PEBB Open Enrollment Quandry

I'll be going to intro meetings at both OHSU and Legacy in the next 2 weeks. I was bummed last night when I discovered that my current insurance (PEBB - Regence BCBS) doesn't cover DS. I did a bunch of reading over the weekend, and like the sound of the DS.  Of course I need input from my surgeon as to waht is best in my case - once I have a surgeon - LOL! I feel like I'm putting the cart before the horse, but right now PEBB is having Open Enrollment. I see that Providence does cover DS. I can't change again until next year. Does anyone have any input for me? I'm reluctant to change and then lose other coverage that Providence doesn't have. I'm NOT considering Kaiser. Patty age 54, BMI 66, co-morbidities: sleep apnea (have c-pap), HBP (treated), HBC (treated)

Hi Patty - I have Regence BCBS also.  I really liked the sound of the DS, and I would have had it done if the insurance covered it.  However, in talking with my surgeon (Robert O'Rourke at OHSU), I figured that RNY was the "gold standard" surgery, it was probably the better choice for me, and the insurance company knew that they were doing my limiting us to RNY or the band.  I have to admit that the sound of being able to eat fairly normally and still lose weight was very appealing, but I guess there can be some rather nasty bathroom side effects.   (Actually, I have enough constipation now to consider it a side effect!). Linda

I hope you can have the DS and come visit on the DS forum- they can aswer your questions on ins. probably too.I had DS in Mar. at OHSU and I LOVE MY DS!!! I am able to eat or drink anything- pop , bubbles are ok too . As for bathoom issues I have none never have- I have one normal BM in am and never diaherrea etc. we have many posts in past trying to get the description of bathroom issues changed as it is incorrectly listed. It is RARELY a side effect...but most folks are told by most RNY surgeons it's a real threat. We are tryiing to get the description of possible side effects to read correctly- right now when you read that description it makes it sound like you will have diaherrea issues after surgery. Oh well- we'll see if Dr. Herron changes it. I talked to Dr. today and mentioned the furor over that description...he laughed and said it is a real shame that people actually think DSr's have nasty bathroom problems.

Yes, I'm a little ticked that I was told DS harbored horrendous bathroom issues, only to end up with an RNY and constant constipation! However, getting that $33,000 bill with the "patient owes" line of $0.00 was GREAT!  You have to do what you're comfortable with financially, and I certainly couldn't pay out of pocket for the DS.  Oh well, so there are a few things I can't eat.  I can live with that. Linda

Dr. O'Rourke was at the OHSU orientation session tonight. 

I was interested to hear his evaluation of the pros and cons of the 2 procedures. 

How do you decide on which Doc does the surgery? My ideal scenario would be if 

all 3 of them - say Drs. X, Y and Z all agree that Dr. Z is best suited to handle my 

case. But I don't suspect that's how it works in the real world. 

It also sounded like Dr. O'Rourke didn't recommend the DS for older, sicker 

patients. I am older, no denying that. But sicker? I dunno. I take quite a few meds

 - for depression, BP control and cholesterol. I have been on a C-PAP for about 

11-12 years. I'm in a lot of pain from my feet and ankles (arthritis aggravated by 

the weight) and use a cane, but I can swim a half mile in about 35-40 minutes.

So I guess we'll see. It does sound like I'll do much better if I lose as much 

weight as I can  before the surgery. Whatever I have, I'd really prefer Lap to Open. 

I'm going to get the  paperwork in order and start the wheels moving.

It sounds like I'll be comparing policies this weekend. I need to figure out if 

switching to Providence to keep all my options open will work with the other 

types of problems my family has ... 

Well, no wonder they call it a journey!

Dr. O'Rourke was very biased at my info seminar too.  In fact, he was trying to encourage us to consider RNY, which I will not consider in any way, shape, or form.  Plus, he used Al Rocker (the weatherman on "Today") and "Randy Jackson" (I don't even know who he is!) as examples of weight re-gains with RNY.  He also tried to dissuade us from considering DS, focusing much more on the negatives and complications and not focusing on the positives at all.  One of the things he said about DS was that "many DS surgeons are now turning away from DS", which is not true at all.   He also admitted to being 30# overweight!  Is that a good example to WLS patients?  I don't think so! Because of his negativism, I felt totally and completely bummed and dissuaded from having WLS for a while until I had my intial appointment with my new PCP.  I mailed my WLS application the same day and had the initial contact with the clinic 5 days later. However, when I had my initial appointment with the NP at OHSU, I told her that I want to be considered for the DS.  She put it on my record and made no attempt to steer me away from the DS.  She also mentioned that Dr. Deveney is the only surgeon at OHSU who does the DS.  He prefers to do the surgery lap but will do it open only when necessary.  Plus, she mentioned that my hospital stay (without complications) will be 2 or 3 nites with lap and about one week with open.  I may be older than 50, but my age is no barrier to having the DS. If a patient is considering RNY, the NP may assign a surgeon.  However, the patient would be free to choose his/her surgeon. When I had my appointment with the dietician in the same clinic immediately following mine with the NP, she discussed the diet and vitamin requirements specific to DS, which is a bit different from the RNY.  She also recommended that I go on a 1,200-calorie diet to lose at least 20# before my surgery. Not sure that I would consider enrolling at Providence, because Providence usually requires that their members utilize their own doctors and hospitals.  Plus, I am not sure that Providence does any WLS either.  I also live within a walking distance from one of Providence's hospitals, but my WLS will be done at OHSU. I have already met some of our OH members in the Portland and Eugene areas and plan on going to more of them in the future.  Watch this board for further info. Best of luck on your journey!

Vicki - I've met two of the three surgeons at OHSU.  Both of them are overweight.  Hey -- they're human, and they are both in high-stress jobs.  As we know, stress can be a major factor in obesity.  I haven't met Dr. Wolfe.  His picture looks as though he's skinny, but then again, so does Dr. O'Rourke's.  I was also given the 1200 calorie diet to lose my pre-op weight.  It works pretty well. Linda

Thanks so much to everyone for the input. I'd sure like to keep the DS as an option, but I don't want to be locked in to using less-qualified surgeons. The reason that I chose Regence-BCBS to begin with was that flexibility. ARGH!!! Lots to think about.

I had intended for the comment about Dr. O'Rourke's weight to be rhetoric.  I did not intend for anybody to comment on that.  I will not mention his weight from now on. Stress and a mostly sedentary life were the major reasons that I put on so much weight over my adult life.  I would be the happiest person on the face of this planet when some of my major stressors are gone. It's possible that I may participate in some of OHSU's WLS research programs, since I am local to OHSU.  If so, I may get a chance to meet Dr. Wolfe, the principal researcher.  I have not made the initial call yet.

I ditto all the comments from going to hear O'Rourke's spiel to getting whatever WLS you can to save your life.  I really hate the fact that some surgeons are biased against surgeries they don't or can't perform....O'Rourke wasn't the only one I heard speak! When my husband spoke up and asked very pointed questions about their comments he changed his "tune" a lot and said "these are only my opinions" and when I said my own physician had DS and was mentoring me toward it he REALLY changed the timbre of his discussion. Then people started to ask what is the DS? And he had to tell them all about it and some were quite angry he hadn't even offered it. He ended by saying we should meet when Dr. Deveny gave his lecture next - and I DID!