Hi all, I'm new

[chevtow]

Hi everybody, got turned onto this site by Larra.

My name is Russ, I'm 41 and from Green Bay - GO PACK !!

I've been obese since about 12 years old. 4 years ago I managed to drop 150 lbs by going strictly low carb and working out (started losing during previous 6 month supervised weight loss). Gradually started putting it back on till I tore my rotator cuff, then the weight just flew back on. Now I'm heavier than ever, and just herniated my 2nd disc in my back. The weight no longer wants to come off

I'm sold on the DS for the quick and long term weight loss, plus I can eat mostly "normal".

I'm also wondering if any members have used University of Chicago for DS? They are listed on DSfacts but it's always nice to hear from someone who has "been there and done that". I do have my initial consult with a surgeon, psych, and dietitian 4-9-14.

Other question I have is about the 6 month supervised weight loss. I called my insurance company and 3 different people told me 3 different answers about if it is required. Then I asked for a copy of my policy, and was referred to their website - read the whole thing and NO mention of 6 month. But I also found something from them that says it is required - it was listed under provider forms. Ticks me off a bit that there seems to be hidden requirements. Think if I appeal right away, because my policy says zip, that I'd have a fighting chance? Or just a waste of time? Don't get me wrong, I'm happy it's covered, but they should be more transparent and their people should know what they are talking about.

Thanks for any help and all the informative posts I've already read !!

 

[Parousia]

Hi Russ, sorry I can't help with any of your questions (I'm Australian), but I just wanted to say "Welcome!" Good to have you on board. Your story is one that will be familiar to many of us here.

Edited to correct name and typo. Apparently I'm going blind!

 

[Patriciakindep]

Hello Russ!!!

I am not from your area, nor do I know much about anything. I am a newbe... I just had my DS 5 weeks ago. I can tell you this, a friend of mine had her surgery at a hospital about an hour away from mine. We have different insurance companies. She needed to lose 10% of her body weight before surgery, I did not have to lose anything. I'm not sure if it differs from Dr to Dr or between insurance companies, maybe both.

Don't fret, someone here will surely know the answer or at the very least how to get the answer. You are in good company here!

Now, to why I started a response at all... I wanted to welcome you and wish you good luck! (Wow, that was a long response just to get across a polite welcome.) LOL.
:Rant-On:

 

[southernlady]

, Russ.

Glad you found us. As to your policy, you should have the copy of your Evidence of Coverage that was sent to you just before it went active or as a downloadable link to your "signed in" section of your insurance company's web site.

Do not go by what is told to you, check what is actually in writing.

Story: my dh is also a DS'er, his insurance company (United Health Care) according to the STANDARD policy, UHC had a 6 month diet requirement BUT his company had overridden that and only a five year history was required and since his BMI had been over 35 with a history of sleep apnea, he easily had the 5 years.

So read your own policy!

 

[jim1969]

Welcome Russ! I had checked into the University Of Chicago and if you don't have a BMI of 50 or the high 40's with extreme diabetes they wont do the DS.

 

[Spiky Bugger]

Yeah, Russ. Welcome. And look for stupid stuff in your policy/evidence of coverage.

At the time, my insurance "allowed" the DS but required that ALL bariatric surgeries be done at a bariatric Center of Excellence. Except....except...wait for it...NONE of the surgeons who performed the DS in my state practiced at a COE.

I did not deal with the customer service people at the insurance company. I simply emailed EVERY in-network bariatric surgeon in the state who did bariatric surgery and asked if they did the DS...the answers were all "no." THEN I wrote to the ins. co. medical director who wrote back and said that if the policy said it was covered, and my doctors recommended it, then it was covered.

Then I contacted their legal department and explained that they were essentially telling me that I could order a cheeseburger, a chicken salad or the lobster/filet mignon dinner, but requiring that I order at a place with a drive-through window. I told them that they were effectively denying a benefit I was paying for...unless THEY could find me an experienced DS surgeon who practiced at a COE. And that the state Department of Insurance could probably explain my position better than I could, so maybe I should just go that route.

And I got approved. Like the next day.

And then I had the surgery.

And then they denied it.

But I had the pre-auth in hand, so they did pay.

Keep in mind that certain procedure codes are denied AUTOMATICALLY. And, when you are finished with :BangHead:, try to chuckle maliciously and whisper to the now-gone person you last spoke to, saying something like, "Just you wait, you (expletive of choice), just you wait."

And then go back to work.

 

[chevtow]

Hi Jim, I remember on the other site that you were unable to use U of C. Unfortunately I have over 50 BMI, so no problem there.
Did you look into Bariatric institute of Wisconsin in Milwaukee? They are a Center of Excellence and do the DS. I also have heard of a doc in Stevens Point that does it but have not checked into him at all. Just thought I'd throw those out there for you to look into

 

[hilary1617]

Hi Russ,

I had a DS with Dr. Alverdy at University of Chicago. He's an excellent surgeon. He provides individualized care and didn't insist on strict adherence to some arbitrary BMI cutoff for DS, though that is a typical insurance hurdle. They do insist on a lot of pre-work, which I think is a good thing, though it was frustrating in the moment.

Please feel free to PM me with any questions.

Hilary

 

[JackieOnLine]

Hi Russ!

 

[Kate]

Welcome Russ!

 

[BrianChesteen]

 

[chevtow]

Thanks for the warm welcome everyone!!

Southern lady I actually have UHC as well, so perhaps my wife's company also overrode the 6 months thing since I see hide nor hair of it in our policy.

 

[newanatomy]

Hi and welcome! So glad you found your way here.

 

[shann]

I had UHC when I had the surgery, and the 6 month diet was required. It all depends on what the company chooses.

 

[huneypie]

That avi wasn't there a few minutes ago *like*