Help a Newbie?!?!?

I've been reading a few posts and I bet this one will be a little unusual, just because everyone else seems to be so on top of their medical issues. I'm 37, male and have a BMI over 50. I used to be a weight lifter (all state power lifter), got strung out on drugs and quit working out (cocaine - big mistake), stopped doing drugs 10 years ago (praise God) and replaced them with carbs (oops), gained 150 pounds (bummer) and now I can barely get off the freakin' couch, fit in the car and where I once bench pressed 400 pounds, now my back hurts taking out the trash! I have NEVER been insured since childhood, NEVER been diagnosed with any weight related issues, and in fact have NEVER even seen a doctor since I was 16. I've tried a few diet plans without supervision and failed miserably. I have NO medical file whatsoever, because I have never been to a doctor as an adult. I want to have my GBS by Christmas 2004, just five months away. I deserve it and so do my wife and kids. I know NOTHING except that it will allow me to eventually go outside my apartment without feeling ashamed, and will likely take care of the constant knee, feet and back pain I have so that I can be more active with my three beautiful kids. I need the most-likely-to-approve insurer and the easiest-to-deal-with-doctor in the Tampa Bay area and any advice you may feel moved to offer. Remember, I've had no contact with the medical community to start building up a record. Also, does insurance commonly cover the post WLS plastic surgery as well??? Thanks! Dana [email protected]

Dana, First - Welcome to the wonderful world of OH. Everyone on here trys to help if possible. Since you have no doctor the first thing you need is a PCP. They can give you a physical and blood work that would start you with your medical records. There are many good doctors around. Do you have insurance? If you do call and ask if they cover WLS. If they say 'No', ask if there is an exclusion clause to your policy. Some do, it is for "Medically Necessary". That means if you can get a doctor to say you must have the WLS you'll probably get it. The Journey is not a short one if you have not had any diet history. Most insurances ask for 6 months doctor documented. If you do not have insurance you would need to self pay. I am not sure what has to be done to get started on that. I would still think the first step is find a Doctor. I hope this helps at least get you started. As I first said question asked here usally can be answered and everyone here are very helpful. Congratulations on your decision to take another step in a better life. You have been clean for 10 years, if you can do that, you can do anything. God Bless you and your family. IMP gail

Thanks Gail! Nope, no insurance yet -- wondering which one to pick, i.e. who is easiest and cheapest. Don't even know the difference between an HMO and a PPO actually. I read a post about a month ago in the insurance section in which someone mentioned that they just went to the doctor with their own diet log, the doctor documented it and they were approved within a week. Anyone with a similiar short jouney please give me some guidance, and thank you again, Gail. Dana

Dana, Welcome to the board! I found almost all my information for this site, it has been a blessing in my journey for WLS. When I started I also had no insurance and was looking into purchaseing a policy for just me that would cover the surgery. Looking into buying insurance was a treasure hunt in itself. It seemed that everyone had some clause that had something to do with pre-exsisting conditions. Basically, I would have to keep the insurance anywhere from 6mths to 2yrs, before they would cover anything I had prior to get a policy with them. I didn't want to wait that long! I didn't know if I could afford to keep a policy current that long either. The I found OH and found out that medicaid would cover the surgery (not sure if that's an option)! So thats where I began my journey at the Medicaid office. I am only 24yrs. old, but also had not seen a PCP at all since I was 16yrs. old. I seen an OB when I gave birth to my children, but that was it for me. Anyhow to make a long story short. I typed up my OWN diet history and my OWN letter of medical necessity (doc. signed), found a PCP, a surgeon who took Medicaid and a few months later I am sitting here with an APPROVAL and surgery date for July 21st. Just keep your head up, leave what happens in Gods hands! Good Luck in your journey to be healthier! ~love and prayers~ MICHELLE

Michelle, Thanks for your response. That's a good tip typing up your own diet history and letter. I'm in Tampa, how close is your surgeon to me and if he/she could do all appointments and surgery as a single cost? See, I technically have medicaid right now, but with this weird $1,800 minimum deductible. If I have a medical expense that is $1,801, Medicaid will cover 100%, but anything less than $1,801 is out of my pocket. That means that the surgery itself would likely be covered, but all the appointments leading up to that point and the after care would not be. I can't afford that. We're looking at an Aetna PPO that would run about $60 a week, but would cover 100% if approved. Obviously we'd like something even cheaper! Thanks, Michelle and God bless you and your surgery and the surgeon doing it. Dana

Dana, Perhaps with the Medicaid - share of cost thing, you can have most if not all of your testing done in the same month. If that happens and if exceeds your share of cost you will have no out of pocket expense. The surgeon I am useing is Dr. Cox he is in Ft. Lauderdale, FL. He is the only surgeon currently accepting Medicaid-share of cost in FL. There is an out of pocket expense for the Psych. of $250 and the nutritionist of $50 bucks. God Bless! ~love and prayers~ MICHELLE

Hey Michelle, now THAT'S what I'm talking about! See, I know there's a way to make this happen quick like. Can you give me Dr. Cox's number? Dana

Dana, Hey there! The number for Dr. Cox is (954) 928-0066. Let Carey know (he'll answer the phone), about your situation and he'll most likely help you set everything up. Good Luck! ~love and prayers~ MICHELLE.

Thanks, Michelle! You're the best!

Dana, with no insurance, trying to pick up insurance on the spur of the moment, and get bypass surgery dosen't seem likely. And any insurance i**** and miss as far as approval. Most insurances require anywhere from 6 month to 12 month supervised diet. This late in the game, if you want to have surgery by the end of the year you may want to consider self pay, if that's an option. If there is anything I can do please feel free to email me with questions. Good luck.