Help a Newbie?!?!?

well.... first off i would like to say two things... welcome to the OH family.. and carbs are much better then coke... i am very proud of you in that area of your life.... but christmas might be a little soon.. i would say christmas of 2005 is more reallistic... i hope your journey is filled with only pleasure... alexa

Hey Alexa and Steve, thanks for your responses... Yes, I recognize I've got some high hopes, i.e. grabbing insurance on the fly and hoping for surgery this year. It's probably a symptom of the same compulsiveness that'll lead me to eat half a chocolate cake at 3 a.m... On the other hand, we went to Israel for a year on a similar wave of bright ideas and that turned out very well for us and some folks we were able to assist. Soooo, I'm gonna try. It seems to me that there's a lot of approvals these insurance companies are making -- it seems like this surgery is common place enough at this point that maybe just maybe, with a little hope and a lot of prayer, maybe I could actually find just the right doctor/insurance combination to pull it off in a hurry. If not, it's all good and I'll just wait a little longer, but it seems like a worthy goal. You guys are GREAT in this forum! What a fantastic site! Anyone have an Aetna PPO in or around Tampa? Dana

Dana, I saw that you mentioned Aetna PPO as an option. I work for Aetna and am also insured by Aetna. While Aetna does cover the surgery, you must have either a 6 month supervised diet and exercise program or a 3 month program with diet, exercise, and several other things. One thing to caution you about is that most PPO plans have pre-existing clauses for any diagnosed conditions so if that is the route you end up taking, don't get diagnosed with anything prior to your effective date of coverage. For example, maybe you think you have diabetes but have never been tested , if there is a pre-excisting clause , don;t be tested until after you are effective on the plan. Another thing to consider is that most HMO plans do not have a pre-existing clause. Good luck and God Bless. If you can get over a drug addiction, you can surely get thru this process! Terri

Hey there Terri, that's some REAL GOOD advice and something I thought I might be able to turn to my favor. I'm researching insurance now, to get an idea of who is the quickest and no-nonsense of the bunch, but until I get that insurance, I won't see a doctor at all for anything. My thought is that once I'm insured, I go in playing a little dumb, like I can't imagine why my feet are in constant pain and cracking, my knees creeking and hurting -- oh yeah, heart disease runs in my family, but that can't really effect ME, can it? I figure that some guy who's never seen a doctor, walking in at over 300 pounds with a long list of serious and never before diagnosed comorbidities and a two year personal log of serious dieting all failed -- well, it just seems like I've got a fair chance of having the doctor tell me I'm in grave danger and we better get you scheduled for a bypass right away. Whatchathink? Dana

You got it - alot of people are not aware of pre-existing clauses and the hoops in insurance so I try to help when I can. Sounds to me like you are going at this exactly right- no appointments, no blood or urine tests, no nothing until you are insured! You are very funny so I will be watching for your posts- sure as heck brightened my day! Me and the hubby are off to take the kids to see Spiderman- gotta fly. Terri

Hi Dana....and Welcome! I have Medicaid "share of cost". I started my journey for WLS Jan 19th and joined a weight loss program with the PCP's clinic, just in case, after not being to a doctor for years. I figured I could get a 6 month diet in while I was getting my testing done. (At a seminar, we were told, Medicaid requires pre-authorization, document of diet history, and at least 1 diet in 2 yrs. She didn't say it had to be "medically supervised", but we did need letter of "medically necessary" for surgery from your pcp). Just make a chart what diets you have tried: dates, lbs loss, lbs gained, exercise, etc. I wrote up my own letter of "medically necessary", did a medical history chart and a diet history chart to give to my pcp to SIGN. (there are samples of letters on here or look in gastricbypassfamily.com). Medicaid told me I didn't need referrals if you have "share of cost". I made my own appts for plumo doc, psych evel (Medicaid requires 4 visits, and they covered mine), cardio doc, gastro doc, etc. Then I just called a couple of days ahead and stopped at pcp office to get a signed "blue script" for each test I had scheduled. He gave me 2-4 of them at a time, for whatever tests I had made for that month. My pcp office weighed me once a month, did blood work and did EKG. Blood work showed I had rheumatoid arthritis. Gastro doc said I had Gerd. These were two more comorbilities, I didn't know I had. Anyway fill your MEDS at the BEGINNING of the MONTH and book just enough of your testing/appts to just cover your " $1,800 " for that MONTH. I can tell you that the sleep study alone cost $3,000. I did mine two nights, but a MONTH apart. One sleep study, my meds, doc visits and blood test were enough to cover my "share of cost for the month". I was done with testing/appts in 2-3 months and approved by May 4th. So it took me 3 1/2 months from start to finish to get approval. (and that included my doctor gone on vacation for a month in Feb, as a set back for me). P.S. I got my Medicaid "share of cost" KICK STARTED by going to ER one night ($4,000 for 4 hours) because it was hard to find a doctor that would accept "share of cost" for me to make an appt. My back was hurting so bad, I couldn't sleep and couldn't stand the pain anymore! Found out it was my spondylolisthesis acting up after they took a back x-ray. Medicaid told me NOT to tell the doctor offices when I called trying to make an appt that I had "share of cost". She told me to tell them "stragiht" Medicaid. My only out-of-pocket cost was $315 for a nutritionist and a couple $2 co-pays for tests. But, my surgeon is four hours away, because he was one of the few that accepted Medicaid "share of cost" and is doing it Lap RNY. Your welcome to email me if you have any other questions or need samples letters, charts or my pcp's name in Oldsmar/Clearwater. He is accepting new patients as far as I know and is open from 8:00 a.m. to midnight! YES..that's right and not a type error! His office hours have worked out GREAT for me being I work full time and don't get done till 7:00 p.m. "sharein_angel@yahoo" Good Luck!! Sharon

Sharon, thank you so much -- what an encouragement! I wish I'd have known all this six months ago. My wife just sat herwe and informed me that my Medicaid has cancelled and that because of her promotion next week, I won't qualify. I'd still very much like the name and number of your pcp, and yes, I would really find your letters and charts and anything else helpful also! I'm not sure what insurance I'm going to end up with. There are a number of plans available through my wife's job. Whatever I get, I know I need to have all my I's dotted and T's crossed if I want things to run quick and smooth. Your story, just 3 1/2 months with the insurer I'd expect to be the most difficult is just a real big encouragement. Thanks, Sharon and if you'd like to email me those charts and sample letters and whatnot, just use this address: [email protected]. Thank you again! Dana