Feeling bummed and a question to ask!

[Brandy Rediker]

Okay Ladies, I got mom all signed up and showed her around. Her name is Vickie. I also bookmarked this site to her favorites. She's suppose to introduce herself. I told her its a great way to make new friends and to learn all about the DS and if she has any questions this is the best place to go. I also bookmarked dsfacts.com so she can read everything on there too. You guys were right, she can't learn nothing with me doing everything for her. I've taken care of her for so long doing everything from making phone calls to getting her to her dr. appts. Now it's time for her to start taking control of her own life and living again once she has her surgery. Thanks ladies!!

 

[Brandy Rediker]

Here is what my mom's insurance thru AARP United Health Care Medicare Complete states about their supervised diet:

Additional information for medical necessity review, where applicable:
Bariatric surgery is medically necessary when ALL of the following criteria have been met:
•
Body mass index (B
MI) = or > 40 kg/m2 or BMI 35.0
-
39.9
kg/m2
with one or more of the
medical comorbidities described above.
•
Documentation of a motivated attempt of weight loss through a structured diet program,
prior to bariatric surgery, which includes physician or other h
ealth care provider notes
and/or diet or weight loss logs from a structured weight loss program for a minimum of 6
months.
(NHLBI, 1998)
•
Psycho
logical evaluation to rule out major mental health disor
ders which would
contraindicate
surgery and determine pat
ient compliance with post
-
opera
tive follow
-
up
care and dietary
guidelines
. (
NHLBI, 1998

Nothing about Failed Attempts. So hopefully with her dr. documenting her fluid retention this will help her get approved. I'm so afraid this will cost her another 6 mos again. I sometimes wish they would put her in the hospital and hook her up to IV's to help get that fluid off her.



Here is the full web address:
https://www.unitedhealthcareonline....licies/Medical Policies/Bariatric_Surgery.pdf

 

[Terri]

I see motivated attempt of weight loss. It does not say she has to lose weight, it basically means she has to try. With the doctors notes saying she was trying and that the gain is due to fluid retention I would think she would be fine. I would also say that if insurance wants to be an asshat and say she needs 6 more months I would appeal that immediately.

 

[Brandy Rediker]

Thank you Terri, I hope that's the case. I would def. make mom appeal it. It's worth fighting for....

 

[Elizabeth N.]

I see nothing about losing any number of pounds.

 

[Brandy Rediker]

No there isn't nothing on there about that, but when I spoke to several representatives they all told me she had to lose 6lbs in those six months she was on the supervised diet. I did talk to Dena I think that was her name and she did tell me that it only apply to failed attempts, she is the insurance lady there. But, after speaking to the representatives from UHC I can't help but worry. Her PCP doesn't seem to be all that worried about it. She seems to think she'll get approved with all the swelling she's been dealing with both before the diet and all thru the diet.

She goes to a new heart dr. Wednesday, Jennie from Dr. Sudan's office wants me to go ahead and get her heart clearance done and faxed over to them along with her Sleep study. That way all she wont have to have anything else done other then what Dr. Sudan request that he wants done himself. Maybe if we get all her ducks in a row they wont have any reason really to deny her. Keeping our fingers crossed and stay positive that everything will go okay.

As for me, I just went back over my insurance and mine says Failed Attempts. So I think I'm okay on that aspect. I'm just so ready to get this started and on the losing side soon. =)

 

[JackieOnLine]

Vicky, you here? *waving hello*

 

[Will2014]

Brandy, I honestly have to ask the following question: Are you sure your mother also having this surgery wasn't YOUR idea and not her own? I'm puzzled by 2 things in all honesty. Her failure to exercise some initiative and get on this board herself, and also her failure to lose 6 lousy lbs as requested by her doctor. I don't know about you guys, but I can lose 6 lbs at my weight simply by exhaling! Seriously, isn't it possible that in your excitement to have your own surgery....you may have inadvertently pushed her to join you? Sort of a bariatric surgery buddy system? Could she be exercising passive resistance with her non compliance, because she's not entirely sold on the idea? Just something you may want to consider exploring further with her...

 

[shann]

Will I see your point, but I just have to offer an alternative. I didn't lose one single pound in my 6 month "diet." While I could say I was going through the process, I didn't really do anything about it until I started my 2 week liquid diet (and then I lost 11 pounds). While in most of my life I'm an optimist, in this case I was definitely not a believer. I just didn't think the surgery could truly happen or I could truly lose weight. In my case, I don't think it was passive resistance, I was just completely sure that this would end up being another failed weight-loss attempt like so many before or in my worst dreams that it would kill me. Just another perspective to what might be going on in her mind.

 

[Will2014]

I hear ya Shann. We ALL on this board are well familiar with failed diets and fear of failing diets. I also make no claim to psychic powers or any inside scoop on what's going on in Vicky's mind. But I have worked in psychiatry for 33 yrs, and my "spidey sense" is activating....so to speak. Me thinks Brandy should have a nice converstation with mom and just consider the possibility that mom is not exactly as motivated as she is. She may be even deathly afraid to have it...but doesn't want to harm her relationship with Brandy by backing out. But...if the Dr. said she couldn't have it.....hmmmm.....it really wouldn't be her fault now would it? Again-I admit to wild speculation and the possibility I'm way off base. But only having "the talk" with mom will prove things one way or the other. Best of luck to both Brandy+Vickie.

 

[Brandy Rediker]

I understand your concern Will2014, but no my mom wants this surgery more then me. Her PROBLEM is she doesn't like being on the computer and talking to ppl ONLY because she feels she's to slow to type. I'm working with her to get on here and introduce herself. It has nothing to do with her compliance to be able to lose weight or have the surgery. My mom hasn't been able to lose anything when all she does is gain in fluid. She was put on nurotain I think that's how you spell for neuropathic pain and at the same time she was put on Dilitazem which is for her heart, during both these new medications she put on 20 lbs. So they took her off both of them to determined which one put her fluid on. We zeroed down to the Dilitazem. She's gotten most of it off her but she's still not down to what she weighed when she first started her diet.

With that being said, she was told by her heart dr. that if she doesn't have wls she wont be around in 5 yrs. This scared her into having the surgery. While I do all the research and granted she needs to be reading up on this herself, it doesn't mean I'm making her have this surgery or any other kind of surgery. I think it's great that we are a buddy system. She understands vitamins better then me and I understand more medical terminology then she does. (She use to sell Herbalife products when I use little for years). I'm very overwhelmed with all these vitamins, with her she's okay with them.

Now with all this being said, she hasn't really made up her mind which surgery she wants, she wants to talk with the surgeon and see what he thinks would be right for her.

I would never ever talk my mom into doing something she doesn't want to do, just because I want her to. I want my mom healthy, my mom is to young to be bed bound and having to wait on me hand and foot because her health is getting worse. She's 59, and I want her around many more years then 5 years. I want to enjoy life with her to be able to go shopping with her rather then have her ride around in a buggy. So yes I want her healthy and taking care of herself, but I wouldn't make her or talk her into doing something she doesn't want to do.

 

[Brandy Rediker]

Actually I'm the one who is scared to death of surgery. But, if my mom can be strong and not afraid to have the surgery then I can be too. All surgeries scares me even when I had my c-sections.

 

[Elizabeth N.]

Brandy, I honestly have to ask the following question: Are you sure your mother also having this surgery wasn't YOUR idea and not her own? I'm puzzled by 2 things in all honesty. Her failure to exercise some initiative and get on this board herself, and also her failure to lose 6 lousy lbs as requested by her doctor. I don't know about you guys, but I can lose 6 lbs at my weight simply by exhaling! Seriously, isn't it possible that in your excitement to have your own surgery....you may have inadvertently pushed her to join you? Sort of a bariatric surgery buddy system? Could she be exercising passive resistance with her non compliance, because she's not entirely sold on the idea? Just something you may want to consider exploring further with her...

Will, she has horrible edema issues because of heart trouble. Trust me, that makes moving any weight just about impossible.

That being said, otherwise your question is a valid one. Brandy, your mom needs to be fully on board herownself and fully understand what's to be done, how she will need to live afterward and what she will need to know to be her own advocate in the face of a pain in ass doctor, because they are everywhere and you will not always be available to run interference.

People who don't really LEARN this stuff tend to have poor DS outcomes.

 

[Elizabeth N.]

Your mom is also going to have an inferior outcome with the other procedures, I'm afraid.

 

[JackieOnLine]

Brandy - do you know what type of computer she has tried to use? seems like slow typing is OK as long as you are comfortable - maybe something portable so she can sit outside or a tablet...I don't know how people post on a phone, they are too small for me.

there is so much fun on the internet - sure would like to see people get more comfortable with it.

sometimes I am talking to patients at work - frequently they are elderly - and they "hate" the computer. sometimes I try to get them interested but have not had any success so far.