Question:
Where do I begin?

I am a 46 y/o very obese woman. I am 5' tall and weigh 332 lbs. I am diabetic, have high blood pressure, arthritis in my neck, acid reflux, bad knees, I can't sleep at night and I can only take a few steps before becoming winded. I have been steadily gaining weight, despite dieting and trying to go to Curves three times a week. My doctor has been suggesting WLS for a couple of years now, but there's been an issue with insurance. I now have insurance, but I'm not even sure they'll pay for the surgery. I don't know where to begin. Do I take it upon myself to get an appointment with a surgeon or do I have my PCP start the ball rolling with the insurance company? Someone please help!!!    — Lori Q. (posted on September 9, 2005)

September 8, 2005
I began right here on the ObesityHelp website. I researched the different Bariatric Doctors in my area. I read all the patients comments and the hospital reviews. I looked to see if that doctor accepted the insurance that I had. I then found out when the next seminar was and went from there. This website is a wonderful resource of information and the people that contribute to this website are very helpful and thoughtful. God bless and best of luck to you. LAP-RNY 6/16/05 292/225
   — LilaDove

September 9, 2005
if you havent already, turn over your insurance card and call the 800 number, ask if wls is a covered benefit under your plan. Do you need a referal from your PCP? if you don't, you can call a bariatric surgeon yourself, register for their info session (if neccessary). The surgeons office will be able to help you get started good luck
   — catmomma3

September 9, 2005
1. Call your ins. company and ask and/or look up insurers on the Obesity Help website. 2. Since your PCP has mentioned it before, you might want to start with him/her. That is how I found my surgeon. My PCP recommended my surgeon and then put me in touch with some of her other patients that had used that surgeon. 3. If your PCP can't get you a name then start on this website to look at the reviews. Hope your ins. will pay. Many of them do now as they are finding that it is a bit more cost effective than paying for your co-mobidities (high BP, acid reflux, etc.) I had my surgery 3 years ago. I had many of the same problems you did. I had WLS for my health, not because I wanted to be a size 8. Good thing too, cause I never made it to size 8. But I am healthy, no meds and I am happy. I hope the best happens for you.
   — Carole J.

September 9, 2005
Hi, I am the same age as you....and started out at 267 pounds at 5'3". I have most of the same co-morbidities you have. I had my open RNY August 10, 2005. I have had no problems or complications. I would call your insurance company first and ask them if they cover WLS and what the requirements are. Each insurance company is different. If they say that they do cover it, ask them which surgeons are covered under your plan. After I found out what was required by my insurance company to cover the surgery, I contacted the surgeon and made my appt. The surgeon you go to should be able to tell you what to do next. Best of luck to you on having the surgery. God bless!!
   — Melannie W.

September 9, 2005
i check out the surgeons frist not sure where you live but the group i went to had a very good history on the surgery they had a orentation and i went to it made a appt with the office and they do all the paper work and let you know if your insa will pay or not and what your out of pocket would be you then will get something from your insurance telling you if it is cover or not by the group you went to i had my surgery on 05/03/2002 the best thing i could of ever did good luck write me if you would like rosemary
   — ROSEMARY A.

September 9, 2005
Lori, First off, I don't live anywhere close to you, I live in Arizona, but, I feel the best action for you would be to have you PCP send you to a surgeon in your area, after seeing that Doctor they will have things you have to do before you get the surgery. Do aws much research on the Doctor before you decide to have this done. Yes, it is the best thing I have ever done. I also was 340 lbs when I started 18 months ago. I now weigh 200 lbs & still have 50 lbs to go. I now where size 14 from 3X & 4 X stuff. I would do it again in a heart beat. I also was diabetic with high blood pressure & sleep apnea. I don't have any of that anymore & feel better than I ever have. I am 51 years old & have a life I never would have had without this surgery. It is not a cure, you have to still work at making right choices in food, but, if you do that and are willing to make change in you lifestyle that made you this unhealthy, You can & will become thin & be so much better. off. This surgeon you choose will have special guidelines & test that you have to have completed . Your Insurance should pay for it since this is "Medically Necessary" & not just for cosmetic reasons. Your PCP & suregeon have to word 3everything correctly when submitting to the Insurance Company. I wish you luck & Hope this helps you in your decision to have this surgery. By the way I have lost 140 lbs now & Could never have done this any other way. E-mail me directly if you have any further question I can help you with at "[email protected]" Marilyn, the Bearlady
   — Marilyn C.

September 10, 2005
Have you talked with your PCP at all about the surgery? You will probably need a ltter from him/her detailing your weight loss attempts and failures as well as your co-morbidites of diabetes , hypertension, and sleep apnea. All insurance companies are different, so you can go to the company's address on the web or call and get information about what is covered and what they require from you. Then you just have to bite the bullet and jump through the hoops they set for you. You should also go see a surgeon. I found my surgeon by researching surgeons. I had to travel an hour and a half to get to mine. Sometimes the people at the surgeon's office know about various insurances, because they deal with them all the time! Even so, be proactive and verify everything. I had the same problems you had and my insurance made me wait six months and diet some more, even though I had dieted for years!
   — Novashannon