Is there any help for my mom!!

Brandy Rediker

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Jan 7, 2014
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As some of you know by reading one of my post my mom has United HealthCare Medicare Complete. They require that she lose 6 lbs during her 6 mos supervised Diet with her PCP. Her problem is swelling. My mom no matter how much water pills she takes just can't get that swelling off her. They changed her meds from lasix 40 mgs twice a day to Bumetanide 1 mg once a day. That's not even working. Her poor feet are so huge they look like balloons. She has a history of CHF and I know she's in AFiB right now, so I don't know if it's the AFib or not. The dr. says there is no fluid on her lungs so that's a good sign it's not CHF, so I'm honestly wondering if the Afib is keeping her from losing her fluid. Do you guys thinks she can get around this and still get approved with her insurance for the WLS? She is going on her 4th month and still hasn't lost 1 lb. She's doing good with eating healthy foods, just can't lose anything because of the fluid. It's really heart breaking because she wants this surgery so bad and she's afraid she'll have to go another 6 mos again. =(
 
Is the doctor sure it's not Afib? When my brother had CHF he had the swelling and ascites, but his lungs stayed clear. Lasix never worked for him. I think he ended up taking Spironolactone... though I believe that the medication for CHF (beta blockers?) was what turned him around as far as the fluid retention was concerned.
 
What exactly has she been eating? Is she tracking her caloric intake and really being honest or is there a chance that she's not telling you that she's eating other things that could be sabotaging her. I say this not to be accusatory, but there are lots of people that hold outdated or skewed views of what's "healthy". Example- I saw someone recommend that another person eat lots of sushi with white rice to fill up their stretched out sleeve to prevent overeating, she really thought that eating white rice would expand in the stomach and fill her up and didn't seem to get the fact that it would equal massive amounts of simple carbs. Plus, I'd be pestering the doctor to try different meds, 2 tries aren't enough to give up in my book.
 
What kind of sadistic SOB is requiring pre-op weight loss in a person her age with her issues??? Did you check the Medicare Guidelines for bariatric surgery?? There is NO requirement for pre-op weight loss. Call a MEDICARE ombudsman and get them to tell UHC they have NO RIGHT to require any pre-op weight loss!
 
No she's been eating pretty good, I fix most of her meals she loves having her veggies steamed with her fish or chicken. I only season her foods with Mrs. Dash. She's always had problems with this swelling for yrs, specially in her legs and feet. Her feet turns dark purple when she sits to long, her heart dr. said this was from her retaining so much fluid. I'm gonna see what the Dr. thinks, if they can either up the dose on this new water pill or change her to something different. @KathyF yes ma'ma she is def. in Afib. They've (heart dr.) has tried twice to convert her back over but both times it failed. Her heart dr. is thinking her sleep apnea is the culprit for keeping her in afib. Also they did a x-ray on her lungs they are clear. I just don't know what to do about this swelling. I'm sorry I stated that she didn't lose 1 lb in the last 3 months but she did, she lost 2 lbs according to her heart dr. not by her PCP. But, she's already gained that back with the swelling. I'm def. gonna have them fax her weight over to her PCP so that she has this in her records that she did lose 2 lbs it's on record. Her heart dr. wants to be notify at all times of everything that is going on with the process with the WLS. He's the one who recommended her to have WLS and is encouraging her to stay with the process. I will contact her PCP to see if they can up her dose on the new water pill. I'll keep you guys posted on what she does for my mom.
 
I don't think she should have to play this game, but if she MUST stick with these rules/barbarians, then maybe try compression stockings on her legs and keeping her feet up for several days before the weigh in, and NO salt the week before. Drinking lots of water at the beginning, so the body will allow itself to quit hoarding it when it thinks there is an infinite supply. She can pee out more than that in a day, if the stars align.
 
I lost 11 pounds in my preop liquid diet. Maybe she could go on full liquids right before her final weigh-in?
Bless her heart-- I hope you find the answers!!!
 
@bearmom I'll have her try that with her socks. I was thinking of just giving her protein drinks for breakfast and lunch then a regular meal for dinner. I think this will help bring down her weight. What do you guys think?
 
This is just cruel. Can't you fight the insurance company, she has a co morbidity that makes it impossible to know if she losesweight or not..
 
@Brandy Rediker I had AFib that a cardiac surgeon jumped to do an Ablasion on, but never addressed the fact that I had SEVERE sleep apnea. The Ablasion was like a bandaid, a temporary fix for an underlying problem that should've been addressed first. Has she had a sleep study?
 
@brooklyngirl yes she's had sleep apnea for over 4 yrs now. She just had another one done and she's now on a bipap now. This was done just recently. Her heart dr. thinks her sleep apnea is not controlled so she has to see the sleep apnea dr. who read her report to see if he can help get her sleep apnea under control. Sleep Apnea is a silent killer, it causes all kinds of problems. 10 to 15 yrs ago nobody knew about sleep apnea and what it can do to your body.
 
I gained 88 lbs waiting to have surgery. I have lymphedema and my swelling was out of control. Lasix never worked for me. Triamterene which is potassium sparing works. I had a letter from my therapist and lots of pics and food journals, every month my PCP noted my swelling getting worse. I think that helped them ultimately go ahead with surgery.
 
Any possibility her docs, who seem to be very supportive, could either write strong letters on her behalf and/or do a physican to physican phone conference with a physician employed by her insurer? The more we learn about her, the more her need for bariatric surgery becomes apparent.

One other idea is that if she goes on near complete bedrest for a few days and takes whatever dose of diuretics her docs think is maximum for her, THEN goes in for the final weigh in, she may pee off enough fluid to meet this requirement, though the improvement will be temporary. But heck, if she can get to the magic number on the scale, the insurer will have to cave in. Bedrest with legs elevated helps to mobilize fluid, which then makes her kidneys work overtime peeing it out. But it really needs to be near complete bedrest with the legs elevated.
 
@Brandy Rediker

If you haven't already read it, the requirement sections (for members who do not live in one of the states listed on the following pages) starts at the bottom of page 3, AND MENTIONS making "A DILIGENT EFFORT" blah blah blah with those EFFORTS MENTIONED in the medical record, which her PCP has done...or will do, right? (Ask the PCP to use the exact wording...a "diligent effort" in her record.)

Print it out...take it to the office of the doctor who is requiring the specific weight loss and ASK, "Where does it say a specific number of pounds? All I can find is that she makes a diligent effort, which she has been doing. Where is this other requirement coming from and how do we appeal it?"
https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/Tools and Resources/Policies and Protocols/UnitedHealthcare Medicare Coverage/Bariatric Surgery_UHCMA_CS.pdf


Of course, if she lives in one of the states mentioned, you have to use THOSE guidelines.
 
If the other efforts don't work, I'd lawyer up and appeal like hell. She OBVIOUSLY has an issue that is NOT going to change, and the insurance company will pay a hell of a lot more money to accompany her to her death than they will pay to get her into surgery sooner rather than later. This is bullshit.
 

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