to you! I did not mean to run on or try to discourage you, whatever you do ...do not give up. Shelia

It is disheartening when the PCP (esp a fellow female) does not appear to be supportive My Dr. simply told me to call OSU and that was that. Prior to that when I told her I needed HELP losing weight she handed me a diet sheet ... lol. I don't think she would prevent the process ... but it sure would help if she made me feel like she supported this!!! I think it is just her personality. She is much younger and obviously has never had weight problems. My weight continually increases each time I see her. I think a man may be more supportive? Oh well ... I am proceeding with or without her. Can you get a new PCP and have your records transferred? Best of luck to you and do not give up. Susan

In addition to what the others have said...the company I work for has 3 different policies we could choose from. 1 excludes the surgery, 1 only approves Barix in Mich. and 1 (which is the one I have) covers some doctors but not Barix. So you need to check your policy when it kicks in. Also I didn't have any documented weight loss attemps either. I just wrote down what I had tried and how much gained or loss. Just don't give up.

I always have to chuckle over the "documented" weight loss. DUH ... look at me ... lol. I may have some problems there because the DRs are all dead, or the places I lost weight through are out of business. I wonder how long weigh****chers and other places are required to keep records? I think i threw out my many cards from WW years ago. Anyone have any ideas as to what is "acceptable" documentation for weight loss attempts? I lost the most weight with the aid of speed, thyroid meds, and diruetics (sp) 25 years ago!!!!!!! through a DR that was very old then. I can't even remember his name. I did the optifast liquid crap in 1989 ... went to Nutrisystems (back when you had to have that lousy vitamin shot). Gosh I have no idea on amounts lost ... all I know is I have a BMI of 42.5 and I hurt all over (walk with cane) and am miserable.