Group Health advise needed

Even if you don't think you have sleep apnea, you should go in for a sleep study anyway. I wasn't convinced that I had it but I do and it's moderately severe! I also believe that Group Health denies every one the first try. If I were you, I would go in for the testing, get the results (hopefully they lean your way) and then send in your appeal. You have to jump through all of their hoops. Trust me, I did it and was finally approved. I wish you tons of luck. If you have any other questions, please let us know. Also, there is a group of us who use the "indoor" messageboard just for Group Health issues. Here is the link: http://www.obesityhelp.com/morbidobesity/member-interests/indoor/ Hope this helps! Lori

Thank you so much! I appreciate the link and the words of encouragement... I've been researching online about sleep apnea - I figured if you weren't a heavy snorer than you probably don't have it... I read that light shallow breathing is part of it - I'm a very quiet sleeper... but I am tired all the time daily - fell asleep in class one day reading to 2nd graders in my rocking chair!!! I was begining to think that I have diabetes... but now I am starting to wake up with headaches or a groggy head - heavy head -- hard to explain... I read that is a symptom -So I am very VERY hopeful that I might have it - one to get the approval - and 2nd - because I'd love to wake up refreshed and with no headache... I'd rather have that than diabetes! Thanks for the post..

Hi Sarah Don't give up....I too believe that GH denies everyone the 1st time around. I had a BMI around 42 and was denied so my PCP helped spend more of THEIR money and ordered a sleep study (I did have apnea) as well as x-rays and an ortho consult for osteoarthritis. Had they taken her recommendadtion for the WLS it would have saved some $$$, but you have to play by GH rules. For my appeal I gathered all my documentation, letters from every DR and my chiropractor as well as wrote a 4 page letter explaining my family history and how my medical conditions and weight effected my daily living. I made a binder with all this info and hand delivered it to GH in Spokane. 2 weeks later, I was approved I am now almost 20 months post op. Down from 245 to 119, my back pain and sleep apnea are gone. Don't give up, it is worth any amount of time and effort it takes to get your approval. Best of Luck to you Kimberly

That is exactly what I intend to do. I have my appt. on the 5th - and I have seen the chiropractor before - not a GH one, but I will be going to that office and getting my file since you mentioned it - anything might help!! I have no idea what arthritis feels like - but it wouldn't surprise me too much if I didn't have it in my lower back where my pain is.... too bad chronic migraines due to weight wasn't on that list! Did GH cover any plastic surgery I wonder... LOL - I can imagine their list of requirements for that . . . I'm still just jaw dropped stunned their requirement is 50BMI ... I can't help but wonder if it is possible to have a 44.6 BMI and not have sleep apnea... HEY - CONGRATS on your weight loss 119? SUPER!!! That is wonderful! I have to admit I'm envious!

I was very upset with Group Health - I went to my PCP with Group Health at the time wanting a referral but he wouldn't even consider it. He said I would be denied. He didn't do any blood tests to see if I was diabetic, didn't even ask me about sleep apnea, or anything! I was devestated. Two years later my husband enrolled us in TriWest since we are retired military. I decided to try again. This time the Dr. ordered all the tests and thought I may have sleep apnea. I don't have diabetes thank goodness, but he said I am borderline, my identical twin has diabetes, runs in the family and I had gestational diabestes. Group Health Dr. didn't even ask. I do have sleep apnea. My BMI is 50. So now the ball is rolling and I will be meeting with Dr. James Weber in Seattle soon. I am so excited! I am glad this Dr. took my concerns more seriously. Janna

It is sad when PCP don't even bother to be your advocate. I've learned a long time ago that most likely if I don't push or ask or tell it won't get mentioned, done or tested.... in fact when I was reviewing my records from eight years ago I weighed 253 and the doctor described me as pleasant and moderatly overweight - MODERATELY??? geeze. . . I went in to talk to my PCP about the denial and he was extremely supportive - he said lets run diabetes, x-rays on my back and get me into the nutritionist since I do need 6 months supervised diet and we should get that going now and also a sleep test. He was also the one that brought up that if nothing comes back to support the requirements - then we'd write the appeal together on the fact I'm labeled Morbidly obese and I have chronic back pain that is interferring in my job. He said you never know what could happen - I was just shocked actually - and have never had a doctor really take the reigns before -- I thought I'd have to go in and beg (as usual)... Glad to hear you're on your way!! good luck! Sarah