Advice

Good Evening,

I am interested in the Roux en Y Gastric Bypass.  I have Fed Blue Cross and Blue Shield; my weight is 320 and my BMI is 51.6.  My question is since I don't have a co-morbidity will I be approved for the surgery?  I will say my knees are killing me and I am taking Prystique for depression.  But ultimately I don't have a co-mobidity that I believe will approve me for this surgery.

I'm so miserable, I am to the point where I am so tired of being this big.  Being depressed increases my eating habits and I just don't want to be in this place anymore.  Nevertheless, I am looking for advice, if someone out there has this particular insurance, could you inform me of the process, how long, what exactly did you have to pay for, and how are things with your post-op.  Is your life style better, what have been your ups and downs? 

I have an appointment for Thursday to speak with the Bariatric Coordinator and start this process (hopefully, if I am approved).  I have been to the seminars and received great information.  But was unable to receive the answers that I am inquiring about in this post.  Could someone please assist and adivise me on what I should do?

I greatly appreciate any input,

Sybibi17

 Your BMI is high enough that you probably don't need the co-mobidity to have the surgery.  The knee problems is a co-mobidity though and I am sure you suffer from back pain, too, have you been tested for sleep apnea?  If not that will probably have to be done and if you need c-pap that will be another one.  Don't give up before you find out something.  

Thank you!  I have not been tested for sleep apnea, but I will definitely look into that.  Thank you so much!

I have bcbs of michigan and I'm almost positive that once your bmi is 50 you don't need anything else.

If your BMI is over 50 (and you can show a weight history of obesity... Sometimes 2 years, sometimes 3 or 5, depending on the policy), they will not require any comorbidities to approve the surgery.  How long it takes is extremely variable even for people with the same policy under the same employer.  Generally, however, once you have completed and prerequisites for your policy (visits to nutritionist, or a 3 or 6 month pre-op diet, etc.) and submit all of the requid info to the insurance company, if you meet the requirements based on BMI alone, the approval usually comes fairly quickly.  (I had Aetna at the time (have BC/BS now), and got my approval in 2 days.)

Almost everyone who is more than a year out from surgery will tell you that their life is MUCH better with the weight loss.  The first few months can be difficult,though.   Best decision I ever made.  Just be sure that you know that this is a lifestyle change (not a "get out of obesity free" card) and that the surgery will not change the psychological or behavioral issues that contribute to your obesity.  The surgery will help you get the weight off, but once you lose the caloric malabsorption,you will have to continue to eat properly (and address the bad eating behaviors) in order to avoid regaining the weight.

Lora

Lora,

Thank you for the insight.  The psychological factor is something I am concerned about.  It is a struggle, and I am trying to work on that daily.  I appreciate your candor/honesty!  I am looking to change my lifestyle.  I have the desire to be healthy whole heartedly.

 I have the exact insurance and at least on Colorado, they kind of promote the surgery.  I found my surgical group though the insurance website.  I have a Bariatric Center for Excellent right here in Fort Collins so it worked out perfectly!  Now I was 274 at first weigh in, BMI of 44 or 46 (can't remember), diabetes, sleep apnea, history of medically supervised weight loss plans, and a history of 20 years of obesity.  Fed BCBS were fantastic to work with however, my surgical group requires so much that the approval process too all of 18 HOURS.  Prior to a consultation, I had to go through 3 months of their nutrition classes (monthly so not a big deal) and go to their information seminar on the different surgeries.  They also required, for those fairly local, to attend at least one support group meeting prior to surgery.  Once I had documentation I completed that, I had my surgery consult and the same day scheduled my surgery, psych eval (require by insurance), and nut consult at the same time.  I started classes in November and could have had surgery in mid-March. but waited for April to work and family reasons.

Go to the website and find a Center of Excellence for the surgery and start from there.  I am not sure about MD, but in CO, it has been fantastic!

Scaura, thank you so much for the information!  This puts me at ease, I am continuously doing my research.  I will definitely research the Center of Excellence.  Thanks again.

Your BMI is pretty high, have you gone to see any doctors on your blood pressure or sleep dr? I thought nothing was wrong with me until I saw the surgeon. He sent me for tests. I have a great heart but my blood pressure is bordeline Hypertension....which is a co-morbidity now on meds to lower it. Your tryglicerides are probably pretty high like mine was which is a co-morbidity,(With that much weight on you it can lead to diabetes...which I am close too as well). Your colesterol could probably be hig too which is another co. Anyways I just want to let you know that definately go to your infomation seminar for the program closest to you. then you can schedule an appt with the surgeon who will talk to you about symptoms you may have and schedule you for sleep test yada yada yada, lol....be honest everything counts. Tell them about every ache....if you have problems sleepin which is part of sleep apnea which is also a co. Then you will go see a bariatic dr who will walk you through labs and you might find out some interesting things that will support you getting this surgery. And I have BC/BS as well and they usually support doing the surgery with just a 40 BMI and over without any CO-Mobidities. Anyway good luck to I which you well.

Bonniebutterfly, your information is quite interesting.  I say that because, I have been overweight ALL my life, there is a history of diabetes in my family, but my PCP did tests on me and I have no traces of diabetes, my cholestoral was slightly high, but in the past if I am extremely stressed my blood pressure can get high and has gotten as high as 189/200. In the past few months, I was stressed and my pressure was high.  But normally, it doesn't get high unless, I am stressed. 

My appointment with the coordinator is Thursday. I will say I am apprehensive, but yet excited about this journey.  I so have the desire to change my life and get on track.  Thank you so much for the information.

Sybibi17