Advice needed

[Saranlhess]

This is a continuation of a insurance discussion from previous thread of mine

I need advice (please be gentle as I'm really in my feelings right now) I just got a message moments ago from my surgeon AFTER completing all of the testing (short of the ekg and abdominal ultrasound, scheduled for the 17th) just got blindsided.

To get into their program I was required to attend the seminar and get insurance approval BEFORE they would even accept me. This took 3 months. Done.

It's been a total of 9 months on this journey and I've lost 65lbs by myself, which have been extremely hard as I struggle with a lot of medical issues.

I was offered 3 surgeries and I chose the DS, it took 9 months for me to mentally be able to choose myself (not including the 17 years that I have already put this off because I was terrified I would leave my children without a parent as I am their only safe parent) I feel like the rug was pulled out from underneath me.

They took 3 months to accept me and get insurance approval to offer me something I would never even have approval for....it doesn't make any sense.

The surgeon's message said the insurance will cover sleeve or bypass and he suggests bypass.

Any advice or input is apprecia
ted.

 

[southernlady]

Read your policy.

If necessary, call your insurance company.

Don’t settle for the RNY given your requirement for NSAIDS.

 

[Spiky Bugger]

What state?

 

[JackieOnLine]

To get into their program I was required to attend the seminar and get insurance approval BEFORE they would even accept me.

The surgeon's message said the insurance will cover sleeve or bypass and he suggests bypass.

oh, I wonder why they either didn't bother to really find out if you could have any of the surgeries or if this was the plan all along.

no wonder you are feeling this way, it is inexcusable to blindside you this late. (and I can't help thinking how much faster and therefore profit making the bypass is)

please, please don't feel like you have to settle for a Rny, there is a good chance they assume you don't have the strength to fight for what you need.

It's been a total of 9 months on this journey and I've lost 65lbs by myself, which have been extremely hard as I struggle with a lot of medical issues.

this is how we know you do: not just losing a big chunk of weight but jumping through all their hoops. that takes a LOT of strength.

don't give up, is what I'm saying. it really matters which surgery you get.

@DianaCox

 

[Saranlhess]

What state?

Illinois

 

[Saranlhess]

Read your policy.

If necessary, call your insurance company.

Don’t settle for the RNY given your requirement for NSAIDS.

I'll be contacting the insurance for an up to date policy on Monday as they still have not sent out the requested policy handbook and online I was able to find their 2022 version.

oh, I wonder why they either didn't bother to really find out if you could have any of the surgeries or if this was the plan all along.

no wonder you are feeling this way, it is inexcusable to blindside you this late. (and I can't help thinking how much faster and therefore profit making the bypass is)

please, please don't feel like you have to settle for a Rny, there is a good chance they assume you don't have the strength to fight for what you need.



this is how we know you do: not just losing a big chunk of weight but jumping through all their hoops. that takes a LOT of strength.

don't give up, is what I'm saying. it really matters which surgery you get.

@DianaCox

If he's pushing RNY on me, then I'll stop going to Him, as I will not get a surgery, especially one of this caliber, that I don't want. Now knowing how beneficial DS would be to me. First step (now that I have a clear head) is contacting them on Monday morning for an updated policy as I've requested one and have yet to receive anything in the mail. It's been months and there is no excuse as the mail does not take that long.

 

[Saranlhess]

I appreciate all of you for being in my corner and constantly giving me guidance, especially when things like this happen. Thank you!

 

[Saranlhess]

I take that back, after doing some research I was finally able to find the 2024 member handbook online. I'll be going through it this weekend and contacting the insurance Monday. Update to come ASAP

 

[JackieOnLine]

go, you: that's the spirit!!!

 

[southernlady]

Okay, you may need to switch to a new surgeon. There are known DS surgeons all over. Okay, I’m drawing a blank but there is an excellent female surgeon in Carmel, Indiana.

 

[Spiky Bugger]

Susie the Skeptic checking in…

I wonder if they ever intended to provide you with the DS. I wonder that because his info with ASMBS lists a few bariatric surgeries but not the DS.

In fact, it looks like bariatric surgery is kind of an afterthought to all the other stuff he does.

https://asmbs.org/provider/james-lau-md-mhpe-facs-pyWo/

 

[hilary1617]

I had DS at UChicago. Excellent surgeon; it's been more than a decade, so not sure if he's still taking DS patients, but the office likely is.

 

[Hiddenrose]

OH! A current thread about an issue I'm also on the edge of! I'm SO very sorry you're having to fight a similar battle as I am. That said, I was up until yesterday scheduled for the Roux-y surgery to be done in AR on July 2 and finally had the oomph to give some push back asking if I could get the SADI-s, since my BMI is around 60. I was told to expect insurance to reject it because it is still considered 'experimental', even though it's just a frequently done part 2 of the Gastric Sleeve that they tend to do as a revision surgery. I did push back a bit myself, though, and they are TRYING to get insurance to cover it. I expect a battle, honestly - everything else with my insurance has been so far!

I, too, am hoping (as stated in another thread) to be able to one day take NSAIDs, have a family history of GERD, and PCOS. I have a lot of inflammatory medical conditions including spinal degeneration and I have a friend who is in a similar boat who DID get the Roux-y (and already had a hernia in her new stomach plus feels unable to control how much weight she continues to lose) and I don't want that outcome! I will say that I'm no as far from you as I could be; traveling about 2 hours to Rogers, AR to see my surgeon, and he does a lot of DS surgeries from my limited understanding.

 

[aaa]

Good job in realizing the RNY wasn’t for you if you hope to be able to take NSAIDs. I knew I wanted the option to be able to take them when I had my TDS 19 years ago, but it was never really necessary till 3 years ago when I began breaking my feet and ankles. Believe me, if I had trouble with painkillers or couldn’t take NSAIDs, I’d be in a world of hurt.

 

[Saranlhess]

Susie the Skeptic checking in…

I wonder if they ever intended to provide you with the DS. I wonder that because his info with ASMBS lists a few bariatric surgeries but not the DS.

In fact, it looks like bariatric surgery is kind of an afterthought to all the other stuff he does.

https://asmbs.org/provider/james-lau-md-mhpe-facs-pyWo/

Thank you for finding this! Reading it now.