Hello from Oklahoma

[august6star]

No, you aren’t wasting your time. I had to call every bariatric practice in the state of Tennessee to get mine.

Would this happen to be what you were requesting. My HealthChoice is not very helpful They can’t even give me the procedure code for the Surgery. https://oklahoma.gov/content/dam/ok/en/omes/documents/EGIDAdminRules.pdf

 

[southernlady]

Would this happen to be what you were requesting. My HealthChoice is not very helpful They can’t even give me the procedure code for the Surgery. https://oklahoma.gov/content/dam/ok/en/omes/documents/EGIDAdminRules.pdf

Looks like it. Is that the newest copy?

 

[august6star]

Yes, it is.

 

[Spiky Bugger]

Looks like it. Is that the newest copy?

I see only admin stuff, no lists of “medical necessities” for any procedures.

 

[august6star]

I see only admin stuff, no lists of “medical necessities” for any procedures.

I feel like everyone is just giving me the run around and no straight answers. I just want to quit and give in. Something is better than nothing with my health. I know that traditional DS would be best but my insurance requires at least a 50 BMI and I am only at a 40 BMI. I am trying to talk myself into the Roux en Y by looking up success stories, but then see the ones that regain. From what I have read, its different for everyone. They say that dumping is like hot flashes and I already have those. Anyone here that has had the Roux en y?

 

[southernlady]

I feel like everyone is just giving me the run around and no straight answers. I just want to quit and give in. Something is better than nothing with my health. I know that traditional DS would be best but my insurance requires at least a 50 BMI and I am only at a 40 BMI. I am trying to talk myself into the Roux en Y by looking up success stories, but then see the ones that regain. From what I have read, its different for everyone. They say that dumping is like hot flashes and I already have those. Anyone here that has had the Roux en y?

Their 50 BMI can be appealed but it will take time. It’s a made up by them arbitrary limit since Medicare, the NIH (National Institute of Health) and ASMBS (the governing body of weight loss and metabolic surgery) all consider anything over 40 fat enough without a comorbid.

 

[Spiky Bugger]

Their 50 BMI can be appealed but it will take time. It’s a made up by them arbitrary limit since Medicare, the NIH (National Institute of Health) and ASMBS (the governing body of weight loss and metabolic surgery) all consider anything over 40 fat enough without a comorbid.

And that was just lowered to, I think, 35.

 

[Spiky Bugger]

I feel like everyone is just giving me the run around and no straight answers. I just want to quit and give in. Something is better than nothing with my health. I know that traditional DS would be best but my insurance requires at least a 50 BMI and I am only at a 40 BMI. I am trying to talk myself into the Roux en Y by looking up success stories, but then see the ones that regain. From what I have read, its different for everyone. They say that dumping is like hot flashes and I already have those. Anyone here that has had the Roux en y?

I understand. I think we all do. But this right here…”I just want to quit and give in. Something is better than nothing with my health.” is what your insurance company WANTS you to do. AND, when you decide to have a cheaper (for them) procedure and it’s great for two or three years, and then it all goes south, and you get fatter and sicker and depressed, THAT’s when you find the “small print” that says, essentially, “…if you have ever had ANY bariatric surgery, even if you paid cash or were with some other insurance company, and even if that surgery didn’t work, you just don’t get another surgery paid for by us.”


You will find INDIVIDUAL RnY success stories, but you should look at the big numbers…those tell how well the different surgeries work for most people. With a BMI of 40, your obesity probably isn’t going to kill you in the next few months if you do all the homework and get whichever surgery you decide you REALLY want. “Want” as in “if it were all free and you could have whatever you wanted, which would you choose?”

There are studies. I’ll look for a link.

 

[Spiky Bugger]

Oh, and WHICH surgery is best for YOUR needs. This article https://pubmed.ncbi.nlm.nih.gov/34731300/
says:

Conclusions: Using SG as reference, RYGB was associated with highest resolution of GERD, whereas BPD/DS was associated with highest resolution of DM and hypertension. These findings can guide decision making regarding choice of bariatric operation.

 

[Spiky Bugger]

This kind of explains the outcomes. “Kind of” because it doesn’t show how many years out.

It appears that Sleeve Gastrectomy (SG) not only provides better weight loss and resolves Diabetes/Sleep Apnea/Hypertension and lowers “bad” cholesterol better than the RnY bypass, it is “the upper half” of the DS. That means that if it wasn’t “enough” to deal with YOUR obesity, you are already halfway to the DS.

For some people, like JackieOnLine , the SG was the right solution. For my sister, it was great for about a year or two, and then she regained all the weight she had lost and more. In my case, it was a failed LapBand that was removed. The chart shows that typically DSers‘ BMIs drop 17.99 points. Mine dropped 20 points. I’m not close to my “ideal” weight, but with effort…which I’m not used to making…lol… I could get there in a few weeks.

 

[southernlady]

The chart shows that typically DSers‘ BMIs drop 17.99 points. Mine dropped 20 points.

I’m the oddball. Mine dropped less than 14 points but it went from 35.2 to 22.

 

[Spiky Bugger]

I’m the oddball. Mine dropped less than 14 points but it went from 35.2 to 22.

I shouldn’t have used “typically.” It should have said ”…on average, DSers…” or ”the mean BMI drop.” So, you are probably QUITE NON-ODDBALL.

AND, you were a lightweight! Getting to your pre-op BMI was a major accomplishment for me; but then, I started at 53-and-change!

 

[southernlady]

I shouldn’t have used “typically.” It should have said ”…on average, DSers…” or ”the mean BMI drop.” So, you are probably QUITE NON-ODDBALL.

AND, you were a lightweight! Getting to your pre-op BMI was a major accomplishment for me; but then,
I started at 53-and-change!

That’s okay, I’ve been an oddball or an outlier since before my journey even started.

 

[august6star]

I see only admin stuff, no lists of “medical necessities” for any procedures.

I will have to talk with the HR at school, I guess. Hopefully they know what I am talking about.

 

[Spiky Bugger]

I will have to talk with the HR at school, I guess. Hopefully they know what I am talking about.

I don’t know that this is EXACTLY your insurance, but if it is, click on “Bariatric Services.” You will then see the hoops and can decide if you want to jump them.

ETA: This is a STARTING point, of the rules they make and want you to follow. They don’t always get what they want.

https://oklahoma.gov/healthchoice/providers/provider-manual.html