Questions about insurance with DSHS

Well, heres the run down of what I am going through. I have insurance through DSHS. I recently had to quit my job because of my knee problems. My knee cap dislocates, which has been going on since I was 9 and wasn't overweight. Recently it has been happening 3-4 times a week. I went to see an orthopedic surgeon and I need surgery on both knee but can not do it until I am down to at least 200 (currently at 380).He says I need to have gastric bypass because I can not exercise and need knee surgery as soon as possible. i am concerned that the state will not pay for the gastric bypass because I don't really have any qualifying co-morbids. My knee problems are not caused by the weight, they are being made worse and they are causing me to gain more weight. i am just not sure how the state works. I'm hoping someone can give me some insight. I have an appointment with my primary care provider on the 3rd to talk about all this. I am just trying to gather as much information as possible. I wonder if it will make it easier because I am not able to work and have been deemed disabled by the ortho surgeon.

Your BMI is over 40...that alone I would think would qualify you. Our insurance policy is you have to have a BMI 40 and up and you automatically qualify...or a BMI of 35-40 with comorbidities. Good luck to you.  I am not quit sure why the doctor would say you have to be at 180 pounds though before he would do the knee surgery. I know many who have had it  between 200-260 and had no problems. I would just think getting some of the weight off is what is going to help you. Best of luck to you. Brandy

With the state you have to be over a certain BMI and have a comoribid, from what I was told last year. The knee surgeon would like to see my right under 200. He said if I absolutely can not take it anymore he will do it at 250. The reason he is concerned about doing it now is because he doesn’t feel with the amount of work I need done it will hold up. They have to reposition my knee cap, remove bone to make the groove deeper, realign everything and tighten and loosen some tendons. Basically what he told me is with the amount of pressure I would be putting on them on a day to day basis could make them worse and once that happens there is no going back.

DEar Jenafer, I had both my knees replaced when I weighed close to 300 and my ortho  surgeron was wonderful......his name is Dr. Stephan Snow,,,,,he's in OLympia......on the westside ...my wls is scheduled for mon 3-3  and my knees are great i'm still 300 pds and I do water arobics and walk the treadmill twice a week.....the water arobics are on the westside  and it cost 48 dollats a month for m-w-f- 1 hour a lessons and its really a workout......think about that to get your knees moving.....good luck to you......Bev

What is a qualifying co-morbid?  Most accept sleep apnea, asthma, urinary incontance( cough, laughing kind), any back pain? there are lots of different co morbids.  Talk it over with your pcp and be very frank. Good luck!

Thanks for the advice.