Help ! Questions about WLS & Insurance please

Hello Everyone. I Hope all is well. I had just a few things to say. First :I have been researching this site for months. I am one of those cases that have dieted over and over and over. I have taken pills and gained all the weight back and then some..I do suffer from depression, polycystic ovarian syndrome and now after looking at the sleep apnea sight, I believe I have that too.. SEVERLY. My driving is effected because I can not stay awake at any given time-which I have nearly wrecked many times - DUH - quit driving before I get myself killed and someone else too. I have my husband drive me to work and anywhere I go. I dont know how I manage to get my work done! I nod all day long. Well I have the typical hard to breath when walking, sciatic nerve pain in my back and legs and so on ....... Basically I am considered morbidly obese. My BMI is 43 or something like that. Well to shorten this story: my PCP recommended Atkins diet Oct 2003 and I went from 281 down to 245. I quit losing in March ( It just quit working ! ) and now I have packed on 15 pounds. My main concern is this. I have struggled for so long. It seems like I am doomed. I know if I go to my PCP she will have a sleep study done..but is sleep apnea enough to be deemed medically neccesary ? On top of depression, PCOS, a past of failed diets and rapid weight gain, sciatic nerve pain and whatever else is going on. Sometimes my blood pressure gets a little high.. I just dont want to go there thinking there might be hope just to have it blown away..I also have BCBS HMO and I havent found anyone in Jacksonville that has posted with this coverage. I do understand that they will quit covering WLS in Jan 2005 .. But this is today and the only speculation is that this surgery is deemed medically neccesary ( added with a long list of things to do ). I am willing to fight but only if I have some ground to stand on. To me this is not an easy way out.. I think it's much more challanging to make this decision. This is a change in your lifestyle. Permanant. And right now... seems like an option that I have been praying for. I thank you for reading my concerns. I appreciate any advice at all. Be blessed and be safe ! Sabrina

well... to me it sounds like it medically nessicary.. what you waiting for... get on the ball.... im not sure if my dr aceps BCBS hmo... but you can call and see... the office number is 954-659-5239 and the dr is dr. raul resenthal [email protected] ... he is in south florida... im not sure if travel is a thing for you or not... but i hope all goes well... be brave!!!

Sweetie, it definitely sounds medically necessary! I agree with prev post, look into it quickly since you know you are limited on time. I don't know if my surgeon takes your insurance but call him and find out. His name is Abbas Shariat 904-246-9464 and he is in Jax beaches. He is a wonderful man and will do everything he can for you. He just did my surgery on Tuesday and did a wonderful job. I wish you the best in everything and please don't hesitate if you need an ear or a shoulder, I am in Jax also. If you go to my profile, all my contact info is there. Take care sweetie and let any of us know if there anything we can do.

okay, I couldn't wait, sorry. I just called Dr. Shariat and they do take BCBS HMO front desk said you have to have a referral from your PCP first but they would be more than happy to talk to you about your options once they recieve the referral. Whether you use Dr Shariat or not, you will probably need a referral so check with your PCP to see if they have any problems getting that for you. Hope this helps at all, Susan

THANKS FOR ALL OF THE HELP !!!! !!!! I have an appt for Monday Morning with my PCP. Pray that she see it my way Bless all of you !

I had open RNY on March 16th. I went to Gainesville to Dr Eric Thoburn with the Center for Obesity. I would highly recommend him. I also have BCBS HMO and I got my approval within 2 weeks of all the paper work being turned in. Shirley in his office helps you get it all together. But please hurry. You have to have your approve in 2004.

Martha ~ I will check into Dr. Thoburn. Thanks ! Is he really ..caring ? I have been reading about beside manners and such. Also what kind of things did BCBS request ? I am glad that someone like Shirley is very helpful. So far I have been reading that insurance companies request all kinds of stuff : Sleep study:Psych test:Upper GI and so much more. But I am sure they will help me with this stuff. Thanks Again !