Question:
Any Advice?

I am 22 years old and I weight somewhere in the 470 range. I have been big my entire life. I have gained 200lbs in 2 years. I am severely depressed and I NEED gastric bypass. I feel like no dr understands or wants to help me. I have medicaid for medical insurance and they have strict guidelines to approve for the surgery. I personally feel like the surgery is what I need to save my life. I have a 20 month old son who needs me and I need him. I cry everyday because I dont want to die. People assume because im fat that I sit and eat twinkies all day. I do sit a lot but I dont really have an appitite. My biological mother died when I was 15 from super morbid obesity. She was somewhere in the 600-700 range. I guess my question is that> Has anyone else had trouble getting a dr to refer you or help you have surgery. I feel like if I dont have it that within 2 years I will be bed ridden and or dead. I do not want this and I do not have the money to pay for the surgery out of pocket. Anyone know of dr's that do charity cases?    — bamagirl642 (posted on June 21, 2008)


June 20, 2008
Hi Ashley, I'm sorry to hear about your predicament. I will be praying for you. I don't have any experience with the Medicaid side of insurance and so I can't give you any advice there. What I can say to you is that God is a good God and He knows all of our needs and will provide them if we just ask. I feel for you, I really do. I come from a family of morbidly obese people, I think the highest weight is 400 lbs but forget the numbers, we all share common issues. I know that the popular myth is that obese people eat and eat and eat all day and that's all we do. Well, my highest weight was 374 and I would eat three meals a day, they just happened to be junk food in content. I wasn't very active and so 1 + 1 + 2. If ever you need someone to talk to, please don't hesitate to contact me. As I said, I'm not really answering your question but I feel as if I could be there for you emotionally. We've all been through it and having support is major. God bless. Pawlla
   — PAWLLA L.

June 20, 2008
Hi, Check with your local weight loss center. I know where I am from they have recently gotten an approval for medicare. Best of Luck.
   — Alvernlaw

June 20, 2008
Ashley, Good morning, I cannot answer your question either. But what I can tell you is simply "Do Not Give Up!" You keep up the fight and find a Dr. that will help you. If your Dr. doesn't want to cooperate then find one that will. You may have to get on here and ask around for doctors in your area that have helped other patients. Get on the phone and just start asking questions anywhere and everywhere. Someone out there WILL help you. But please for the sake of yourself and your son do not give up. I sincerely wish you the best of luck.
   — Jean N.

June 21, 2008
Ashley, I had medicare and they approved the surgery in a heartbeat. Contact a surgeon who does the Weight Loss Surgery and they will help you get the approval..Have your Primary Care Physican request it for you. If he won't then find another, I know that doctors for medicare and medicaid are hard to find. Go to the find bariatric surgeons on this website and find a doctor in your area that take your insurance. Good Luck and don't give up...oh, some county hospitals have a weight clinic, may take some time to get in but they do the surgeries. I know the ones around here, Parkland (Dallas, TX) does.
   — dyates2948

June 21, 2008
Ashley, I looked up a doctor in Decater and here is the info William Jay Suggs, M.D. 1874 Beltline Rd SW Suite 100 Decatur, AL 35601 Phone: (256) 351-9445 He takes Medicare so call and ask about medicaid, they use the same process...Good Luck
   — dyates2948

June 21, 2008
Ashley....You definitely need a different primary doc if he/she is pushing you into diet pills or weight watchers...when you're the weight you're at, it should be very apparent that you'll struggle with those kind of programs. I'd follow the advice of the one response here...that recommends a physician that understands your needs and desire to better your life with WLS. I do know they will require you to lose weight prior to surgery..... and that is for your own good.... your own safety....for during surgery as well as after. It will help your liver shrink, so that the surgeon can perform the surgery more easily as well as more safely. It will also help you recover faster if you start getting out and walking and eating smaller portions and healthier food. I know you said that you don't eat that much, but keeping a food journal might help you see the amount of calories you're taking in...as well as the grams of fat. I'd consider starting on a low-carb diet....nothing extreme...but you need to get use to eating higher amounts of protein for after surgery. You will also be required to get a psych eval.....and don't dread this...it's for your own good as well. It will better equip you in understanding why you eat, or what you're eating, as well as how your emotions affect your daily life. Post surgery you'll be dealing with a lot of issues.... and it's a life changing event....that is for the rest of your life. The psychologist will help you figure out if you can handle this kind of life change. There will be a lot of hoops to jump through...but it's all worth it......believe me. I'm 8 months out and down 97 pounds.....and feel better than I've ever felt in my entire life. I'm not to goal yet....but working at getting there. And now.... I feel like anything is possible in my life.....including being alive to see my young son grow, graduate, go to college... get married...and give me grandkids! I often wondered if I'd see all that....or I'd be leaving him motherless. So I understand your fears. Feel your fear.....but do this anyway..... because honey....you will not regret it! Best wishes....and get to work....find that doc.....jump through those hoops....and get up and walk...even if it's just for 5 minutes at a time. It's all worth it! Hugs Cheryl
   — Cheryl K.

June 21, 2008
Hi, I also have Medicaid [called Staywell in Florida]. At certian times a year here you can change from one type of Nedicaid to another. So, I made it my goal to find out which one would cover Gastric by pass. Here it is Staywell. I found out all the hoops I would need to go thruto be approved for the surg. And spent a VERY LONG feeling yr doing EVERYTING that was required to be approved. My most wonderful Dr's office was very helpful to give me a list to follow and it was sometimes very hard to be waiting but it is ALL worth it. As Dr. Gordon in Largo, Fl. made one request for the surg and because ALL the test were done I was approved right away. With Medicad & Medicare you have to use a Hospital of Excellence..which means the Dr. & hospital have done a certian amount of procedures. I will have NO out of pocket coasts. I would be happy to wxplain to you anything you want to know on my email. [email protected] Will keep you in my prayers,
   — tootsie52

June 21, 2008
I do not have insurance coverage and I am going to India for my surgery in August of this year. It is half the cost and wonderful healthcare system. The cost includes the flight and the hotel for the two weeks I will be there. I do not take healthcare lightly since I have been in the field for many years. I know it is alot of money but it is worth my life and health so I can raise my kids. Good luck! Jen-mom
   — jen-mom

June 21, 2008
I don't know anything about medicaid but a girl that just started working at my job had surgery in Feb and she said medicaid paid for hers. She even said that they are paying for her to have a TT in January 08. She weighed about 700 lbs before surgery and is now around 550 that maybe why though. Keep trying, don't give up and find a new Dr if you have too. Your in my prayers.
   — DEBI R.

June 21, 2008
I forgot to mention the reason she is having a TT in Janurary 08 before she reaches goal is because she has a very large pannus and it severly affects her walking so that's why she's scheduled for TT so soon and maybe why Medicaid is willing to pay.
   — DEBI R.

June 21, 2008
Hi Ashley. I'm not sure on the Medicaid part, but I know I didn't need my PCP referal. I just went in to a seminar and met with a surgeon and they basically took care of it from there. I did have some of co-morbidity stuff and they got my PCP's records and I did tell my PCP I was going ahead with the surgery and found out then he was ALL FOR IT! Check with a weight loss facility in your area, I'm sure they will help you through the steps you would need to do. GOOD LUCK!!!
   — Toni Todd

June 21, 2008
Hi Ashley! First of all, you have taken a step in the right direction to change your life and have found an AWESOME web site and group of people to be around. I would look for a local gastric bypass support group and try contacting those people. I have looked a lot for people in my area who know the doctors and surgeons and that's been a big help also. This web site actually has a way to look on local (for your state) message boards and find local support groups. You've found a great tool! Good luck to you!! :O) Michelle
   — mkettles

June 21, 2008
Hi Ashley...I don't have the answer you're looking for but I did find a website for Dr's in your area... http://www.obesityhelp.com/morbidobesity/bariatric+surgeon+profile+Gregory+Adams+nmn.html Check it out and I hope it will be helpful for you !! I'm new to OH but I think you've definitely made a step in the right direction by coming here...these people are amazing !! Take care Ashely and the very best of luck to you ~ debz
   — debz_58

June 21, 2008
I know that medicaid does cover the surgery in NY. I would suggest going to a local support group. That is a great resource of information. You will have to jump through hoops like a trained poodle, but it is VERY worth it. If you find surgeons in your area, they may offer a seminar to help guid you as well. If your current primary care doc is not supportive, change docs! The clearance process can take 6 months. Most require a series of clearances / evaluations from nutritionist, cardiologist, pulmonary, psychiatric and so on. Best of luck to you on taking charge of your destiny!
   — robinmarra

June 21, 2008
Hi Ashley, Sorry to here of your obesity problem. I live in western KY and I had my RNY at Centennial Hospital in Nashville. They have a Center of Exellence Bariatric Program that is fabulous. I do not have Medicaid but I do know some people with Medicaid that has had their surgery there. You are really not that far from Nashville. Google Centennial and click on Bariatrics. I'm not sure if they take out of state Medicaid but it would be worth a try. I looked far and wide to find just the program for me and I decided to drive 2 1/2 hours to have my surgery. Try checking into that and see what yo can find out. Good luck.
   — t_roxus

June 21, 2008
Hello, I had mu surgery on October 2 2007. I was approved through medicare/ medicaid because of the medical issues I had due to my obesity. (diabtes, high blood pressure, arthritis) I am not sure were you are from but I had a six month waiting period for mu insurance to approve the surgery. I am sure there is something that you can do. Some of these doctors here offer a seminar and they try to get approval of your insurance. I dont understand why you cant get any doctor to refer you. Go over there head and see a wls doctor yourself. I wish you the best! Lynn
   — Lynnmon

June 21, 2008
hey Lynn again. you can e-mail me if you like. [email protected]
   — Lynnmon

June 21, 2008
Hi, I too am sorry for everything you are going through. I had Medicare and had no problems having my family Dr. write the letter of necessity. I was 394 pounds and 5'10". I too suffer from depression. The medicine people take for that makes you gain weight so fast and it is damn near impossible to get it off. I dont see why your Dr. wouldnt give you a letter of necessity. I didnt take a look at your profile so I dont know where you are from, sorry. I just so understand the feelings you are going through and at least you are seeing it early on. I wish the best for you and know in my heart that something good will happen for you!!
   — Nuttin2no1

June 22, 2008
Step 1 is finding a different PCP. Some just aren't Weight loss surgery advocates.. and it sounds like yours isn't. since he/she is advising you to do WW and what not. Medicaid is an awesome insurance to have. Have you been going to your same doc for the last 6 months?? You may need a 6 month MD supervised diet.. Please also research Duodenal Switch.. It seems to do wonders for some. Please keep in touch with me, I've got a lot of experience w/ the Medicaid part of this and I will help you out along the way if you need anything.
   — Katrina B.

June 22, 2008
I live in IN and know that medicaid does cover it here. I would go to the doctors here on this site and find one near you. If there isn't one there has to be one somewhere in your state. Believe me it is worth the travel if you need to. It may tell you on this site if they take medicaid or you may have to call the office. I think you will need a 6 month weight loss physician followed diet, but that shouldn't be a problem if you go to your pcp regularly. The wls doctor's insurance people will deal with that. There is ways to go about this. It might take a bit of time but trust me you will not regret it at all. You are going to have to jump through hoops but you get use to it. Know that you are worth it and there is a lot of people here on OH that is in your corner and rooting for you. Take care of yourself, make sure you walk (the doctor may make you go on a weight loss diet before surgery too). It is like my wls doctor told me, he didn't care if you walked for 3 minutes just as long as the next day you took another 1 or 2 steps more than you did the day before. Exercise is a must do!! I will be keeping you in my special prayers. Please make sure that you keep us posted on how things are going. If you have any other questions please, please, please make sure you get on here and ask. We will help you in any way that we can. Good luck and may God bless you and your son.
   — Brenda R.

June 22, 2008
I'd like to point out to people that Medicaid is not at all the same thing as Medicare and a doctor who takes one does not necessarily take the other. You said "I have medicaid for medical insurance and they have strict guidelines to approve for the surgery." I'm not sure what the problem is... You need to get a copy of those guidelines and start working towards doing whatever needs to be done to meet them. You are going to find that there are strict guidelines for weight loss surgery whether you've got medicare, medicaid, private insurance, or are paying for it yourself. I doubt you are going to find a doctor willing to take a "charity" case, especially when you've got medicaid. A lot of people can't afford / don't have coverage for WLS so there are a ton of "charity" cases waiting for free surgery. If your primary care doctor isn't willing to refer you for surgery, you need to find out why... if s/he flat out refuses under any circumstance to refer you, then you need to find a new doctor. You need to get some help so that you can deal with the depression. I would suggest talking to your primary care doctor or calling medicaid and asking for a referral for a mental health evaluation and services. You aren't going to find a doctor who is willing to do surgery on someone with severe depression, especially if they aren't in treatment. WLS is not a quick fix. It takes a lot of hard work to get there and a lot of hard work afterwards too. You've gotten some good suggestions on here... I would also suggest keeping a food diary, maybe use fitday or something, to keep track of what and how much you are eating. From my own experience, having a small or even no appetite doesn't mean that there is no eating / overeating going on.... and you can overeat / gain weight from healthly stuff too. It will also help if you start to or increase your exercise... it doesn't have to be anything hardcore--go to the mall and walk in the air conditioning (or check out one of their wheelchairs and roll yourself), swim, get an exercise video... there are exercise programs geared towards people with disabilities... exercise videos to be done while sitting in a chair, etc. Watching what you eat and exercising itself is not likely enough to cause you to lose a significant amount of weight... but what it will do is show your doctor/surgeon/medicaid that you are ready, willing, and capable of making the lifestyle changes needed to be successful after WLS. Good luck.
   — mrsidknee

June 22, 2008
Hi honey, I had my RNY in february and had Medicaid also. I don't know who you have as your MCP but I had Paramount Advantage and they covered every penny! If I were you I would look into getting or switching your MCP. If you're not sure where to start to change or get an MCP (managed care plan) call your case worker and tell them that you want an MCP or need to change the one you have. I wouldn't tell them why because many people out there don't understand the surgery and may give you false information by trying to act like they know who would cover it and why. Also, I don't know where you're from but I am from Bowling Green, Ohio and I had the best surgeon ever. Dr. Brian Lane. he has since moved to Toledo, which is only about 20-30 miles away but he is still seeing his same patients as well as new. You'll have to keep us informed as to your progress and whether you find any help with insurance and what not. God Bless and the best of luck to you!! Angie Kimball (sillyguts)
   — Sillyguts

June 22, 2008
You have probably heard the same advise before, stop caring what others think. If you look at the top of the OH page you will see a drop down thats says in red "find a:" they list different types of medical doctors and bariatric surgeons. I am sure a skilled PCP who cares about life especially your life will help you cut through the red tape necessary to get your surgery. Pray alot and it will happen for you. You have a beautyful family don't beat your self up. Good Luck and God Bless.
   — Ira Sansolo

June 22, 2008
Hi Ashley, I first want to give you a hug girl (((((Ashley))))). I had medicaid and didn't have a problem getting covered...I was approved within a couple of days from when my paperwork was submitted....I had done the pre surgery tests...I did have to pay out of pocket for the nutritional appt. but my insurance covered the psych eval. I had a lap rny/gb in 10/23/03. I weighed approx. 340+lbs, I am 5'4" tall and I was turning 41 yrs old when I had the surgery. I lost 170lbs and now I am hovering around 178-183lbs. I am healthier, I thought I was going to die within 5yrs if i didn't have the surgery. I still have depression issues, the surgery is not on our brains, but with my pouch, I always will have this tool to help me stay healthy. I researched all I could so that i could do everything possible to make my surgery a success....read all you can and take care of yourself. If you want to talk email me. You can read my story on my page...I started journaling in 2002 and have been slacking alittle the past year, but you can read what I went through. Good Luck!! Lisa H.
   — Lisa H.

June 23, 2008
I live in Illinois and have the medical card. I found ONE doctor in chicago that would do the lap band surgery with the medical card. I was approved in a couple days after my paperwork was submitted. PLEASE do not give up...there are docs out there that will do it... just keep calling around. You might have to travel a couple hours like I did but it's well worth it.
   — willish

June 23, 2008
Hang in there. Check out Dr. Suggs, it shows one of his patients had medicare, so maybe he can help with medicaid as well! Keep fighting, sometimes you have to keep asking, pushing, to get what you need! http://www.obesityhelp.com/morbidobesity/bariatric+surgeon+insurers+William+Suggs+kbs.html
   — Val_T

June 23, 2008
Depending on the state some medicaid does pay for this surgery. It will take awhile and you will need to show that you can and will use the surgery as a tool to weight loss. You will need to diet and exercise. I started larger than you and I just keep working at it. You can get there just keep up the good work.
   — ntssmith

June 24, 2008
wow, there is a lot going on here. Fist I would lose the doctor. Based on your history that you shared this is something that needs to be done now and not latter (my opinion). Call the health insurance company and ask them for names of doctors who take the insurance. Personally I would start with the lap band and then get a revision down the road. It is a safer start for you medically. Also try to eat as if U already have the band, eating slow and chewing extremely well. U do realize there is a mandatory psy. test called the MMPI that U must take. A lot of the depression can be from the weight and self esteem issues. BUT DON'T give up! Get a new doctor who is familiar with our kind of issues. Also, there are issues here between you and the doctor who may think you are not really trying. I too can not afford to go to Weight watchers or Jenny Craig, I too live off food stamps so I understand the money issues. Once you have changed your cooking and eating style, that will help to convince the doctors as well. Get involved into a nutrition group now so that it is documented. Local hospitals have them all the time. If U R diabetic, a training program for that will help also. Good luck. I would love to know how you make out so feel free to keep in touch with me. Chell
   — chell1957




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