Hi from Texas!

[brooklyngirl]

Actually, it wasn't a cot...just a cheap-ass army bed of the Basic Training variety. I misspoke. Or exaggerated. Or lied, but only a little.

That's a cot in my book!

 

[DianaCox]

OK, insurance "guru" here (I have spent the last 10 years helping people get insurance approval for the DS, along with Larra for most of that time).

The DS is a standard of care procedure, and if you qualify for ANY bariatric surgery, you should be able to have the DS. But insurance companies are mostly ********, and try to put in "policies" that deny access to MOs and limit the DS to just SMOs or SSMOs. But if you appeal, you can almost ALWAYS win. What you need to see is the EOC (Evidence of Coverage), an about 80-100 page document that specifies the conditions of YOUR plan (what YOUR company paid for). You get that from your HR department. You also need to ask if your plan is self-funded or fully funded.

Yes, sleep apnea is a serious comorbidity, and yes it can help argue your case - but bottom line is, anyone who qualifies for bariatric surgery should be allowed to get the DS, if they and their surgeon agree. @Larra and I may be able to help you.

 

[Parousia]

Hi all,

I am preop and still trying to figure out which procedure would be best for me.
I have a consultation with Dr. Ayoola next month (11/10), but they've already told me my BCBS (Federal) wouldn't cover DS at my BMI (41) without comorbidities. I haven't been to a PCP in years, so I have an appointment on Tues to do bloodwork and start a history in hopefully one place. Dr Ayoola's office sent me what they would require preop so I can get it done at the same time. I am in the process of gathering some medical records from various places to have a medical history. That being said, if I really don't have comorbidities, I'm not sure the "best" procedure for weightloss and maintaining that weightloss (DS) is best for me? Is it overkill? My 2nd choice is VSG. There is something about the stomach just hanging out in the RNY that just creeps me out.

Anyway, my name is Connie. Single mom to one teenage boy, 2 Frenchies, 1 Doberman, and a Fat Cat that could probably also benefit from VSG, but then who would keep our feet warm in the winter?!

Welcome Connie .

 

[southernlady]

And @Purple Frog, if you want/NEED Diana and Larra to help you, and do not want your entire medical history on the forum, just click on one of their names and a overlay will pop up and an option on there is "Start a Conversation", Make sure to add the other one as well once you get the box open to start the conversation.

They WILL need to see a copy of your Evidence of Coverage at some point but they DO help many get the surgery they need.

 

[southernlady]

Actually, it wasn't a cot...just a cheap-ass army bed of the Basic Training variety. I misspoke. Or exaggerated. Or lied, but only a little.

Yeap, slept in enough of those damned things...but I was MUCH YOUNGER, and my back had not gone to hell.

There were two types of military cots...the one above that was what was found on base and was "permanent". Then there was the folding wood or metal AND canvas variety that was what we got out in the field. Assuming we weren't just on the ground.

 

[JackieOnLine]

Hello, Purple Frog!

 

[Purple Frog]

Thank you, Diana! I just called and they are closed for the weekend. I'll try again Monday.
It's federal so I'm thinking fully funded, but I'm honestly not sure what those 2 terms even mean. I googled, but that didn't help much.
I always feel like I can be/sound more assertive if I know wtf I'm talking about.

 

[Elizabeth N.]

Then you absolutely NEED one. Like NOW.

 

[robs477]

Maybe I please disagree with you, Rob? Just a teensy bit?

WTF do you mean you can fake sleep apnea and it's easy?! I may have to hit you over the head with my now-unused
Bi-Pap machine, if you keep this up! LOL

FIRST, you have to get tested. Christ, that's fun. I'm an army vet, so I got to go to the VA (it was free that way) and take my jammies and have some psycho glue electrodes to my scalp with some concoction that was pretty much glue, wax and dried up bugers. They next morning...after I spent a night sleeping ( trying to sleep) with some guy I'd never met...usually I require at least a kind word and a mojito...they try to remove the goo with some tincture of emu piss or something. Whatever clothing it lands on is instantaneously out of service.

And the sleeping part...the test only works if you sleep...on an army cot, with some guy across the room, ugh. I have had the test on two other occasions, more elite surroundings. But it is NOT a fun experience.

Then...the results! When you get them and learn that your obesity is causing...over and over, all night long...your lungs to cease functioning! It is, my dear, a bit of an eye opener.

Sleep apnea may SEEM like a fake, because it doesn't hurt...but it can kill you. AND, if you get diagnosed with it and get a good fit and figure out how to use your BiPAP or CPAP, the first night you get some sleep with that thing is like a whole new life...it's really great.

You may have it.

Get tested and maybe you will enjoy a really restful slumber, too!

Please dont hurt me spiky! You are absolutly right...I worded that a little sloppy. FAKE was the wrong choice of words. I have been using a CPAP machine for TWELVE years and I LOVE it!!! I can get six hours of oxygenated sleep and wake up rested and ready to go! I tell everyone that the worst part of having it is, I dont get to take naps anymore, sometimes those are fun!

So....I DO know about sleep apnea. The point I was trying to make is, theres a good chance that she has it (high % of overweight people do), and could maybe do a few things to "Enhance her chances for diagnosis".

 

[robs477]

Welcome @Purple Frog

I had the RNY back in April 2009 ==> Best decision I've ever made in my adult life.
I was 438 pounds at my highest weight and am happy to say I've maintained a weightloss of 200+ pounds. I personally don't think there's anything creepy about the procedure. I think my pouch is awesomeness LOL -- To each their own though.

Here's wishing you the best of luck in whichever procedure you choose. BF.org is a wonderful community and will be here to support your WLS success!
Again welcome. Enjoy and happy posting.

J.

Yes, to re-iterate...one size does not fit all. The RNY or the VSG works out great for some folks, that’s very true. For me it wouldn’t because I need more malabsorbtion, but as J said, she is a true example and success story.

 

[Purple Frog]

Then you absolutely NEED one. Like NOW.

Will do!

 

[Spiky Bugger]

Please dont hurt me spiky! You are absolutly right...I worded that a little sloppy. FAKE was the wrong choice of words. I have been using a CPAP machine for TWELVE years and I LOVE it!!! I can get six hours of oxygenated sleep and wake up rested and ready to go! I tell everyone that the worst part of having it is, I dont get to take naps anymore, sometimes those are fun!

So....I DO know about sleep apnea. The point I was trying to make is, theres a good chance that she has it (high % of overweight people do), and could maybe do a few things to "Enhance her chances for diagnosis".

Oh...you're one of those "go buy some rolls of quarters on your way to weigh in" people? I knew I kinda liked you!

 

[more2adore]

Welcome @Purple Frog !

And @robs477 - I can tell you with 1000% certainty that my SEVERE sleep apnea was KILLING ME SLOWLY. Not only was the night of the sleep study one of the, if not THE, single worst experience of my life (fully in agreement with @Spiky Bugger on everything except the cot!) But I was ceasing to breathe more than 40 times per night! My brain was severely deprived of oxygen. Years of never getting quality sleep destroyed my immune system and caused me to fall asleep all day long, and while driving! When it was at it's worst, I can tell you that life was not worth living anymore. Definitely not something I could've, or would've wanted to, fake.

*oh, and it also ****** up my heart. Years of the repeated cycles of not breathing and my heart speeding up to try to get more oxygen to my brain and then slowing down once I started breathing again, gave me AFib and SVT. I was at a high risk for a stroke because of those things as well. I don't think I would've live to see 40 if it hadn't gotten addressed.

40 times per night, or per hour? The number they give you (AHI = Apnea/Hypopnea Index) is per hour. If yours were 40, you had 40 flow limitations (breathing restrictions) of some type per HOUR.

Mine was 120 per hour! You can bet your ass I was on CPAP religiously the second they gave me one.

 

[brooklyngirl]

40 times per night, or per hour? The number they give you (AHI = Apnea/Hypopnea Index) is per hour. If yours were 40, you had 40 flow limitations (breathing restrictions) of some type per HOUR.

Mine was 120 per hour! You can bet your ass I was on CPAP religiously the second they gave me one.

Yes, I think you're right! I guess I've tried to block out that entire experience!

 

[Larra]

Hi and welcome, Purple Frog (love that name)

You are ahead of the game in that you have already figured out that the insurance company people you speak with by phone are clueless. What's more, they are just putting in their hours and have no real concern for any individual hapless enough to need their help. And they are not experts on the bariatric surgery part of your policy, they get questions about everything. bottom line, no one cares more about this than you.
Get your policy - you are entitled to it, either online or on paper. Read it for yourself. Know what you need to have wrong with you to qualify for bariatric surgery in general and the DS specifically. Also learn your appeals rights, in case you request authorization for the DS and get a denial, which happens...a lot...but which can be successfully challenged in many (not all) cases. IMHO having 125 lbs to lose is plenty for the DS, even without comorbidities, though your insurer may disagree.