WLS w/ PEIA

mandy76
on 12/11/09 9:07 pm - Bluefield, WV
I have PEIA and am contemplating weight loss surgery.  I know they do RNY and lapband, but I've decided to go with RNY because the lapband just isn't for me.  Is there anyone else who has PEIA who has recently had RNY?  Can you give me any suggestions with how to get approved.  IIRC, they want you to diet for a year and lose 10% of your body weight and not have any regain.  Is that right?  Is there anything I need to know when dealing with them?  Any tips, tricks, suggestions?  Thanks! 
~Janis ~
on 12/14/09 12:55 pm
Mandy,

I don't have PEIA coverage but I did some research for my sister and remember reading their requirements for surgery.  You may have already visited this site but here it is just in case you haven't.  http://www.westvirginia.com/peia/page.cfm?section=251&storyi d=5366  . 

Good luck with your journey! Janis
skinnygirl1978
on 2/10/10 1:11 pm
Yes. PEIA is very difficult to get approved. My best friend is a teacher and is trying to have the surgery and they have tried to make it so hard in hopes that she gives up.  Her policy states she must see her primary doctor 12 consecutive month, must lose 10% of her EBW within that 12 months and CANNOT gain even an ounce within the time or she will be disqualified. I'm not sure about the other requirements, but if you're determined, I believe you can do it.
peyo
on 2/19/10 2:56 pm - Charleston, WV
i am one week post op and i did the whole weighloss program priior to surgery.  Not only did  I loose weight over the 2years but I also gained 22.5pounds.  During the 2 years I ended up w/uterine cancer and also had to have a total knee replacement. A  total hysterectomy cleared up the uc and of course knee replacement fixed the knee.  I finally sat down w/surgeon and said look, I have been here non stop (like 4 missed visits) in 2 years.  I have participated and dropped out when the knee problem becomes too hard to bear and then rested my knees for 3 months and exercised again and went up and down on weight.  He said that PEia is becoming somewhat easier to deal with.  and I said well i want to do my psych eval and just go for it.  i was willing to have to fight an appeal than just set and spin away another year.  i did my psych eval in mid dec. 2010 and had my endoscopy on 12/11/2009.  I got a call on like 1/21/2010 that they had good news at the drs. office.  i called back, thinking that they had submitted me for surgery. 

SURPRISE - not only was a submitted, i was APPROVED on first go round even with a 22 pound weight gain.  My surgery RYN was on 2/10/2010 and i have lost 24.5 pounds.  i have had NO problems with eating and everything stays down w/ no problems.  I even know when i have to go to bathroom and was surprised that there were not frequent overwhelming trips to bathroom - everything feels and acts as before except less food taken in.
peyo
jamiller25271
on 3/4/10 12:51 pm - Ripley, WV
That  sounds   great like  your on  your way to  a whole  new  you.
Dr Ross done  my surgery back  10/08  I have lost  85 pds    and   feel so much better,  need to lose another 50pds   ...  it is   so nice  to   have  fun again.
jamiller25271
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CrazyCatt55
on 3/10/10 5:59 pm
What typeof surgery did Dr. Rossi do?  Lapband, RNY or gastric bypass?  Thanks
lscheller
on 4/24/10 10:38 pm - Elkins , WV
RNY on 12/30/09 with
I have PEIA and did not have the 10% loss but was approved due to other medical issues that I have. Yes, this insurances seems to be one of teh hardest but do not give up. I did the year visits with my PCP and lost some and then would gain it back. I had my surgery on Dec. 30, 2009 and I am doing great with a 75 pound loss so far. Just do not give up.
        
mandy76
on 4/25/10 6:15 am - Bluefield, WV
 What other underlying health issues will allow you to bypass the one year of dieting rule that they have?
lscheller
on 4/25/10 11:01 pm - Elkins , WV
RNY on 12/30/09 with
I did the one year but did not lose the 10%. I have CHF and some of the medications I am on make me gain and there was nothing I could do to get it to come off. I started in June of 08 and had my surgery Dec. 09 at Dr Shins in Charleston, WV at CAMC. I was told by my heart doc that I needed to get the weight off. My PCP stayed on top of everything to make sure I would get this done the first time. Do you have health issues other than being over weight?
lscheller
on 4/25/10 11:05 pm - Elkins , WV
RNY on 12/30/09 with
If you have any questions please ask I will help as much as I can because I know PEIA is hard to deal with. I know of another who got approved without the 10% but had surgery out of state due to she lives close to the boarder of PA and has PEIA.  Call them everyday and push for what you want and need to help you become healthier.
mandy76
on 4/10/12 3:11 pm - Bluefield, WV
mandy76
on 4/25/11 4:11 pm - Bluefield, WV
Well, I have now been diagnosed with high blood pressure.  I am also having problems with my joints and what an orthopedist described as a significant amount of arthritis in my lower back.  So far my blood sugar is behaving.  I am fairly certain I could be diagnosed with sleep apnea.  When I had an upper respiratory infection last month, I actually choked and wake up gasping for air.  I just feel really disgusted that PEIA makes it so hard to get approved.  I mean, I will be thirty five this year and have been dealing with obesity since I was five years old.  I actually remember crying in the pediatrician's office when I weighed over a hundred pounds in the third grade - I weighed more than my mother.  So do I start with a family doctor or do I seek out one of the surgeons who does the surgery and allow him to document everything?
angie1973
on 10/23/11 6:18 pm
RNY on 09/25/13 with
does peia have a specific diet to follow for the 12 months medically supervised diet?  also, Do you have to wait a certain amount of time after you get the insurance before u can use it for wls?
blessed_1970
on 10/8/10 9:11 am
REALIZE Band on 11/10/10 with
I know from a coworkers experience that PEIA is very difficult to work with...they told her that she had to maintain her weight for a yr without gain or loss....