Newbie looking for some answers if possible

I'm to be at a consultation Jan. 11 in NC with a Dr. Heniford, I'm from SC though, I live in Gaffney.... What I'm wondering is if my insurance bc/bs ppo is gonna require the supervised dr. weight loss when I'm gonna try to have the WLS with 2 other surgeries..... In other words I had a reflux operation back in June, 2005 but it failed (broke stitches so back to square 1) and I have to have that redone and also a hernia fixed that came in my incesion ..... the doctor that did the operation said I was so complicated to work on that he is sending me to someone else that he feels can do those operations and he was gonna also recommend the wls to go with it since I'm 4' 10" and weight 220 ....... he said my stomach was just too heavy to hold stitches alone without having the wls..... my question is..... How hard is this gonna be to get approved ??? I've not been checked for sleep apena but my hubby says I snore so loud he can hear me all over the house.... the reflux is so bad I vomit in my sleep and it runs into my lungs making me wake up coughing it out...... but with the bottom of my stomach like it is (full of gastric abrasions) I don't know what else I can do for approval ..... so help is very needed here........

YOUR CASE IS FAR TOO COMPLICATED FOR ANY OF US TO GIVE YOU ADVISE AS TO WHAT YOUR INSURANCE WILL DO, MS STEPHANIE ... YOUR BEST BET WOULD SEEM TO BE TO GET A COPY OF THEIR CRITERIA & FOLLOW IT TO THE LETTER ... YOU & YOUR DOCTORS WILL HAVE TO BE VERY PRO-ACTIVE. HAVE EACH OF YOUR DOCTORS WRITE LETTERS OF MEDICAL NECESSITY STATING THE EXTREME SEVERITY OF YOUR CO-MORBS ... A SLEEP STUDY WOULDN'T HURT AS THAT IS A MAJOR CO-MORB. IF YOUR PARTICULAR BC/BS POLICY REQUIRES THE DOCTOR-SUPERVISED WEIGHT LOSS PROGRAM, I'D ASK MY DIFFERENT PHYSICIANS TO WRITE A STATEMENT IN THEIR LETTER OF MEDICAL NECESSITY THAT DELAYING THE NECESSARY 3 SURGERIES (INCLUDING WLS) WOULD PLACE YOUR HEALTH/LIFE IN DANGER ... OR, WHATEVER THEY FEEL WOULD ADD SOME MEDICAL PUNCH TO YOUR CASE & ASK THE INSURANCE FOR A WAIVER OF THOSE REQUIREMENTS FOR THE SAFETY OF THE PATIENT. AS FOR THE REFLUX AT NIGHT ... MY MOM NOW SLEEPS ON ONE OF THOSE SLANTED FOAM PILLOWS & DOES AMAZINGLY BETTER. IT'S LIKE A BIG SQUARE BLOCK OF FOAM CUT IN HALF AT A SLANT & YOU GET 1/2 OF IT, IF YOU CAN VISUALIZE IT. USUALLY, IF FLUIDS ARE COMING UP, IT'S WORSENED IF YOU LAY FLAT OR SLIGHTLY RAISED. WITH THIS SLANT PILLOW, YOU'RE AT A LARGE INCLINE. HOPES IT HELPS. GOD BLESS YOU DAWN & NICK

Thank you so much for responding... I have one of those raisers.... and plus 2 pillows on top of that....... nothing helps me at night I suffer so badly..... we're so scared I'm gonna drown from the stuff going into my lungs...... As for the insurance I didn't think of all of that.... You have been so much of a great help !!!!! Thanks bunches Stephie

I FIGURED THAT IF YOU WERE IN THAT BAD A CONDITION, THAT YOU HAD ONE, BUT ... JUST IN CASE, I WANTED TO OFFER THE INFORMATION. TWO OTHER THINGS ... CONSIDERING THE SEVERITY OF YOUR CASE & BEING SO PHYSICALLY FRAGILE, YOU MAY NOT EVEN BE PHYSICALLY ABLE TO PERFORM EXERCISES IF YOUR INSURANCE REQUIRES IT. I WILL MAKE AN ASSUMPTION HERE & SAY THAT I WOULDN'T THINK AN INSURANCE COMPANY CAN REQUIRE YOU TO DO SOMETHING THAT HAS THE POTENTIAL TO HARM YOU ... TAKING INTO CONSIDERATION YOU CONDITION. NOW, THAT KIND OF AUGUEMENT WOULD BE UP TO YOUR PHYSICIANS TO STATE IN THE APPROPRIATE MEDICAL TERMS. THE OTHER THING IS THAT IT WOULD BENEFIT YOU IF YOU WROTE UP TWO DOCUMENTS YOURSELF. YOU KNOW YOUR BODY THE BEST & YOU EXPERIENCE THE BURDENS THAT YOUR CO-MORBS CAUSE ... LIKE YOU POSTED TO ME THAT YOU ARE AFRAID THAT YOU WILL DROWN DUE TO THE SEVERITY OF YOUR REFLUX. I WROTE A LONG DOCUMENT & NOTED EVERY PHYSICAL CONDITION & CO-MORB FROM THE PAIN IN MY SHOULDERS FROM MY BRA STRAPS TO NOT BEING ABLE TO WALK WITHOUT EXCRUIATING PAIN. THE SECOND DOCUMENT WAS A DETAILED REPORT OF HOW ALL THESE MEDICAL CONDITIONS IMPACTED MY LIFESTYLE. LIVING IN CONSTANT FEAR OF DYING WOULD BE A POWERFUL STATEMENT FOR YOU TO MAKE. I RELAYED HOW I COULDN'T EVEN TIE MY OWN SHOES OR GET OFF THE COUCH WITHOUT HELP FROM MY HUSBAND ... HOW THE WEIGHT & PAIN NEGATIVELY IMPACTED OUR SEX LIFE ... HOW MUCH PAIN MEDICATION I WAS TAKING ... HOW I COULDN'T PLAY WITH THE GRANDCHILDREN ANY MORE DUE TO PAIN & THE INABILIBY TO MOVE EASILY. I MEAN YOU TELL THEM EVERYTHING. REMEMBER, YOU'RE WORKING WITH HUMAN BEINGS & EVEN THE MOST STOIC HAVE A HEART. &, IT WILL SUPPORT ANYTHING YOUR PHYSICIANS PLACE IN THEIR MEDICAL REPORTS/LETTERS WHILE SHOWING THAT YOU ARE PROACTIVE & AWARE OF THE ISSUES OF OBESITY. IT'S A LOT OF WORK & SOMETIMES EMBARRASSING, BUT I KNOW IT HELPED MY CASE. I POSTED A LONG LIST OF CO-MORBS THE OTHER DAY ... DID YOU READ THEM? SORRY, I DON'T REMEMBER. GOD BLESS, MS STEPHIE DAWN & NICK

Thank you Ms. Dawn I read the list and was surprised that I had well way over half of them...... I seen the surgeon today and he agrees I need WLS... I have to have a upper gi done.... endoscopy..... couple of meetings with him and his support team...... see a phsc.. and dietician..... he thinks my insurance will have no problem approving since the reflux surgery I just had in June failed..... so I'm looking so much forward to being on the losing side.... He said with the bypass there will be no acid *WOOT* I can't wait till I can really lay down and sleep .... something I've not been able to do in 10 years or more..... no wonder my lower back kills me from having to sleep sitting up basically ..... You and the others on the board have been so much help to me in the month that I've been lurking...... I've read tons of profiles and I've done research on the pros and cons of the RNY and the one pro I like is I can LIVE to be older than my parents..... not that far from my mom's age when she died......

I KNOW, MS STEPHANIE ... THAT CO-MORB LIST SURPRISES A LOT OF PEOPLE. WE'RE ALL SO USED TO HAVING MEDICAL CONDITIONS & LIFESTYLE LIMITATIONS, THAT WE DON'T EVEN THINK ABOUT HOW MANY WE HAVE. GOOD, GOOD, GOOD ... SO GLAD YOUR SURGEON IS GOING THROUGH WITH ALL YOUR TESTING. YOU JUST WON'T BELIEVE HOW FAST & HOW MUCH YOUR HEALTH WILL IMPROVE AFTER WLS. IT'S DOWNRIGHT MIRACULOUS. DECADES OF MEDICAL CONDITIONS JUST DISAPPEAR. I WAS BLOWN AWAY WITH THIS ASPECT OF THE PROCESS. KEEP PRESSING FORWARD! GOD BLESS DAWN & NICK