Good Morning

Well I went to see my Doctor here in Sierra Vista and he said that by the end of May he will submit all the paper work for this surgery but I have to loose 5% of my body weight. That is 15 pounds. I know it does not seem like alot after years of dieting but that just really chaps my lips if you know what I mean. So maybe in June or July I will get my surgery date. Thank you to all who have welcomed me and written. It feels so nice to know that I am not alone. I am going to do a little work on my pond because it is just a beautiful day.

Hi Jessica, I have a real quick question. Who wants you to lose 5% of your body weight before they submit paper work for the surgery? And what are some of the qualifications that you were given in order for Mercy care to pay for the surgery? I got a list from my surgeon and it did not include losing any weight before the surgery.I was just curious. Thanks. Tanya

Hello, I think I already emailed you but just in case I messed up. My insurance company(Mercy Care) requires that you must loose 5% of your total body weight before they will even look at your paperwork. Dr. Fangs office gave me this long list of requirements from Mercy Care that you have to take care of before they will submit your paperwork for auth. I also called the insurance company because I could not believe they would do this and they said "YES"

I also had sleep apnea. I had to sleep in the living room because my snoring was LOUD! When I went to visit family members I had to try to stay awake and like I was asleep so I wouldn't wake them up, be the talk during breakfast, or made fun of. We both would be dead if it wasn't for this surgery. I'm giving to much away. I need to be booked in 60 Minutes, or Dateline or any talk show.(ha ha ha)

Just an "FYI"...sometimes the pre surgery weight loss is required by the anesthesiologist and passed on down as orders through your surgeon or Bariatric coordinator. The anestheisologist review your file with co morbids and BMI and for some they insist on a pre-surgery weight loss. Losing weight right before surgery removes a layer around the vital organs which gives you a better chance of surviving the surgery. Too much insulation (fat) can inhibit ventilation....and air is needed for survival. .... Most recommendations have very little to do with insurances and more about YOUR safety and health. A good surgeon will do all he/she can to keep from adding a "negative percentage" to their stats! aka: Fatality! Hang in there! Joyce

Actually, i can totally relate...have you read my profile? i really haven't seen my surgeon since feb 2005 , my pcp takes care of me. But i can't blame my surgeon fully for what happened, but just think he should have had me checked for sleep apnea knowing i had a lot of problems already. If he had done this, it would have been smooth sailing for me. But had i not had my surgery, i would be dead already, i'm sure of that. Anyway, i'm glad you're here to tell the story. Hugs Linda

All I can say is WOW! Every time I talk to someone there is diff criteria that we have to meet for this surgery. I now have AP/IPA through AHCCCS. There criteria is so out there I think they want you to be almost dead before they even consider you for the surgery. I was going to change to mercy care during open enrollment, but I dont know what to do now. It sounds like Mercy care is as bad as AP/IPA. When my surgeon sent me the criteria that they got from mercy care, the ins lady at my surgeons office said it was just updated by Mercy care. The list was a third of what AP/IPA's list was. Now that I am speaking to different people about Mercy care I am begining to wonder about switching. Any suggestions would be appreciated. The ins companies work like the goverment. The rules are whatever suits them at the time. Please dont take this as I dont believe what you are saying. I am just even more confused.... I hope that I am not the only one that is feeling hopeless and helpless on my wls journey. Thanks for the reponses. Hope all is well with everyone. So any suggestions please post them or e mail me. Thank you all.

I have heard both good and bad about the two different insurance plans. All I can tell you is try and wait and we both will keep in contact and see how things are going. Do you have all your paperwork in and are you waiting for the insurance to approve you? I am just waiting for May to come around and then I will see what happens. Everything but the 6 month consecutive supervised weight and the 5% weight loss is done. After that my PCP will submit everything. Oh I did hear from a friend who works in his office that another person with your insurance is trying to get approved since October and has not. She has even gotten a denial letter and appealed. But then I go to this website and see all the approvals from both plans from other patients and get excited so I do not know.

Hi Jessica, I am kind of in a pickle. I started doing my 6 month Dr. supervised diet in Jan. June will be my 6th month. But open enrollment is in July. If I go ahead and have my pcp submit in June, then I might miss the open enrollment period, because it might take a long time to get notice from AP/IPA. Then I will have to waite till next July. I just do not know what to do. I already talked to a caseworker from AP/IPA and she told me that there is no way I even qualify right now. I am atleast 24 months away from even qualifying.Then there is the question of finding a good supportive Dr. that will deal with the wls and the referrals. So I just do not know what to do. It has already taken me over 2 years to get my pcp now to get the referrals going, and it is still not going real good with that either. I just do not know if people really know how to do their jobs or they just don't want to. But it is like that with everything. So everyone that has posted in regards tothis I appreciate it and yes we will keep in touch. I just need to make a decision on what road I am going to take with the ins deal.I know that mercy Care has a lot less criteria to meet. And I also know that there are very few approvals through AP/IPA, so I will have to ponder this for a while. I also do not know that if the 6 months I put in while I have AP/IPA will count with Mercy care. It should because it is an attempt, and it is by a board certified M.D. So any knowledge on this or input would be appreciated. Thanks Jessica. We will keep in touch. Tanya

Hello, well I wish I could give you more advise but I have no clue about AP/IPA. I hear that it is very difficult to get aprroval from Mercy Care also. I wish I had a magic wand. All we can do is wait and then submit all the paper work and see. Now make sure you let me know if you get approved and I will do the same. I hear the surgery is around 20-25 thousand dollars. I looked into fiancing myself and the payments would be around 300.00 a month. So if all else fails I might have to do that. I do not work but hey who would hire me this fat anyway. (sorry) All we can do is pray, pray, pray. Keep in touch Jessie