Frustrated, cant stop crying

Hello. I'm new to the forum. Not new to being "morbidly obese". Here's a bit about me/my story, tho I know each of you has your own, and I know/hope with time I'll get to know you. I have put on 150 lbs. in the past 2 years. I was close to normal weight (normal to me) now I'm 350 lbs. and I continue to gain. I've tried everything - with my dr. help...meds, programs (OA, WW, FP4H, etc) nothing works, nothing helps curb my voracious appetite. I am in pain all the time. My knees, my legs, my feet, my hips, my lower back. I am 34 years old, and I have arthritis. My doctor is not the best. He's the "herd 'em up, head 'em out" type. He wont get me checked for ANYTHING. I went into his office today in tears, begging for his advocacy, and I had to ask him to repeat the bloodwork he did a year ago that was borderline diabetes. That's the best I could get out of him today. I have been in his office a number of times complaining about the pain in my legs and my knees, my lower back, and he wont get me checked for any kind of joint problems or anything. There are days when I can hardly get out of bed I'm in so much pain, and I'm on a high dose of methadone, so you know it's gotta be bad. I have heartburn ALL the time. Sleep Apnea? Probably. He WONT get me checked for any of these things. Imean, you would think your dr. would want to help you, right? I have headaches all the time. I don't know. I don't know if it's just me, or if he's really a quack. Imean, do I need a new doctor? I feel like I have some of these "comorbidity" issues that insurance companies talk about. I want the lap band surgery. I have OHP plus. I fit the criteria, as far as I know, especially if my doctor finds some "comorbidity" issues going on, but why doesn't he want to help me? He saw my tears today and didn't seem to care at all. Do I need to find a new doctor? Or just give up on this? Is it really a dead end? Will OHP cover anyone? Do you like...have to be on your death bed for them to cover you? Or do you just need a good doctor who will advocate for you? I'm new to all this, I don't know how the paper trails work, but I do need to do something. I have 2 small children, I'm a single mom back in school full time. I can barely chase after them. (I also struggle with depression and chronic anxiety, and I see a counselor regarding my issues with weight) I just don't know what to do or what my next step should be. I left that appointment feeling like I will never be able to have this surgery. I don't know...any words of encouragement? What should I do next? Will getting a new dr. help? Or am I already in a losing battle with OHP? Resources? Anything? Thank you so much for taking the time to read this. I know you all are probably on similar boats.

Thanks,
Jessica

Oh boy! Take a DEEP breath! hold, and let it out. First there are a lot of things you need to do. YES, YOU NEED A NEW DR! Don't put up with any crap anymore! You need to be seen. The amount of weight you have gained in 2 years needs to be addressed.

You need a lot of tests run to see if there is anything going on that is causing this, if you can't get your current dr to take a serious look at this, then yes, change your Dr. Start researching your options. Is there a particular reason you want lap band? You don't mention how tall you are so I'm not sure what your current BMI is. Lap band may not be your best bet. Have you checked into the VSG which is another restrictive only surgery? have you looked into the RNY or DS? both are malabsorptive as well as restrictive.

You need to find out what OHP will cover and what it won't cover. Can you call them and find out? A good Dr. who will advocate for you is always a plus, but you also have to be a good advocate for YOURSELF! That means do your homework. Talk to your insurance find out what they cover willingly (I say willingly because if you are doing research and find something works for you more than what they say they cover you can fight them for what you want!). Find out their requirements. Research all the main 4 surgery types and learn them upside down and backwards! Find a new dr. who is not totally anti-weight loss surgery. Get your tests done and find out what you are dealing with healthwise and see if there is anything compounding your problems besides just "gaining weight". Some problems will have to be addressed, treated and under controll before you can have any weight loss surgery.

Check out each of the weight loss forums here on OH and get as much info as you possibly can. Talk with your therapist. Is your depression and anxiety so high that it could cause problems?

Lots to do, but it's doable. Just start at the beginning and keep at it.

Good luck Jessica!

Thanks..ya I'm 5'7" so I think that puts me at a BMI > 50. So that is extremely high, I know. I am going to get a new dr. as soon as possible. I did call OHP and asked them if they cover weight loss surgery, and they said, (and I quote) "If it is something that your doctor and you decide is the best option". So I just said, ok, I'll talk to my dr. and left it at that. But when I talked to my doctor, he was really "himhaw" about it, he just said, "Well, they say that, but it is very difficult to get them to cover it. You have to have "comorbidity" issues. And I asked him, "Ok like, what kind of comorbidity issues?" and he said, "Well, like Diabetes, joint problems, etc." and I said..."DUH, I've told you over and over how much pain I'm in, I can barely flippin walk anymore AND last time we did blood work a year ago it was borderling Diabetes, so, wouldn't you say I have some of these "comorbidity" issues?" But he just kind of shrugged it off. He doesn't want to check me out for anything. He was like, "Do you want to try the Fastin again?" I'm like, "NO, IT DIDN'T WORK AND I HATE THE WAY IT MADE ME FEEL!" (Not to mention the fact that it's very expensive) He just wanted to write me a script and get me out of his office. He didn't even really want to talk to me about it. He had no empathy at all, I'm sitting there in his office in one of those really heartfelt crying episodes where you lose your breath and bleed catharsis everywhere. I want a female doctor. But how does one know what your new doctor's going to be like? Is there a "rate your doctor" website like there's a "rate your professor" website? There should be.
 So should I call OHP back and ask them for specifics? I mean they kind of gave me a vague answer that was totally contradictory to what my doctor told me. I try to avoid dr's. dxing me as "depressed" because they just want to medicate me, and the meds make me suicidal. I have PTSD which is a pretty serious anxiety disorder. So I do have psychological issues, which are also considered "comorbid", arent they? Anyway, I do have a lot of health problems associated with my weight. My weight problem is central to my whole life. It literally negatively effects EVERY area of my life. I can't think of anything but losing this weight, you'd think I would be more motivated to just do it "the old fashioned way", but I just can't seem to get into that frame of mind. I don't want to be one of those people that they have to come cut me out of my house because I won't fit through the doorways. I HATE THIS SOOO MUCH!!!
Anyway, thanks for the advice. I will do more research and try to hang in there. I cannot give up. This is definately the battle of a lifetime.
Jess

My suggestion:

A) Call OHP find out exactly what their requirements are, having them send or fax it to you in writing. Also find out exactly WHICH WLS types they will cover willingly you might also find out if they have a list of Dr.s and WLS programs that accept their insurance. You might also ask if they would cover the psych. evaluation that you may have to take for the program or if you will have to pay out of pocket or it. It's been a while since I've delt with OHP and don't remember what all they cover.

B) Start calling around for another Dr. when you do ask them a few questions right off the bat.

          1. Does this Dr. deal with many patients who have had WLS?
          2. I AM going to have WLS  and I would like to know how PROACTIVE they are
          3. Does this Dr. work with any particular WLS surgeon he would recommend? (this is kind of                 sneaky way to find out if they actually deal with many WLS patients as well)
         4. How soon would this Dr. be able to schedule me for tests for A,b,c Etc.

This way they kind of have an idea that you are meaning business. They may not be able to answer all of you questions but you DR. darn well should be able to as soon as you meet with them. They should also know what tests you need to have immediately. I had (a mammogram, an echocardiogram,and a sleep study) I also met with two dieticians, and had my diabetes controlled with eating and metformin before surgery depending on your cir****tances and how high your Ha1c is you may need to have several appointments.

C) Find out if OHP will pay for you to meet with a dietician. If for nothing else to make sure your diabetes (if you do have it and are diagnosed with it) is being worked on as soon as possible.

D) Find a free informational WLS seminar in your area and go to it. You will probably have to pre-register for it so start looking now. This will also start giving you more information about some of your local options.

E) talk to your therapist, find out what they think of the idea of you going through the surgery and what pro/con's they can see with your mental health and what recommendations they would make for you.

Those would be the first things I can think of right now. The biggest thing is just getting the ball rolling. Once it starts moving, hopefully everything will fall into place for you!

Katie

Katie is giving you a lot of good advice. But, let me chime in and verify that you need a new doctor.

A year ago I went to my PCP and (once again) asked for help taking off my 300+ lbs that I had for the past 10 years. All he suggested was all the stuff that I had already tried and failed (WW, Nutrosystem, etc.) I was mad!!

Then, a co-worker said he was getting RNY surgery and our company insurance covered it. I went to our insurance website and verified that it was covered. I called the insurance and they told me there was only one weight loss clinic in my state that they covered. I went to them. (FYI, they are a Bariatric Center for Excellence - something I'd look for in a WLS clinic.)

I let the clinic take care of all the paper work, insurance forms, etc. I started working with them in July and had surgery in October. WLS clinics are the professionals and they know what the insurance companies require. A PCP is rarely equiped to handle the boondogle approval process for weight loss surgery.

Although I'm not currently in Oregon (moving there shortly), my WLS doctor said that OHSU is an excellent facility. He suggested I go there if I run into problems while living in the Portland area. However, I just found out that my insurance only covers Legacy Good Samaritan Hospital and Medical Center (and they are a Bariatric Center for Excellence).

Finally, be sure to research all your options. Although my doctor does lap band, RNY, DS, and VGS he went over the pros and cons with me and recommended RNY for me. There's really no single solution for everyone. But, make sure you make an informed decision.

thank you guys so much for the advice. I actually have already found a new dr. I did do my research and found a female doctor who seems to have a great reputation, although I didn't think to ask about her experience with WLS. I have an appt. to see her in a couple of weeks. I guess we'll see what happens. Next step to do I think Is call OHP and have them send me some info. I will definately ask those questions you suggested.

I really appreciate your help in giving me some advice to get me started in the right direction. I know I need to have this done, but I havn't got an extra 20 g's layin' around, ya know? I mean, who does, really? I know a lot of people who have had this done that aren't rich or anything. So how did they do it? Probably just the same as many of you have, I guess.

Are there any success stories out there with people who have gotten OHP to pay for their surgery? How did you go about it?

Thanks all, so much
Jess

According to the website, OHP plus will pay for bariatric surgery if you meet the qualifications. I did find a pdf for your DR to fill out and submit to OHP

www.odscompanies.com/pdfs/ohp_bariatricsurgeryeval.pdf

But yeah, find out what "hoops" you have to jump through. i.e. 6 month supervised diet, co-morbidities, Psych eval Etc.

Best of luck!

Good that you have found another physician.  Most will refer you to the 'local' program for bariatric surgery.  Once there, you will have contact with the surgeon.

OHP will not be able to give you any specifics.  It will depend on the information provided by the pcp and the surgeon.  However, most surgeons will be able to tell you whether you meet the criteria.

Hang in there.  At the least, your pcp can prescribe an antidepressant to help you feel better in the short term.

best of luck.

thank you guys so much for your info. Ya, I saw that PDF. I'll bring it with me to my dr. appt. I didn't think OHP would want to give out specifics.  My last dr. made it seem like they're not going to cover me, so don't even try. He told me a story about someone who sued them and they were covered, but outside of forcing them to cover me, they wont. But, I'm feeling a bit more confident now after talking to you guys.

One more question...do you know if OHP -or any insurance for that matter - covers the dr. visits with the surgeons? Probably not, huh, 'cause they have to be on the "approved list". Well, I will just talk with my dr. about all of this. If I have to pay for a couple of appt. out of pocket I will.

So the "local program" for bariatric surgery...is that like one of those seminars that I always hear advertised? Is that the best way to make free contact with a surgeon? From there would I have a chance to consult him for free? (beside the cost of attending the seminar) Or am I pretty much going to have to pay out of pocket to see the surgeon?

Thanks!
Jess

I am not familiar with Eugene, but I know there is at least one program that is a 'center of excellence"  That means they have completed a certain number of successful surgeries with good results.  The seminars are generally free, they can help you understand the options for surgery.  they often have an insurance person who can tell you the likelihood of approval by OHP.  Normally, your pcp will need to refer you to the surgeon/program to begin the process.  Usually, the surgeon/program with get initial approval to start the pre-op testing, with the final approval for surgery pending.