-
-
- WEIGHT LOSS RELATED
- Main Forum
- Exercise & Fitness
- Diet & Nutrition
- WLS Graduates
- More
- MEDICAL CONDITIONS
- Arthritis
- Cancer
- Diabetes
- Fibromyalgia
- More
- SURGERY DATES
- GO LOCAL
- Regional Forums
-
- OTHER TOOLS
- BMI Calculator
| Author | Message |
 OH Member Since: 01/23/12 [Latest Posts] | Post Date: 2/3/12 5:48 pm I am a newly diagnosed diabetic - type 2 who the doctor just recently placed on metformin 1000 mg twice a day. My hgb alc was only 6.1 but my fasting glucoses X 2 were elevated 143 and 157. I am trying to get insurance approval for the sleeve and meet all of the criteria for the insurance company but have been denied because my employer has stipulations in this coverage which states that you have to be uncontrolled on medications for diabetes and hypertension. I have just been placed on meds for both in order to see if I can satisfy this criteria but of course, the meds have to be unsuccessful at treating these conditions. My question is what criteria would indicate that the metformin is not controlling the diabetes or is an unsuccessful medications??? Thanks! |
  |
Member Since: 09/06/10 [Latest Posts] | Post Date: 2/3/12 8:34 pm If your insurance has this stipulation, then this is a question for them. I am sure they have this defined within the restrictions. it's probably an hba1c number, but it might really be any criteria. I'd call them and ask them to define it - or talk to your HR department. Good luck! |
 |
OH Member Since: 01/23/12 [Latest Posts] | Post Date: 2/4/12 9:35 am The problem is, it is not defined anywhere. When I talk to United Healthcare they tell me it is a restriction that my employer has placed as criteria for them to pay for the surgery (not all of it mind you only $25,000 and only to the hospital. I am still responsible for the anesthesia fees, doctor fees and any other fees that accumulate. They are only paying for the hospital expenses). When I call my benefits department where I work, they know nothing about these restrictions and as of yet have not been able to find any paperwork which has these restrictions outlined. I have never been given anything that states these restrictions from my employer or United Healthcare and it is not in our summary of benefits booklet from the insurance. The benefits person I have been speaking with is in the process of trying to locate this policy and if it is not able to be located and I have not received it, I plan to appeal based on this and see what happens. In the meantime, the doctor has reluctantly put me on medications in an attempt to satisfy this criteria requirement but feels almost certain that it will work which will mean no surgery because it was effective and needs to be ineffective. It stinks !!!!!!! |
| |
Member Since: 09/06/10 [Latest Posts] | Post Date: 2/8/12 7:46 am I might also try to challenge on the basis that, if it is not defined anywhere, how are you or your insurance company supposed to know when you either have met the criteria or you haven't? I have other thoughts about ways to circumvent this, but they are probably best kept to myself.... :-) Best of luck. |
| |
OH Member Since: 01/23/12 [Latest Posts] | Post Date: 2/8/12 7:54 am I totally agree !!! How am I suppose to know what criteria needs to be met if it is not stated anywhere. I would be interested in knowing what your other thoughts are!!!!! I could give you my email address if you would rather email me about it privately. Just let me know. |
| |
 VA RNY (02/28/12) Member Since: 02/01/12[Latest Posts] | Post Date: 2/8/12 9:05 pm Every person has a unique health history. I can only tell you about my experience. I had insulin-dependent gestational diabetes when I was pregnant with my second child (my son). I was 32. I was in serious denial. My mother is type 2 diabetic (& has never been overweight; she is exceedingly petite); my paternal grandmother was the same. My ob/gyn told me I should be prepared that, around when I turned 40, I would be diagnosed as a type 2 diabetic. I was like, yippee.  Sure enough, I was diagnosed at age 41 (2002) with type 2 diabetes. The doctor put me on 2 meds: Avandia & Metformin. I started checking my blood glucose (bg) every day. It never changed; it varied between about 126 & 160. It never ever got lower. My fasting bg was 126 when I was diagnosed. The doc increased my dosage of both drugs. No change in bg. Then they came out with a drug called Avandamet (a combination of Avandia & Metformin). No change in bg. Dosage increased again; no change. Then the FDA pulled Avandia AND Avandamet off the market. Who knows why? The pharm companies don't tell you why. There are rumors: the drugs are dangerous to the liver; the drugs don't work; who knows? The doctors certainly don't tell you. The internet has a thousand different theories about it. My doc then put me on Metformin only (2006). I started with 500mg a day. No change in fasting bg. Dosage increased to 1000mg (500 am, 500 pm). Fasting bg was now approaching 180. At this point, I asked my primary care physician about just cutting to the chase & going on insulin. She about had a heart attack. I was like, "Why? Why does that upset you so much? The oral meds have never worked." She just said, "That is just such a huge step. You do NOT want to do that. Once you get on insulin, there's no turning back."  I didn't get it! Why was that option off the table? The only thing I can think of is that the pharm companies want to keep these oral meds on the market to make money. Maybe they make more money off of the oral meds than they do insulin. I started injecting insulin (Lantus) on 4/10/2010. It's the only thing that brought down my bg. I started with 20 units. I'm up to 85 now.  The upshot: I would be surprised if the Metformin works for you. I haven't met anyone who's been successful lowering their fasting bg on this drug. It's like the pharm companies are just rolling the dice & hoping the oral meds work. So far, they haven't. Not one that I know of has worked. Perhaps you could have your primary care physician look into the success rate of oral diabetes meds & write a letter to your insurance company saying it's his experience that the oral meds don't work, & that he feels the only alternative is to either start you on insulin OR go to the permanent solution, weight loss surgery. Worth a try! Feel free to write me if you want to talk. I wish you only the best!  GG   |
| |
Member Since: 09/06/10 [Latest Posts] | Post Date: 2/9/12 7:59 am Love Lantus and metformin - use them both with much better success since RNY! |
| |
© 2012 ObesityHelp, Inc. All Rights Reserved.
