HELP! Just now "informed" I probably won't qualify for DS because BMI under 60

[writegirl]

The only words of wisdom I have is that we don't mind the "F bomb" on this site. I know it sounds helpless, yet I have faith in the women we have here who can move mountains and help get the DS approved.

Keep us posted. We are a very supportive community and we support the DS. I realize that not everyone is suited for the DS, but if one wants restriction and malabsorption, the DS is the way to go.

Thank you for being so understanding! I know that everyone here is incredibly supportive--I'm really lucky to have been told about this community early on in this process and I have learned more than I ever realized I needed to know because of this forum.

 

[writegirl]

Well, so, clearly fight for the DS, but the sleeve will work. Look at the data on this page, it's just not a well as the DS. - http://www.paclap.com/downloads/comparing-options-for-WLS.pdf So you could get the sleeve and then do a revision if you need it and you might not. But fight for the DS.

Also, I get the issue of you pay for health care and your surgery is NOT covered. I was so pissed about this too. I have a good job and I have good health insurance and they would only cover 8k. It's a business and that is a shame.

Thank you--I appreciate your supportiveness in this. The thing that I was trying to avoid was having to have two WLS because the first one wasn't the right one for me. My doctor straight up told me he would not recommend the sleeve for me because of the likliehood of significant regain. I suppose if I have no other option, I'll see if the insurance will approve me for a sleeve, but it's not what I want and not what my surgeon wants me to have. I definitely don't want the RnY. My sister has that and has had nothing but health issues ever since. She needs a hip replacement in May because she's been non-compliant with her supplements, but part of the reason she is non-compliant is because of the wretched dumping syndrome with RnY. Supplements have always caused her to get/feel sick and/or constipated.

Only in this country do we allow insurance companies to get in the way of decisions between a doctor and patient. It's outrageous!

 

[DianaCox]

Even if your insurance terminates, you can pay for COBRA coverage until you have surgery (at least six months).

 

[hilary1617]

@writegirl I am so sorry for this setback. I'm on your side and wish you the best. Go! Fight! Win!

 

[writegirl]

Even if your insurance terminates, you can pay for COBRA coverage until you have surgery (at least six months).

I don't think I can afford COBRA with no job. The cost is like $1100 a month for what I've been told.

 

[galaxygrrl]

I don't think I can afford COBRA with no job. The cost is like $1100 a month for what I've been told.

Look at the Affordable Care Act then. The whole point is if you can't afford insurance, you will qualify for Medicaid. You will have the opportunity to the end of the year. (As for the politics....don't get me started....)

Hang tough. Larra and Diana will help you out and you will get support from this board

 

[writegirl]

Tennessee is one of the states that rejected the Medicaid expansion. We have this crap system called TennCare and it's not as comprehensive as some of the straight Medicare is in other states. If you do not qualify for ACA here, they stick you on TennCare (if you're lucky). Our ACA market is actually quite expensive because our useless legislature rejected the expansions. But, I will look into whatever options there may be. I doubt any of them in this state would cover DS. They might cover a sleeve.

 

[Butterfly]

I want to just chime in my second-hand frustration that you're having to go through this. The people here are amazing, and I truly hope they can help you. We're here if you need to launch a few f-bombs and vent. Best of luck.

As for the sleeve: I was a tad over 500 pounds when I sought WLS. My insurance at the time would NOT cover any WLS so I took every penny I had in the world and got a cheapish sleeve. I got down to 299 pounds before I started to regain. I had people trying to tell me to get the RNY, but after a few other people told me about the DS I knew for sure that was what I need. I get it, I really do.

Then again, my BMI was off the charts when I started. Perhaps with yours being around 50, you'd be more successful?

 

[writegirl]

I want to just chime in my second-hand frustration that you're having to go through this. The people here are amazing, and I truly hope they can help you. We're here if you need to launch a few f-bombs and vent. Best of luck.

As for the sleeve: I was a tad over 500 pounds when I sought WLS. My insurance at the time would NOT cover any WLS so I took every penny I had in the world and got a cheapish sleeve. I got down to 299 pounds before I started to regain. I had people trying to tell me to get the RNY, but after a few other people told me about the DS I knew for sure that was what I need. I get it, I really do.

Then again, my BMI was off the charts when I started. Perhaps with yours being around 50, you'd be more successful?

Thank you for your support and perspective. Wow, you had significant WL with the sleeve! That seems to be the exception though, and not the rule. If I remember correctly, my surgeon recommended the DS because the overall WL with the sleeve is only like 8 percent of the BMI as an average. I may have that figure balled up--it was seven months ago--but I remember it was such a small percentage compared to RnY and especially DS. He would not recommend the RnY at that time because I suffer from pretty intense bouts of acid reflux and being able to drink while eating is something I value because it helps tamp that down. And... then there is the dumping syndrome with RnY. Since I teach for a living, I can't just abandon class to "go" in a hurry most times. My surgeon said that while dumping can still happen with DS, it's usually less of a life-issue than it is with RnY.

The sleeve may be my only option and, if so, it really sucks. I don't want a sleeve. I don't believe in it as a long-term solution. I see the sleeve as a bandaid for a WLS patient like me. I think the sleeve is probably perfect for someone who is a true lightweight. We bigger people will always find a way to be bigger--at least that's what I think after reading and researching so much about WLS (a good portion of it read here).

I'm not sure I want to go through surgery and put my body through that for a bandaid that will probably need a revision and it seems likely that with the renewed climate of predatory healthcare arriving with the death of the ACA, we'll see fewer revisions being approved by insurance.

I'm at a loss for what to do. I am in no way mentally prepared for a sleeve. I've prepared myself for life with DS, not life planning for a revision to DS while my sleeve procedure disappoints me and starves my body. I mean, there is a story about some poor woman on the sleeve forum who is living life drinking medifast and some other horrid protien liquid in order to lose enough weight to get her knees replaced. I hope someone has warned her that life like that is A.) not sustainable and B.) seriously sad. My heart breaks for her--but her story seems pretty indicative of life with a sleeve if you don't want to regain.

 

[galaxygrrl]

Take a deep breath, you have not had the good fight yet. Diana and Larra can help. See where you end up first after going through the appeals process.

 

[writegirl]

Take a deep breath, you have not had the good fight yet. Diana and Larra can help. See where you end up first after going through the appeals process.

Maybe I'll slip through and get approved. It's not likely, though. I'm panicked about not having the time to appeal before I lose my insurance. I am applying to every job at the university in hopes they'll hire me to do something--anything--full time. I know Diana and Larra can work miracles. I don't know how they do it, but they're angels on earth! Thank you for reminding me to breath.

 

[Leeayn Byrd]

my insurance had something to the effect of "Malabsorption surgery BMI must be 50+"
BUT.....I had HBP, Diabetic, GERD, joint pain, Hiatal hernia, producing estrogen (I am a cancer survivor and needed the weight OOF to stop producing estrogen).....
My BMI was 41, I was approved on the first shot, no appeal needed.
So don't panic. If Insurance denies, you have the right ladies above on your side

 

[Susan in Tennessee]

Tennessee is one of the states that rejected the Medicaid expansion. We have this crap system called TennCare and it's not as comprehensive as some of the straight Medicare is in other states. If you do not qualify for ACA here, they stick you on TennCare (if you're lucky). Our ACA market is actually quite expensive because our useless legislature rejected the expansions. But, I will look into whatever options there may be. I doubt any of them in this state would cover DS. They might cover a sleeve.

None of the policies I found cover Bariatric surgery of any kind here in TN.

Before ACA I had a policy I purchased through the state which was for people who had been turned down by other companies. It still had a hefty premium but st least I. Could get it. It was BCBS and had the high Bmi stipulation for DS.

At that time I wasn't a member here so knew nothing about possibility of overturning the requirement so I put things off because I knew The gastric bypass or Rny was not for me. If I'd only known. That policy was terminated when ACA became available. I feel your frustration.

 

[k9ophile]

Tennessee is one of the states that rejected the Medicaid expansion. We have this crap system called TennCare and it's not as comprehensive as some of the straight Medicare is in other states. If you do not qualify for ACA here, they stick you on TennCare (if you're lucky). Our ACA market is actually quite expensive because our useless legislature rejected the expansions. But, I will look into whatever options there may be. I doubt any of them in this state would cover DS. They might cover a sleeve.

Yeah, but we don't have income tax. Snort! (Not everyone appreciates my sarcasm.)

In all seriousness, TN's unwillingness to participate in ACA is damned near criminal. I have a dear friend who lost her full time job and went through hell finding an ACA policy that would work for her and that she could afford, then that went kaput. Her second go-round was as bad as the first. She finally got a full-time job with insurance. I have Medicare and a good secondary; I feel blessed and incredibly lucky.

 

[DSRIGGS]

I wish you well. The VSG will result in weight loss, but the problem with the VSG is that the weight doesn't tend to say off long term and for the VSG to work a person has to be vigilant in adhering to a very low calorie diet. That is obviously much easier said than done.

For me the DS is the only procedure I ever considered.

As Larra and Diana have stated get your EOC and get going on the appeal. If it doesn't strictly prohibit coverage they will help you find a way win your appeal for the DS.

Best wishes.