Any advice on how to get approved?

I am in Lancaster/Berks county areas of Pa. I am on Gateway Medicare assured and Access. I am 5'4" and 240ish pounds. I talked to my family doctor and he was like I hate to say this but your not heavy enough. I have high blood preasure, sleep apnea and slight asthma. He says since they are all controlled with meds and c-pap that they are most likely not going to pay. I have to wait until July to go to the weightloss seminar at Reading hospital. I was just wondering if there is anyone here who has had surgery under similar cir****tances? I would love to hear from anyone who has been throught the Reading hospital WLS center as well.

I would go and see Doctor Alan Brader at Lancaster General... because you are a 100 pounds over weight... and meds will only do so mu*****ontroling those issues...

BUt, I would get a letter from your asthma doctor, the people treating you for sleep apnea, and see a interist doc to treat your high blood pressure (since it seems your family doc doesn't support this idea)... if you also have large boobs and have back problems a letter from a chircopactor will help too... because smaller boobs also mean it will make breathing easier (my asthma doc even put that in his letter for me)...

My chiroprator and asthma doc are going to write letters for me when it comes time for recontrution surgery... my boobs never got smaller... so now I'm a 38G and have back issues since I lost my big butt lol...

But, brader is awesome... he was going to be my doctor until he switched to Lancaster General from Barix... he is very straight forward and he might even have some more ideas for ya... good luck...

I was also going to suggest seeing another dr.  Your BMI is over 40, so you would qualify even if you didn't have any comorbidities.   If you have the surgery, chances are very high that you will no longer need the meds, thus saving you and your insurance company even more money.  AND MORE IMPORTANTLY giving you a better quality of life and health!

you've been given great advice so far...if you follow their advice the next step is to make sure you have very good records. records that show your health issues, your weight, any documented weight loss attempts. even if you have this you will probably still need a supervised diet, but with this stuff it will help your case later on.

I echo the suggestion to getting over to Dr. Brader.  He is a former Barix doc, and there are many here who are his "Babies."  He is an expert on WLS, and can advise you on exactly what you need to do to get approval. 

Also, get the medical documentation on your comorbidities, and how your weight impacts them. 

Keep returning here to let us know how you are making out.  We are here for you.

Hugs,
Trish

Sorry I am little late on catching up on the posts but I totally relate to your concerns. I too am 5'4" and at my heaviest weight 240ish and my primary told me for years to lose the weight the old fashion way but could not do it long term. I looked into the WLS for about 2 years and met with Dr Brader for my intial consult and he totally agreed that since I was overweight by almost 100lbs all my life this surgery was right for me. Now the insurance company did not feel that I was heavy enough and made me jump thru the hoop which put on another 15lbs making me 255lbs at consult!! Holy Cow! but I was able to get approval and I did not have any other co-morbidities other than my blood pressure spiked because of the weight gain. Good Luck on whatever decision you make but Dr Brader is a good guy and would definately help you answer any questions or concerns you may have. Take Care:)

Thanks for all the support and advice. I did attend Dr. Braders seminar unfortunately the Lancaster General is not a center for excellence and will not take medicare insurance. So I can't go to him. I must go to Reading hospital for the insurance to pay. My twin sister is going through Dr. Braders office because she is on medicaid only and they do take that. I will attend Reading seminar in July and keep up with my family doctor. He says he will do what he can but, he doesn't believe the insurance will pay. He is not against me getting the surgery as I first thought he was. He just made the same stupid coment all skinny doctors make. There is no reason why you shouldn't be able to lose the weight the old fashion way. If that were true I wouldn't be in his office asking for help to get WLS. Why can't people understand. I am not fat becuase I am lazy or a glutton. I am always trying to lose weight.. I am glad to find freinds on this forum that understand. I will keep in touch and let you all know how it is going.
Thank,
Sharon