I'm tired of being stuck at square one

ammnlb07
on 4/12/12 2:24 pm
 I have been a member of this group for some time.  I have had my hopes up of getting the lap-band for so long. It seems like I am going from one dietician to another with no hope of gettting the procedure done. It is so frustrating. I do everything they ask of me, my own research, count calories, count carbs, keep food journals, keep exercise journals, exercise on a regular basis, take my medicine daily, chart everything, and yet every time I mention weight loss surgery they act as if I don't need it. I am so over weight, in so much pain, and have so many health problems that are due to my weight. I just want the weight to start coming off. I just feel that this surgery is the extra step needed to accomplish my goals. I have no desire to be picture perfect. I know thats not realistic. BUTTTT a healthy weight is something ideal for me. Even 150-175 pounds would mean so much to me. YETTTTT the past 3 dieticians have refused to chart my weight loss efforts for 6 months in a row for insurance purposes. I don't want to go to yet another dietician, start the 6 months over again, just to be back at square one. Ughhhh. Its not as though I'm asking for a boob job, some form of unecessary surgery, or something like that. I am asking as a person who is 5'1, severely overweight, in pain every day, who wants to have children, who wants to do things without so much effort, who wants to feel good about myself, who wants to get up and do things, who doesn't want to stay away from others because I'm so self conscious about myself. I just want to lose this weight. I understand that the procedure is costly, but I'm willing to pay my share. The same that I do with any other medical bill. So why is everyone making such a big deal out of this. It shouldn't take this long to be approved for a surgery.  Sorry for my venting. This is the only place where I feel I can be me, and vent openly about my weight without feeling out of place. I hope someone understands :(
Dev *.
on 4/12/12 11:21 pm - Austin, TX
Well, the dieticians aren't the ones to refer you, you need to speak with your primary care doctor about getting a referral. Also, if the dieticians have kept any records at all, you should be able to use those records to show that you have been followed in some fashion, even if it was by more than one dietician over the last 6+ months.
Have you looked into what your specific insurance requires for approval? Even for those that do require 6 months of a medically supervised weight loss program, sometimes going to Weigh****chers and having your primary care doc follow you counts!

Banded 03/22/06  276/261/184 (highest/surgery/lowest)

Sleeved 07/11/2013  228/165 (surgery/current) (111lbs lost)

Mom to two of the cutest boys on earth.

grannymedic1
on 4/13/12 12:53 am - Lake Odessa, MI
Revision on 08/21/12
Start with your pcp. Get a record of weight gain over time. See what conditions you may have that qualify as comorbidities. If your doc won't refer you then contact a good wls clinic and go for an orientation to learn more. You don't have to do just one. You have to choose one that you are comfortable with. I started one place then attended some wls support groups to add to my research and discovered that the best docs were at another bariatric clinic. I took the tests that I had done at the first center (they are required to give you them at your request) and took them to my first appointment at the second center. That eliminated the duplication. As Dev said get the records from those dieticians and your pcp's records of weight gain, etc.

Take all those records with you in a note book as well as record of any wls support group meetings you have attended. These things will let them know you are serious. Most centers will have their own requirements and will know the particulars for your insurance requirements. I had called my own insurance and knew the basics, though they told me I had to have the 6 month supervised diet but the insurance guru at my bariatric center (choose a center of excellence at the minimum) told me that my insurance had just recently dropped that requirement. By taking my records, etc. I was able to be qualified within 4 or 5 weeks.

Unfortunately I had to wait about 5 months to be able to pay for the upfront expenses that insurance would not cover. In that 5 months I continued to attend wls support groups, worked hard at trying to lose some more weight and getting stronger physically. As far as exercise I had significant pain so was only able to tolerate going from a 5 minute walk to a 15 minute one and not every day, at that. All those things I had continued with allowed me to avoid a liquid diet before surgery and only have to do a shorter restricted diet. Not all centers are that way so expect the worst. By attempting to lose more weight and strengthening my resolve I had a head start so when surgery time came I was able to resume normal activity again quictkly and improve more rapidly.

Most insurances will not count the weight loss against you. I dropped below the bmi mine required but they still allowed surgery. Again, the ins. guru can tell you.

Good luck and keep us posted. Continue your research to find the best wls for you.

Sue

                    

Highest weight: 212.8 Current weight 135 Lost 77.8 pounds

    

Tom C.
on 4/13/12 2:58 am - Mount Arlington, NJ

The advice of starting with your PCP is sound. However with that said, please know there are many Doctors who DON’T believe in Bariatric surgery. They feel it’s the “easy way out" (how WRONG THEY ARE), and/or that it can be done with diet and exercise.

Well while I don’t have a MD degree, I do know from experience (and real life) DIET and EXERCISE ALONE doesn’t ALWAYS WORK. If it did, the world would be a size 2.

Here’s my question – what do YOU FEEL?!?!?!? If you think you can’t do it WITHOUT bariatric help, then who’s to tell you differently?!?!??! Until you walk in our shoes, and wear our clothes, you’ll never truly know how it is.

Before you decide to do anything, sit down and do a lot of soul searching, and ask yourself the really hard questions. It’s not easy, I know. Just remember this isn’t a cure all, and you WILL NEED TO WORK IT EVERYDAY. Can you do that?!?!?! If you think you can, then take the next step(s) – and be determine to get it done no matter what ANYONE says.

Good luck, and know we’re here for you!!

Good Luck on your Journey !!

Tom

“Nothing I will ever eat will give me the feeling I get as when I lose weight”  The views expressed are based on my own experiences - and should NOT BE FOLLOWED IN LIEU OF DOCTOR’S ADVICE/INSTRUCTIONS. Only your Doctor knows your condition, and make sure you talk to them before making any changes to your diet
ammnlb07
on 4/13/12 4:33 am
 Thanks for all the advice and posts. I appreciate it. I contacted a weight loss clinic over a year ago. They set me up for an orientation, gave me all the information, paperwork, and things like that. They said that was as far as they could go with my current insurance provider until I arranged 6 months of consecutive documented weight loss with a physician/dietician. I have been working with this particular dietician since August, and the same set of physicians since August. They take my weight into account as far as my health conditions go, and put me on different diets. But so far nothing seems to help. And any time that I mention weight loss surgery all they say is that is an "option" They don't go any further. I express my desire to have weight loss surgery, inform them of how long I have been looking into weight loss surgery, how they're not the first doctors I have spoken to about this, and yet nothing. They have yet to send a referral, speak with me in detail about the rest of the process for weight loss surgery, or anything. I just don't know what else I'm supposed to do. And the insurance company said without the referrals submitted, the documented weight loss, and things like that there is nothing they can do. 
kathkeb
on 4/13/12 8:30 am
Start with your insurer -- do they even cover Bariatric procedures?

I have United Healthcare -- so does my husband.  His policy covers WLS under certain cir****tances, mine does not -- period.  My company does not payfor the coverage, so it was self pay for me.
Or I had to wait 9 months and change to his insurance and then start qualifying under his policy.

It would have taken about 18 months -- by that time I was at my goal weight by self-paying.  I was fortunate to be able to do that.

I would definitely find out EXACTLY what your insurer requires --- and then start there.
Your PCP should be documenting your weight.
You might be able to join Weigh****chers or another organized group that provides a Weigh In record.

Take the time to research ALL of the 4 types of WLS and pick the best option for you.

Good luck!
Kath

  
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