Newbie! I have some questions~

Hello all :-) I am fairly new to OH and would like to first introduce myself!  (Skip to the red line if you don't feel like reading~ ) My name is Kristen, I am 23 and a college grad (Villa Julie College '07! I'm sure you've never heard of it, most people in Maryland haven't even heard of it lol...)  A few months after I got out of college, I began having some issues.  #1 After not getting my period for 3 months, it came back with a vengence!  #2 Started having some other odd symptoms (spells of feeling light-headed, frequent bathroom trips..) And of course, this would happen right AFTER I graduate and have no insurance, right? So months later of dealing with Dr appointments and large COBRA payments, I was diagnosed with PCOS and Type II Diabetes. This was a crushing blow to me.. (which was quickly followed by me losing my job and falling into severe depression..) Since then I have been diagnosed with Hypertension and am still trying to figure out an issue with my sleep. I started a new job that is all around better than the one I lost, so I told myself this year was going to be better! I started looking into WLS when I read an article that said WLS is shown to cure co-morbidities, such as diabetes. Since then, I've done a lot of research and getting WLS has become my one real big hope for improving the outcome of my life. (Sorry, that was a long intro ~.~; ) --------------------------------------------------------------------------- Anyway, I am now starting the journey... I am looking to hear about your experiences of getting there. I am mostly concerned that I will not be approved. I've kind of been weighing the things that are both in my favor or against me and I'm really not sure which way the scale is going to tip. Reasons why they would approve me Diabetes PCOS Hypertension BMI 40.5 Family history of heart disease Possibly infertile (thanks to PCOS) Reasons they could deny me I'm young? (Is this a contributing factor to their decision?) I don't have a strongly documented diet history* My diabetes is currently pretty mild.. (it's being controlled w/o medicine right now and my AC1 is good) I have not been 'morbidly' obese my entire life (I have been at least overweight /obese my entire life, but my BMI wasn't always this high) *I have seen my doctor pretty much every month for more than 6 months, and my medical history would show I dropped weight and have then remained at my current, but it doesn't nec. reflect a supervised diet... What do you all think from your experiences? I'm just worried about the process being delayed, I feel so motivated it's hard to wait!! Thanks for reading - looking foward to your responses. ~Kristen

Welcome Kristen!! You'll love this board because the people here offer such great support! I find myself reading the forums daily. It's a great place to meet others who know excatly what you're going through!!  As far as approval is concerned I dont think your age will be an issue because I'm 21, won't be 22 for about 4 months and I was approved to  have my surgery on Friday. I don't know what your insurance requires you to have to be approved. [i would definetly look into that] But for me I had to provide 5 years of documented failed weight loss trials, a letter from my PCP, a letter from a nutritionist, and a letter from a therapist. At the time my BMI was 45 and I had a family history full of comorbidities. Most insruance companies require some kind of documented weight loss, whether it is 6 months or 5 years. So that might be something you want start.  Hope this helps.  Goodluck with getting approval!! Kepp us posted on your weight loss journey. Holly

Thanks, Holly! I actually called my insurance provider yesterday (Lumenos Consumer Health Driven something or another... PPO - based in the Blue Cross network) and the guy I spoke with just beat around the bush. Maybe I just didn't pose my questions properly.. I asked first about my eligibiltiy for WLS with my plan, in which I was told they do accept them on a case by case basis. However, when I asked what I needed to make my case.. he mumbled something about my PCP and that was all I really got out of the guy. I know my PCP will support me, as she was the one who told me about Dr. S and this website, but my insurance provider is so new no one seems to know anything about it! I'm not sure where I can get some good information from them..

Basically, every single insurance company, and more specifically, every single insurance policy, is different. So, based on what you said, under the criteria I faced, you would be fine, but you need to find out for sure from your company...there is a good section on what to ask the insurance company - including the specific procedure codes you would like them to approve you for - on the website from Duke Weight Loss Surgery in NC where I had my surgery - dukewls.org - check it out....

Hi kristen and welcome! As they said above every insurance company, and every individual plan is very different.  I would suggest calling them up and requesting in writing a copy of the approval process for WLS.  My insurance company also beat around the bush.  I thought I was ready to go but then 10 days before surgery they requested my diet history.  Fortunately I had some weigh****chers booklets that they accepted.  You definitely want to know exactly what you will need and it is helpful to get that in writing. As for more general rules, I think most (but def not all) insurance companies see you as medically necessary if your BMI is above 40.  Some will consider you if your BMI is between 35-40 and you have comorbities.  Also just to note, I also have PCOS and my insurance does not consider that a comorbitity.  Family history also doesn't really count in terms of the insurance either, at least in my experience.  The hypertension and diabetes are pretty clear cut comorbities.  Also, I don't think your age will hold you back at all.  So, I made a short answer long, but the most important step for you is to pester your insurance company until they give you a CLEAR answer on exactly what you need for approval.  Good luck with everything!!!

hi kristen and welcome to the 20's board. well we have a lot in common, i had diabities, pcos, family history of heart disease, being a "light weight". ok so not to get you down, but thus far which i am only 3 weeks post op my pcos is crazy. since about march 22 i have been having my period and i am on the pill and it just isnt helping it. i have also gone up to 13 months without a period and have gone as long as 4 months bleeding straight..but you wanna know something i ahve two beautiful kids. anyways welcome again, and ask away with your questions

Your insurance company most likely has a website and you can find your plan there. I have Medica and I can log in and it shows my benefits. It also shows a list of things I need to be approved. Also, if you start doing the surgery process with a clinic, a lot of time they take your insurance info, figure out what you need to be approved, and lead  you through the process. When they have everything, they file all the paperwork with your insurance. I was lucky  enough to have a clinic that did that. I didn't have to do anything but follow their steps. I hope that helps and good luck!! By the way, I am 23 as well and age doesn't matter.

Welcome to the board. Your first step would be to find out if your insurance covers WLS and what their requirements are. Honestly I wouldnt worry about why they would approve or deny you - first you need to find out the guidelines, then you need to submit for approval. Even if the insurance denies you there are appeals processes in place - I was denied 3 times before I got approved. While being denied isnt fun, you still have options available so you have to look on the bright side.