HELP! BLUE CROSS BLUE SHIELD OF TN BLUE ADVANTAGE (MEDICARE)

AprilMusicCity
on 8/30/14 4:52 am

ANYONE that has knowledge that will help me know what to do and give my hope that I can get the Gastric Bypass,

I am 37 years old and I had major spine surgery 4 years ago at the age of 33 years old. I had 8 ruptured discs in my neck and back. I had a spinal fusion in c/6 and c/7 and then a spinal fusion in T2-L2 with 23 screws and 23 rods, 8 discectomies, and laminectomy of the spinal covering. I have always had problems with my weight and yo-yo dieting. I weighed around 180 pounds when I had my spinal fusion surgery. That surgery was traumatizing to my body and my mind.... It was the most horrific surgery I have ever been through! I have Fibromyalgia so when they cut through all of those muscles in my back it devastated my body!! I have never recovered from that surgery. As I laid on the couch for months and months which turned into years along with taking high doses of Lyrica caused a significant weight gain! I gained 100 pounds so I now weigh 280 pounds and I am 5'8 making my BMI a 43! All of this extra weight on top of my spinal fusion has given me chronic pain that I have to manage with narcotic pain medicine. The pain medicine causes my acid reflux to be much worse as well as shortness of breath and wheezing and constipation. I have Osteoarthritis throughout my body, I tore the meniscus in my right knee and had to have it repaired in 2007, I have degenerative disc and joint disease, I was hospitalized the day after Christmas in 2012 for Strep Throat that was so severe and my health is so bad that I couldn't fight it off and get rid of it!! I am trying to heal now from a Tibial Stress Fracture in my right leg caused by all of this excess weight weighing down on my knees, I had a stress fracture in my left foot/ankle from the stress of the excess weight as well. My vitamin D level has been scary low many times over the last few years. One lab test showed that my vitamin D level was a 4! I am currently taking a prescription of 50,000 IU Vitamin D for a year to keep it at a healthy level. As you can see I have many comorbidities and my BMI is 43. I want to get off of the narcotic pain medicine as well because it scares me to be on something that will eat my organs up long term including my heart! :( Heart disease runs significantly in my family as well as lung disease. I already have heart palpitations, chest pain, severe shortness of breath and a constant wheezing/whistling sound, excessive sweating and high blood pressure (not on medication for this, but it's high at a stage 1 hypertension level).... Oh and my back does not bend anymore because with the fusion my spine is just one long bone now. With it not bending and all of the weight I carry on the front of my upper body I feel like I am trapped in a straight jacket unable to move!! I struggle to get up from sitting down or get up from bed. I have to roll over to the side to get up! All of this is constantly making me strain my back muscles and my Sciatica. It's just awful!! I really feel that I might actually be able to be less disabled if I can get this surgery and get the weight off. As far as insurance since I am on permanent disability I am on Medicare.

I have a supplement insurance which is Blue Cross Blue Shield of TN- Blue Advantage (Garnet) Do you know any of the requirements for this insurance? I know that my plan does cover the Gastric Bypass surgery. Do you know if I have to wait the 6 months and all of that?

Any information that you can give to help me would be more than appreciated!!!

Thank you so much.... :) April 

 

poet_kelly
on 8/30/14 12:06 pm - OH

You can get much more info, and accurate info, by calling the number on your insurance card.  They can tell you exactly what your specific policy covers and what it requires.  None of us here have access to your insurance information so we can't really tell you that.

 

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

AprilMusicCity
on 8/30/14 1:55 pm

Umm.... I don't know you so I don't know your occupation weather it be a doctor or not. As far as your comment goes, I didn't expect for anyone on this website to have direct access to my insurance policy. If you don't have any information to share with me then obviously my post was not for you to respond to. I didn't expect for someone to diagnose me on here or tell me word for word what my insurance provider would require of me... I am obviously going to be contacting them to start this process of getting the surgery. From what I have read this is a online support group for people that share their experiences with this surgery and all of the process they have gone through or are going through... I don't need someone to respond in that manner to my questions. I have enough to deal with health wise and signed up for this site for support and friendship with people who know what I am going through....

AprilMusicCity
on 8/30/14 5:30 pm

please forgive my last reply...I am just not feeling well and it came out in my reply as hostility. sorry! Thank u for your advice. 

poet_kelly
on 8/31/14 12:08 am - OH

Apology accepted.  I really didn't mean to come across as unhelpful.  the best way to get the answer to your questions really is to call your insurance company. Even if someone here has the same insurance company, they may have a different policy or the rules may have changed since their surgery. 

View more of my photos at ObesityHelp.com          Kelly

Please note: I AM NOT A DOCTOR.  If you want medical advice, talk to your doctor.  Whatever I post, there is probably some surgeon or other health care provider somewhere that disagrees with me.  If you want to know what your surgeon thinks, then ask him or her.    Check out my blog.

 

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