Anyone with experience having WLS at BMI 37-39
I have fought weight all my life. I have done the Yo-Yo affect. I also have been on diets 3 time doctor supervised using the Phentermine drug everytime I go off the drug I gain the weight and sometimes more back. When I did lose the weight on Phenteramine and even off I exercised sometime from 3 times a week all the way up to 7 times a week hard. I just have no success long term. I have done alot of research on WLS and I am so prepared and wanting to go forward but I am afraid that insurance will not cover. I have started to have problems with my ankles just recently sprained it badly and will continue to have problems with it for up to a year is what I was told. I also have GERD I had surgery for it in 2003 but after that had a child and it no longer is working I can't take medication for it because I am allergic to all the meds I can use and have severe lifethreatening reactions from taking them. Due the the reactions I now carry and Epi Pen. I have dealt with depression but mostly due to lack of self confidence cause by the weight. I have heart disease, high blood pressure, and Diabetes in my immediate family. I want to take care of this before it is to out of control does anyone have any experience with a similiar situation to mine. I have BCBS.
I am guessing many have some type of experience to some point. I am not sure what your real question is tho. Are you trying to find out if you have enough history to warrant getting the surgery? Are you asking what it is you need to do? More information on what you are really looking for would be helpful. Would love to help you answer questions at any time.
If you think you are ready to make a life long commitment to this life style change, it never hurts to research it good,meet with doctors and try to get the ball rolling. The worst thing that could happen is you don't qualify for it. Then you would at least know what you need to do to be able to qualify. You need a bases to be able to build your case.
It sounds like with your family history and your own history that there are issues there to warrant a surgery. The surgery is not the fix all of the world. You have to be so committed to using your "new tool" to make it work for you. You have to take vitamins for the rest of your life like clock work. You have to give up somethings that are current in your life now to make the changes. You have/need a support system in place when you go through this. This is not an easy journey.
Please ask away. Research all angles and study hard. It is worth it in the end
Kelly/tink
If you think you are ready to make a life long commitment to this life style change, it never hurts to research it good,meet with doctors and try to get the ball rolling. The worst thing that could happen is you don't qualify for it. Then you would at least know what you need to do to be able to qualify. You need a bases to be able to build your case.
It sounds like with your family history and your own history that there are issues there to warrant a surgery. The surgery is not the fix all of the world. You have to be so committed to using your "new tool" to make it work for you. You have to take vitamins for the rest of your life like clock work. You have to give up somethings that are current in your life now to make the changes. You have/need a support system in place when you go through this. This is not an easy journey.
Please ask away. Research all angles and study hard. It is worth it in the end
Kelly/tink
Maintaining! Start weight 257,Current weight 122,Loss of 135# and 114 inches,Size 22-24W now size 4 to 0 (zero),Healthy life=Priceless
www.onetruemedia.com/shared
www.onetruemedia.com/shared
I have been researching for about a year. I have narrowed it to two doctors both at Center of Excellence in WLS. One is in Bismarck Dr. Bruderer and the other Dr. Graham in Sioux Falls. My question I guess was more if it sounds like I might have a chance. I have already started to gather the last 10 years of weight loss yo yo up and down. I have requested my records from doctor I have been on Phenteramine 3 times in the past 10 years with success until I am taken off the drug. I also used weigh****chers, herbalife, and YMCA which I have requested records for all to show my trials. I know I am looking at a lifestyle change I just feel like I need the right tool to get me started and stick to it.
Anything worth having is worth fighting for.
I will not try and sell you one surgery over the next, that is not why I am here. I know for me a big factor was what will be covered under my insurance. I didn't want a huge out of pocket mess. I went with RNY because that is what was right for ME.
Every surgery has it's rick factors, we just deal with it as we do any part of life.
The rule of thumb I have always been told was... 100 pounds over weight with a history of co morbs. or more co morbs that over run the wight part. Go for it and try. You sound like your getting all your ducks in a row, good job!
Kelly/tink
I will not try and sell you one surgery over the next, that is not why I am here. I know for me a big factor was what will be covered under my insurance. I didn't want a huge out of pocket mess. I went with RNY because that is what was right for ME.
Every surgery has it's rick factors, we just deal with it as we do any part of life.
The rule of thumb I have always been told was... 100 pounds over weight with a history of co morbs. or more co morbs that over run the wight part. Go for it and try. You sound like your getting all your ducks in a row, good job!
Kelly/tink
Maintaining! Start weight 257,Current weight 122,Loss of 135# and 114 inches,Size 22-24W now size 4 to 0 (zero),Healthy life=Priceless
www.onetruemedia.com/shared
www.onetruemedia.com/shared
with a BMI in the range you're talking about... have you looked into the sleeve? The VSG forum on this site has a wealth of information and sooo many success stories of people with BMI's in your range. My starting BMI was at 49 and I'm doing very well with it. 2 lbs away from goal, and am currently re-assessing some new goals because I CAN do this. I've come so far (98 lbs)... I have no doubt that I can lose another 20 or 30.
Dr. Schmit in Bismarck did mine in July. For me, the sleeve was the best option out there. I didn't want a full blown RNY--the malabsorbtion factor to me was a huge turn off, and being uninsured there was no way I could afford that out of pocket anyway. And I didn't want a lap band, either.... the odds of complications for that were too high for my comfort, not to mention the cost of maintenance after that first year.
The biggest obstacle with the sleeve is that, to my knowledge, BCBS still doesn't cover it. It is considered "investigational" as a weight loss procedure. It does sound like that is changing, though... more people are getting it covered than they were a year ago. It is certainly worth the fight; but if you still have to pay out of pocket for it... basically it's the cost of a decent used car. It's slightly more than what you'd pay out of pocket for a lapband, but with no further maintenance visits down the road it comes out to be a better "bargain". No fills, and it's permanent. I couldn't be more pleased.
Feel free to PM me or read my blog if you are interested in my experience with this particular surgery. Good luck to you.
Dr. Schmit in Bismarck did mine in July. For me, the sleeve was the best option out there. I didn't want a full blown RNY--the malabsorbtion factor to me was a huge turn off, and being uninsured there was no way I could afford that out of pocket anyway. And I didn't want a lap band, either.... the odds of complications for that were too high for my comfort, not to mention the cost of maintenance after that first year.
The biggest obstacle with the sleeve is that, to my knowledge, BCBS still doesn't cover it. It is considered "investigational" as a weight loss procedure. It does sound like that is changing, though... more people are getting it covered than they were a year ago. It is certainly worth the fight; but if you still have to pay out of pocket for it... basically it's the cost of a decent used car. It's slightly more than what you'd pay out of pocket for a lapband, but with no further maintenance visits down the road it comes out to be a better "bargain". No fills, and it's permanent. I couldn't be more pleased.
Feel free to PM me or read my blog if you are interested in my experience with this particular surgery. Good luck to you.
I had a bmi of 39.5 when I had my laproscopic RNY. That being said, I was denied by my insurance twice before pursuing it once again (8-9 months later).
I thought I would get approved due to co-morbidities and family history. I can't say how your insurance is different than mine (I had NDBCBS), but for ME they didn't consider anything family history related. Only things that directly affected me.
The denial letters I received basically said there were the following items that would count as comorbidities:
1. high blood pressure - not controlled by medication (i.e. on meds, but not working)
2. Sleep Apnea - not controlled by CPAP (just a diagnosis of Sleep Apnea wasn't enough)
3. Diabetes
I think those are the ones my letter mentioned. At any rate, right before my information was submitted to insurance, I was diagnosed with Sleep Apnea and on CPAP. After struggling for months with different masks, removing the mask during my sleep without realizing it, and still struggling with sleep issues, my doctor wrote a letter to my insurance indicating that my Sleep Apnea was NOT controlled and that if I were to lose a substantial amount of weight, it would perhaps cure itself. After they received that letter, they approved my surgery.
I am not telling you this to discourage you, just being honest. The biggest thing is to realize that no matter what, you probably have some comorbidities without even realizing it. Your insurance may be different than mine, and keep in mind that they want us to go away. They decline a lot of first requests hoping people will quit trying (at least that has been my experience).
Good luck to you. This is the hardest fight I've had to put up, but well worth it.
I thought I would get approved due to co-morbidities and family history. I can't say how your insurance is different than mine (I had NDBCBS), but for ME they didn't consider anything family history related. Only things that directly affected me.
The denial letters I received basically said there were the following items that would count as comorbidities:
1. high blood pressure - not controlled by medication (i.e. on meds, but not working)
2. Sleep Apnea - not controlled by CPAP (just a diagnosis of Sleep Apnea wasn't enough)
3. Diabetes
I think those are the ones my letter mentioned. At any rate, right before my information was submitted to insurance, I was diagnosed with Sleep Apnea and on CPAP. After struggling for months with different masks, removing the mask during my sleep without realizing it, and still struggling with sleep issues, my doctor wrote a letter to my insurance indicating that my Sleep Apnea was NOT controlled and that if I were to lose a substantial amount of weight, it would perhaps cure itself. After they received that letter, they approved my surgery.
I am not telling you this to discourage you, just being honest. The biggest thing is to realize that no matter what, you probably have some comorbidities without even realizing it. Your insurance may be different than mine, and keep in mind that they want us to go away. They decline a lot of first requests hoping people will quit trying (at least that has been my experience).
Good luck to you. This is the hardest fight I've had to put up, but well worth it.
Lori
248/137/140
Lap RNY 7/2/07
To the world you are just one person, but to one person you are the world.
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