All who pray, please pray for me.

Have you considered going outside the US for surgery? It's really pretty common for DSers to travel quite a ways for surgery, and prices are SO much better. There's only ONE vetted DS surgeon in Mexico, Dr. Ungson, but I think his price for the DS is about 16K, everything included.

There's a list of vetted DS surgeons at www.dsfacts.com that you should check out. And even if you choose to stay in the US, I personally would re-think Dr. Wilson...

 I have acid reflux too, Have been taking Prilosec for years-  It was one of my comorbidities, along with documented hip arthritis, causng pain w/every step limiting all exercise, and swelling limbs w/pitting edema especially with plane flights- causing vein issues taking 2 weeks to resolve leg pain post flights. Now I have knee arthritis. My doc said all people after a certain age have arthritis. you are under the age for arthritis. The 12 month supervised weightloss program seems long, and discouraging !!! I did hear of a less expensive special offer for WLS- D.S., somewhere on line. Research all the WLS sites.

Try to think of anything unusual you may have to add to your comorbidity list. I think there are over 30. Your doctor or PCP can help you.

 Abe, I had gastric bypass surgery in November of 2005.

I felt like I had to jump through a bunch of idiotic, pointless, and time-wasting hoops. But, I did what I had to do all the while telling myself that it was a matter of when, not if, I'd get my surgery (Turns out gastric bypass was a bad choice for me, but that's another story. You're smart for choosing the DS). 

All in all, it took me about two years to get approval for my surgery. It was a lot of work, and it was hard to see others getting approval and going ahead with their surgeries, while I was still stuck jumping through stupid hoops. 

My insurance required a six-month doctor supervised diet. I had visits with my primary care doctor where I made sure that the visit was only to discuss a diet. Your medical records have to show that your visits were for the diet only. If you have to see your doctor for anything other than your diet, schedule a separate appointment for it.

I saw my doctor just once a month. I refused to go more often than that. I was weighed, we discussed my weight loss (A whopping two pound loss in six months!), and my efforts to exercise. I made sure notes on everything we discussed were written on my medical record for each visit. My insurance paid for the visits. I just had to pay my co-pay. 

I hated that diet rule. Like you, I knew more dieting was a waste of time and I was disgusted at the idea of having to do yet another freaking useless diet. But it's what I had to do to get approval, so I went through the motions and did what needed to be done. 


I had to see a psychiatrist to prove that I was sane enough to handle the demands of having weight loss surgery, so I found a therapist that dealt with weight issues. I had to visit him a few times, and take some silly personality test...which was actually very enlightening, so I'm glad I took it. I made sure there were records of each visit to prove that I was doing what my insurance wanted. I went through the motions and did what needed to be done. 

Then I had to have a few visits with a nutritionist. It was a stupid waste of time, in my opinion. She didn't tell me anything I didn't already know, and in fact she didn't seem to know much about how to keep your nutrition up after gastric bypass. I made sure records were kept, and I went through the motions and did what needed to be done. 

I then got copies of every visit to every professional I saw. I made copies of the copies in case I lost some of my records. I also contacted old doctors and got medical records going back ten years! My insurance wanted proof of obesity going back five years, but I wanted to present a strong case.  

I went through my records with a yellow highlighter and highlighted anything that I thought was relevant to prove my need to have weight loss surgery. Any mention of back pain, migraines, the arthritis in my hip, anything at all, no matter how trivial it might seem. I highlighted these things so that the insurance people deciding my case would see what I wanted them to see. It was overkill, I know, but it worked. 

In addition, I got three doctors to write letters stating that I needed weight loss surgery. Actually, with at least one of the doctors, I wrote the letter myself and he signed it. 

I did absolutely everything I could think of to win my case. I went way overboard. It took two years of hard, hard work. But I got approval on the first try, and my insurance paid 100%. I never saw a bill. 

I had Aetna at the time, and it was really good insurance. Now my insurance is United Health Care, and I'm not sure what it's going to take to get approval from them for my revision. But I do know that if I have to jump through some stupid, pointless hoops to get approval, then that's what I'll do. 

You may need to do the same, and that's okay. We have all had to deal with insurance and paperwork and stupid rules. Some here have had to work for years to get their surgeries. The important thing is to not rush off to some unknown, cut-rate surgeon because you want your surgery now and you don't want to pay much money. With weight loss surgery, remember, you get what you pay for. And since this is only the rest of your entire life we're talking about, it's better to wait and jump through the annoying insurance hoops and maybe pay a little more than you wanted to, and get your surgery with a good, experienced, skilled surgeon. 

I'm sorry if I come off as preachy. I don't mean to. I can tell you're frustrated and I can totally relate. The thing is, this is serious. You're going to have do things you don't want to do in order to improve, and most likely save, your life. It might take longer to get your surgery than you want to wait. So be it. It might cost more money than you want to pay. So be it. You'll have to do stupid things like long-ass stupid diets. So be it. This is your life were talking about. You do what you gotta do.

My motto in situations like this is to give myself twenty-four hours to scream and cry and feel sorry for myself, then buckle down and do what needs to be done to achieve my goals. My motto works...most of the time. Sometimes I need more than twenty-four hours to indulge in self pity. lol. But eventually I have to stop crying and just get to work. 

So the moral of the story is, do what you have to do, even if you hate it and know that it's a waste of time, energy, and money. Fight hard for what you know you need. Know that you're not alone; we've all dealt with frustrations trying to get our surgeries. And don't ever, ever, ever go with a cheap and inexperienced surgeon. It's just not worth it, and it just might destroy you. 

Good luck to you, 

Lynda

PS: What's your insurance? Oh, and sorry this is so long. I can't do short for some reason. 

PPS: I was 38 when I had my gastric bypass. Now I pushing 45 and I may be looking at another year before I can get my revision. You're smart to do this while you're still young. 

 
Hey there, Abe.  I'm a praying woman, and I believe in the power of prayer!  

!) Definitely try to appeal.  Most insurances only require six months of a supervised eating plan.  12 months with the co-morbidities you have is putting your health at risk.

2) Read the fine print about your required weight loss program.  Most don't require you to lose weight, but you want to be sure.  My doctor was a pre-surgery pro, and she used my 6 month time to re-educate me on how to eat well.  For example, the first month was learning to eat more protein for breakfast, which controls the appetite during the day; month two was to add protein to my lunch for the same reason, etc.  I reported what I ate, and she reported the counseling she gave me.  She also reported my weight for the month, and coded my visits as primarily weight loss / diet counseling, even if she did other stuff like give me a physical.  Easy peasy.

3) For your 6- month or 12-month program, whatever you do, stay inside 30 days and inside calendar months.  For example, Jan 31 and March 1 are 29 or 30 days apart, but if you were to skip February, they make you start counting over.  Try to get an appointment every calendar month around the same date (it doesn't have to be exact).

4) I have some links in my signature for people who are doing research on the duodenal switch.  Check them out!

5) Budget-wise, do the math.  If 20% of your surgery with a local DS surgeon is going to be more expensive or relatively equal in cost than going out of the country or paying cash to another vetted surgeon, I'd say go with paying out of pocket.  You can go whenever you're ready that way.

6)  DO NOT pick a surgeon who is not on the vetted surgeon's list at DSFacts.com, under any cir****tances.  Just trust me on this one.

Hang in there!  Every insurance company is wacky and has their own issues.  You can totally get through this!

Agreeing with you in prayer for God's favor in this process.

Hi Abe,

My heart goes out to you.  I know the frustration and fear of wanting something and although it
seems that it can be within your reach, somehow is not.  I wanted surgery so bad, I would literally
cry about it because I was so tired of carrying 353 pounds around on this 5'3" frame
each day, not to mention enduring the hurtful comments that society makes towards obese people. 
That is just heartbreaking in and of itself, let alone the medical problems that it brings.  I wanted the lapband so bad, I could taste it, and when i was told I'd have to wait 6 months, I was beside myself
with self-pity.  But in those 6 months  I found the DS, which changed my life forever. 

I'd hang around the boards and get so much inspiration from others who went down this road
before me, from not knowing if I'd get approved to the fear of the actual surgery itself, but it all
worked out and it will work out for you too.

God knew what was best for me and it definately wasn't the lapband.  Watching
that lapband commercial (that I'd seen a million times before but never paid it any attention)
started me on my journey and led me to this wonderful surgery.  Not only did I cry about
it, but I dreamed about it. There are very few things in life that i wanted more than this. 

Please hang in there and know that God does hear prayers and He will make sure all things will
work together for your benefit.  I agree with larra that you should appeal the 12 month waiting
period as well.  I'd like to also add that you become best friends with your PCP because this
doctor's notes will help your case more than you know.  I was very fortunate to have a wonderful
doctor who was my ally in the fight against obesity and wanted me to succeed. Make sure you
have one; if you don't have one, get one.

I will definately be keeping you in my prayers so don't give up!  It will happen for you, just
keep the faith!

Berta

Thank you all for your advice and prayers.  I'm yet fighting and will not give up until this is done!