Checking in.....3 months and 10 days post-op

[Amey]

Dr. Simper has seen my friend and talked with him a few times. He was with me at all the classes and when I went for my surgery and each of my doctor visits with him. Dr. Simper has already agreed to take him on as a patient.....It's just an insurance game now.

 

[southernlady]

Amey, does he have reg Medicare or a Medicare Supp or Medicare Advantage? Each one is slightly different but they are ALL suppose to follow original Medicare rules.

Also as LONG as he meets the standards to have Medicare cover WLS in the first place (over 40 BMI with no comorbids and over 35 with comorbids, and very few comorbids accepted except for the big ones like diabetes, sleep apnea), he SHOULD be able to get Medicare to cover a revision.

However, how much he pays out of pocket is dependent on which way he is covered. JUST Medicare...it's only 80% with him owing the other 20%. With a Medicare Advantage plan, many are 100% after a yearly deductible (mine was 245.00 back in 2011) and copays (40.00 each for the specialists) for visits are paid.

 

[Larra]

@Amey that is great that he has an experienced ds surgeon lined up. Now get him over here to be part of our community. @southernlady is our Medicare expert and it sounds hopeful. He'll need to understand what he's getting into, esp with this type of revision, which is so much more complex than a virgin DS or lap band to DS revision. This isn't for the faint of heart, but it sounds like he really needs it.

 

[Amey]

He is on disability due to the tracheostomy and a few other physical barriers that would be either extremely alleviated or completely gone as a result of DS surgery. So....I'm not sure which Medicare he has....He said he has parts A, B, C, and D....whatever that means. He has an appointment with Dr. Simper on Tuesday so I'll know more then. And I will definately get him in this group and have him introduce himself. Thanks for all the help!!!

 

[southernlady]

He said he has parts A, B, C, and D....whatever that means. He has an appointment with Dr. Simper on Tuesday so I'll know more then.

Okay, Part A covers:
Hospital care (inpatient)
Limited home health services
Skilled nursing facility care, provided that custodial care isn't the only care required
Hospice care

Part B covers:
Services and supplies that are medically necessary to treat your health condition. This can include outpatient care, preventive services, ambulance services, and durable medical equipment. It also covers part-time or intermittent home health and rehabilitative services, such as physical therapy, if they are ordered by a doctor to treat your condition.

Some of the preventive services Medicare Part B covers include a one-time "Welcome to Medicare" physical exam, flu and hepatitis B shots, cardiovascular screenings, cancer screenings, diabetes screenings, and more.

Part C is the Medicare Advantage and combines Part A & B into one policy usually with a major carrier such as BCBS, Humana, UHC (to name a few). Like employer based plans, they can be an HMO or a PPO or even a PPFS. And the PPO can be regional, not nationwide.

Part D is the Prescription drug coverage and can be rolled into the part C OR had separately with A/B.

So if he has C, he has a Medicare Advantage plan and that may or may not include D (optional with a plan C) but most people get it rolled into the Medicare Advantage plan.

With Part A and/or B, you use the standard Red/White/Blue card that looks like this:

Notice that it has Parts A and B listed and the effective dates of the coverage.

IF you have Plan C, you put aside THAT card and use one issued by the insurance company that manages your Medicare plan. In my case, it's a Humana card. On it toward the top, it states" A Medicare Health Plan with Prescription Drug Coverage". It also has a group number and a member number that is NOT my SS #.

 

[southernlady]

@Amey that is great that he has an experienced ds surgeon lined up. Now get him over here to be part of our community. @southernlady is our Medicare expert and it sounds hopeful. He'll need to understand what he's getting into, esp with this type of revision, which is so much more complex than a virgin DS or lap band to DS revision. This isn't for the faint of heart, but it sounds like he really needs it.

NO expert, just been living with it as my insurance since 2000 when I got it due to disability. Until Dec 2011, it was my secondary. then it became my only option.

 

[CaraOC]

Hi Everybody!

I haven't checked in for awhile so I thought I would let you all know how I am doing, since I know you have been up at night wondering about me haha. I have been reading the posts but I haven't commented much because it's a pain on my phone and for some reason this site freezes my phone when I try to post.

Anywhoozle....I had DS surgery on June 10, 2016 with Dr. Simper in Salt Lake City, UT. I weighed 340 the day before surgery....and to be honest that was the highest weight I have ever seen. I was mortified!!! On Friday, September 16th I weighed 283.6 for a loss of 56.4 pounds in 14 weeks. I met my 3 month/25% of EWL goal with 3.6 pounds to spare (my goal is 140, I am 5'7")....so I would say I am on the right track. I have not had a stall (knocking on wood and throwing salt over my shoulder!!)

I have lost 2 pants sizes and am almost in a size 22. Before surgery I think I was a 28 or 30. I couldn't get my size 24 Gloria Vanderbilt Amanda jeans over my thighs and I had to buy stretchy Walmart 4X elastic waist pants that were not very loose. So I'm not really sure what size I was. I am wearing 24s now but I have to put them in the dryer (HUGE NSV - I have NEVER put jeans in the dryer!!!) or they fall off me and they are really loose after an hour of wearing them. BUT the 22s are still too tight to wear all day without fearing a busted thigh seam or a stomach ache. I'll get there.....

I have had my 3-month labs done and have got some of the results back. I will be posting my trends spreadsheet because I am concerned about some results....I think I need to double up on a couple things. BUT the biggest difference is that all my cholesterol levels are DOWN and my good cholesterol is UP. WHAT?!? My triglycerides have been decreased in half. I was shocked!!

AND my ferretin that was so low before surgery and I was trying to get an infusion (it was in the 40s) is now in the mid 70s. How does that even happen? I was taking 3 Proferrin a day....and they were going straight through me and giving me horrible diarrhea....I was cutting the pills and crushing them and I was still not absorbing them. So on a hunch I switched to Ferrofood on July 17th. The difference was immediate and amazing! No more greenish-black diarrhea, no stomach cramps.....I had normal tan-ish/gray poops for the first time since surgery and I even went through a week of constipation for the first time in my life (let's not do that again mmmkkkayyy!!) and after that everything was fine and I'm NORMAL for the first time in my life I have a predictable bathroom schedule. Going from IBS-D that kept me home from work at least a couple days a month to 1-2 times a day perfect poops is AMAZING!!!

I have had absolutely NO REGRETS!!! NONE!!! Sure, I miss some foods (like an alcoholic misses vodka)....but I would never trade a plate of garlic bread for everything that I have gained! I have more self-confidence, energy, my knees don't cry when I walk up the stairs at night!! And I actually want to get out of my house and do things (I didn't say exercise....let's not get crazy!!) like go for drives and go to a movie and put make-up on and do my hair. I didn't realize how totally exhausted I was .....I really didn't care about my appearance or if I left my house for anything but work and food. WOW!!! What a difference 3 months makes!!!

When I was going through hell with my insurance company and working with @DianaCox and @Larra to get approval I promised them that I would pay their kindness and hard work forward and that if I could help anyone else that I would. I can say that I am fulfilling that promise. I have a friend that has a failed RNY that is going through the process to get a revision to DS with Dr. Simper. My friend has been with me through the surgery and hormonal head spinning and levitating and for some reason he still wants to be my friend. He has medicare and of course they are giving him grief and has had to cancel the initial appt with Dr. Simper twice...but we are not giving up. If he gets a denial then I'll be sending him here to see if Diana and Larra can help him.

So.....that's my 3 month story.......and it has probably taken you that long to read this lol.

Thank you soooooo much for everyone's support and not letting me give up when I was trying to get approved. I LOVE MY DS!!!!

This picture is the day before my surgery and about 2 weeks ago......


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I've been ebaying and donating the most of my closet. As much as I'm thrilled to be getting smaller I could cry over how much I can no longer use. I would highly recommend you stick with eBay and thrift stores as the pounds keep on dropping. I think it helps to not always wear stuff that are much too big. You have to wear stuff that you can really notice the shrinking you inside!! If you want to pick up the expense of a flat rate shipping box I'd gladly pass on to you some pants in smaller sizes. No cheap crap either. Fat as I am I got standards!!!

 

[Amey]

I've been ebaying and donating the most of my closet. As much as I'm thrilled to be getting smaller I could cry over how much I can no longer use. I would highly recommend you stick with eBay and thrift stores as the pounds keep on dropping. I think it helps to not always wear stuff that are much too big. You have to wear stuff that you can really notice the shrinking you inside!! If you want to pick up the expense of a flat rate shipping box I'd gladly pass on to you some pants in smaller sizes. No cheap crap either. Fat as I am I got standards!!!

That would be awesome! Thank you sooo much! I will most definitely take you up on your offer.... I am very thankful! At this point not wearing clown pants or being naked are pretty serious standards lol. Do you have a paypal? If you will PM your info and how much a flat rate box costs I would be happy to send you the money. This is very generous of you... Thank you!

 

[Amey]

@southernlady My friend has part C with the prescriptions. It's through Pacific Source. Dr Simper is out of the network but his office got him approved to see Dr Simper because there isn't a surgeon in the network that provides an RNY to DS revision. I'm hoping they don't give him a lot of flack to get surgery.... He really needs this!