Dot T.
My Journey at a glance:
2007
9-21 Found out New insurance covers WLS
9-25 Made appointments for informational Seminars
10-01 New Insurance goes into effect
10-2 Talked to PCP about WLS
10-16 Info Seminar (Dr. Out of Network)
11-4 Info Seminar (This is the Surgeon I'm using)
11-9 Cardiologist (EKG)
11-9 Sleep Study
11-13 Support Group Meeting
11-15 Cardiologist (Echo & Adenosine Stress Test)
12-4 Sleep Study W/ CPAP
12-20 Psych Eval MMPI 2
12-27 Psych Results of MMPI 2
2008
1-3 Pulmo - Chest X-ray, Lung function
1-8 Consultation Scheduled
1-8 Support Group Meeting
1-17 Dietitian Appointment
1-23 Surgeon Consultation
2-12 Support Group Meeting
2-27 Weight Check w/ Dr. K's Nurse (down 9.5 lbs)
2-27 lab work (h. pylori, thyroid, liver function)
2-29 Submitted to Insurance
3-11 Support Group Meeting
MY STORY
Hi, I'm Dot, stay at home mom of two girls ages 14 and 9. I'm married to Josh and we live in Oklahoma. I have not been overweight my whole life, but my weight has been climbing since 1993. I'm just starting my WLS journey!!
I have not been overweight my whole life. Really just since having my first daughter 14 years ago at the age of 21. Other than the yo-yoing up and down over the past 14 years, my weight has only been going upward. Especially, it seems, since having a hysterectomy last year 
My sister had roux-en-y 4 1/2 years ago which has been very successful for her. We are shaped different though. I guess she takes more after our dad's side of the family. I would call her apple shaped. I take more after my mom and am pear shaped. My sister had a slightly higher bmi at the time of her surgery than I do and we have different co-mobidities. She had PCOS and was wanting to lose weight to get pregnant and I'm DONE having babies! 
Enough about her...
I have elevated cholesterol, elevated blood pressure (neither of which are being treated), plantar facitis, shortness of breath upon exertion, low self esteem, gall stones, heart burn, lower back pain, family history of heart disease, family history of diabetes, possible sleep apnea, depression, and I'm post-menopausal due to hysterectomy. In addition to all of that, I feel like my weight is having an effect on my marriage and that sucks! 
As far as dieting over the years, I've done the starvation diet (lol), slimfast, weight watchers, nutri-system, e-diets, scarsdale, OTC weight loss meds, and doctor supervised (phentermine) from a local weight loss clinic. I have bought so many books to try to help me with various diets that I could fill a small library! Not to mention (again) having that money for self-pay! 
As far as my exercise... It comes and goes. I'll get on a roll and do good for awhile and then fall off the wagon and stop. I've tried going on daily walks, I've purchased a treadmill (I ended up using it as an anex to my closet), so many exercise videos and pieces of equipment that if I still had all of that money, I could self-pay for my surgery, and I was a member of curves at one time. 
I have had some success with all of these methods of weight loss and exercise, but not lasting results. I'm looking for something that will keep the weight off long term. 
I have thought about wls several times over the years, but #1) didn't have a high enough BMI #2) couldn't afford it #3)had insurance that did not cover it under any circumstances 
. As for #1, since having my hysterectomy that has not been a problem. I can't seem to take off weight no matter how hard I try, but it sure doesn't have any problem sticking to me! As for #2 & #3 recently hubby got a different job that *does* cover "surgical treatment of morbid obesity withhealth problems that are aggravated by or related to the morbid obesity, including gastric by-pass, etc."
Now, I just have to go to a seminar, choose a doctor, have my consult, *probably* have some tests to prove it is necessary, and then get approved! (I know, probably easier said than done)
Well, enough of my story for now. I need to get some things done. I'll update soon!
INSURANCE STUFF:
The following is directly from our "Employee Benefits Plan" book regarding WLS:
SURGICAL TREATMENT OF MORBID OBESITY
Covered expenses shall include charges for surgical treatment of morbid obesity for covered persons with health problems that are aggravated by or related to the morbid obesity, including, but not limited to gastric by-pass, gastric stapling, or gastric balloon.
DEFINITIONS
Covered Expenses -- Medically necessary services, supplies, or treatments that are recommended or provided by a physician, professional provider, or covered facility for the treatment of an illness or injury and that are not specifically excluded from coverage herein. Covered expenses shall include specified preventative care services.
Morbid Obesity -- A diagnosed condition in which the body weight is one hundred (100) pounds or more over the medically recommended weight in the most recent Metropolitan LIfe Insurance Company tables for a person of the same height, age, and mobility as the covered person, or having a BMI (body massindex) of forty (40) or higher, or having a BMI of thirty-five (35) in conjunction with any of the following co-morbidities: coronary artery disease, type II diabetes, clinically significant obstructive sleep apnea or medically refractory hypertension (blood pressure > 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management).
Medically necessary -- Service, supply, or treatment which is determined by the claims processor, named fiduciary for post-service claim appeals, named fiduciary for pre-service claim appeals, employer/plan administrator, or their designee to be:
1. Appropriate and consistent with the symptoms and provided for the diagnosis or treatment of the covered person's illness or injury and which could not have been omitted without adversely affecting the covered person's condition or the quality of the care rendered; and
2. Supplied or performed in accordance with current standards of medical practice within the United States; and
3. Not primarily for the convenience of the covered person or the covered person's family or professional provider; and
4. In an appropriate supply or level of service that safely can be provided; and
5. Is recommended or approved by the attending professional provider.
The fact that a professional provider may prescribe, order, recommend, perform, or approve a service, supply, or treatment does not, in and of itself, make the service, supply, or treatment medically necessary and the claims processor, named fiduciary for post-service claim appeals, named fiduciary for pre-service claim appeals, employer/plan administrator or its designee shall be final and binding.
Illness -- A bodily disorder, disease, physical sickness, or pregnancy of a covered person.
Claims Processor -- CoreSource Inc.
Named Fiduciary -- CoreSource Inc.
Employer/Plan Administrator -- Atlas America Inc.
MEDICAL EXCLUSIONS
** Charges for services, supplies, or treatment primarily for weight reduction or treatment of obesity including, but not limited to: exercise programs or use of exercise equipment; special diets or diet supplements; appetite suppressants; Nutri/System, Weight Watchers, or similar programs; and hospital confinements for weight reduction programs.
** Charges for surgical weight reduction procedures and all related charges, unless resulting from morbid obesity.
