Here's to HOPE

Hello all,

I am new to OH, having stumbled upon it early this week while researching doctors in my area. I've found lots of helpful information here. Today, I took the first step! After reading great things about him in his reviews, I had a consult with Dr. Joseph Cribbins. I've decided that I'd like to have gastric bypass. I feel that is the best choice for me. His staff were all fantastic. Everyone was so understanding and kind, especially Tonya. She made me feel as if I were a real person, she seemed so genuinely happy for me and this prospect of surgery and life change. I am very much looking forward to continuing on towards getting a surgery date.

Here is my aggravation: INSURANCE. First though, let me say how very-very-very thankful I am that I do indeed have insurance, as I've been obese much of my adult life, and since I was a single mom on Medicaid until March 2006 when I married my lovely husband, bariatric surgery was never an option. Having said that, we have Aetna HMO, which requires three months of seeing a nutritionist, learning behavior modification, etc. Aside from the fact that I am in need of this surgery just from a weight standpoint, a really big reason we are persuing it at this moment in time is because I am suffering from three torn discs in my back. Since it's that many discs, spinal fusion surgery isn't a good option, as it doesn't work too well from what I understand. The pain I have from my back problems is intense. I am on medication therapy at the moment. Both the spinal surgeon I saw twice and the pain management doctor I saw numerous times reccommended that I have this surgery and that the weight loss can give me significant pain relief. My question is, have any of you ever personally experienced or ever known anyone where Aetna bypassed the three month waiting period due to a medically necessary situation? I am at my wit's end with dealing with my back pain and to know I could get this surgery and get the ball rolling on that, it's frustrating to have to wait to begin.

Any advice would be much appreciated! Thanks :)

Valerie, unfortunately I'm not aware of any instance where an insurance company will bypass the requirements of getting WLS.  Their requirements are there to be sure the patient is ready for such a lifestyle change and fully understands what they will need to do to be healthy and successful.

I know you are ready now but seriously 3 months isn't a very long time, it's goes by quickly.  Some insurance companies require 6-12 months of a supervised diet and any missed appts, etc. require you to start over.  Your insurance seems pretty easy if it approves WLS as a covered benefit.  Consider yourself fortunate.....I was a self pay and would of gladly gone through whatever necessary to have my insurance pay for surgery.  I was out $25,000 to be healthy, and would do it again if necessary.

Hi Valerie and Welcome to the TMB !!!!

I also have Aetna HMO ( Had Aetna PPO at time of surgery though).....I would imagine every case it totally different.    I would call the insurance co directly and ask them that question.    They are usually pretty upfront and honest with the answers.    3 months really pass quicker than you think....some have to do 6 months and some 12 months so 3 isn't really very much time.    You have other things that you will have to do....physc evaluation and other stuff so trust me.....3 months pass very quickly if they tell you "NO".     Also for my surgery the approved me in less than 1 day.    Hang in there and don't get discouraged.   You do know that if you get RNY you wont be able to take any NSAIDS don't you????   Just want you to know that.    Good luck and I will keep you in my prayers that everything will go the way you need it to go.   Please keep us updated!!!!


Hugs and blessings ~~~ Vivian

Thank you both for your replies!

Cajungirl, don't get me wrong, I'm not complaining by any means, and I do consider myself extremely lucky! :)  I tried to stress my thankfulness for the insurance,  three month wait or not.
I am just so very weary of living my life with chronic pain. Some days I can't walk from the bed to the bathroom without stopping. Obviously though, some days are worse than others.

Vivian, I did not know that about the NSAIDS. He didn't mention it. I do plan to keep researching both surgery types though, and I have an open mind about it:) I just want to feel better!

Valerie....check into the VSG ( gastric sleeve ) is a awesome surgery with about the same weight loss results as the RNY.   Not totally sure if it is covered by insurance yet though.    If Aetna covers DS alot of surgeons will file the sleeve under DS cause it is the first stage in a DS.    Go to the surgery page on Obesity help and research the surgerys and then check with the insurance co. or the surgeon and decide then if it is a option for you.    It is just that RNY patients can't take NSAIDS.     Bummer sometimes....but still I wouldn't take back my RNY for nothing !!!!!   Good luck and keep us posted on your findings and what you decide.

Hugs and blessings ~~~ Vivian

Viv,

I think the more accurate thing to say is that SOME doctors NEVER allow the use of NSAIDs for patients who have the RNY.

Some doctors do allow the use of NSAIDS after a particular period of time and will even allow them in moderation prior to that outset date.

Medicine is an art and protocal and/or recommendation differ from surgeon to surgeon. 

I'm glad to hear that your house clean up is in process and that the insurance company is covering the charges.  It sounds like we both have a lot of the same going on right now.  My daughter is graduating from High School on June 4th, her prom in this weekend, she has Choir banquet (and asked me to go as her date ...woohhhhoooo) the following weekend, and I have too many family members coming in town for graduation!  YIKES! 

Congratulations on all of your son's accomplishments (and yours too) and good luck!

Thanks Vanessa.    Congrats to your daughter too.    Hopefully these loud fans to dry the sheetrock will be out on saturday....or that is what they are guessing.    And you are right.   Some do let you use NSAIDS just not on a constant use basis.     And like everything else....we know all surgeon's requirements are NOT created equal !!!   LOL   You have fun at your daughters choir banquet.    My son graduates May 31st.    He is wanted to major in Vocal Performance in college.   He has a awesome voice and I am prejudiced but eveyone who hears him sing agrees with me on that.   I have had lots say he should try out for American Idol.
Have a great weekend !!!

Hugs and blessings ~~~ Vivian

Wow! My daughter IS majoring in musical/vocal performance!  She's going to a local college for now and is planning to attend Loyola University in 2011 and graduate from there.

Maybe they could get together and record a duet! ?! ?!  

Have you heard of PCA / Power Chord Academy?  I can't remember where I got the recommendation for it but I got a recent notice about the session(s) being help at University of Texas, Dallas this summer.  If you're interested and you can't find it on google, let me know and I can email the brochure and/or web site to you.  They get to study, write, perform live, and even record a CD!  :-) 

WOW that is too cool.   Caleb is going to be going to University of Texas at Arlington.   He is NOT ready to go way off to college.   LOL   That is OK.....Momma doesn't really want him to leave either.    No I have not heard of PCA.   I will ask him if he has heard of it.   He is in Theatre in addition to choir and there school musical was nominated for 7 Betty Buckley awards so tonight they are going to be performing part of the musical at Casa Manina in Fort Worth.    That would be cool for them to get together and record a duet!!!!   I will mention it to him.  Good luck to your daughter.

Hugs and blessings ~~~ Vivian

If the duet doesn't work, maybe an arranged marriage would?  I'm not crazy about her current boyfriend! :-(

She's been in theatre (several musical leads), dance, and vocal performance (Chorus and special talent shows) her entire life.

She IS a song.  She doesn't live music; she is music!

The parallels are almost spooky!  LOL

:-)