Does sympathy work???

[Azuredreams]

This is more a rant then anything.

I havent been banded yet... hell I havent even checked to see if my insurance Oklahoma bcbs will cover me. But alot of what I have read is that one of the qualifications is 6 months of trying to loose before being approved.

Here is my problem. I have NEVER been able to lose weight on a diet since puberty except once when I was working my ass off at a veterans center as a nursing assistant. constantly moving lifting and working
I wasnt even on a diet I was just working that HARD and the pounds just started falling off....

...I was working so hard that I ruptured one lumbar disc and and tore another, eventually after two years of life altering PAIN and two years of NOT moving, and not to mention 2+ years of pain medications and steriod injections and back surgury.... I gained.

I went from 270 which is heavy... but in my case smaller then I was in highschool to now im a whopping 361 pounds.

Im not able to lose weight because simply it hurts to move the amount I need to move to lose.

I am still in pain, but its something that I know that I will have to deal with for my entire life. I have no other choice to accept that. What I cant accept is that I dont loose weight by sticking to a diet... if I could stick to a diet, and it worked, then I wouldnt feel that I needed this surgury.

Im grumpy

I have been threw alot of back injury crap for the last four years... The doctors have already told me that with the disc that I have that is torn I am more then likely going to rupture it in the next few years... and I dont wish that on my worst enemy.
Im dealing with it the best I can and really am doing better, and dont want sympathy.... butttttttttttt
If I play my cards right do yall think that I can get sympathy from the insurance company to let me get by with out a 6 month diet??? I need surgury ASAP.

:wink2:

PS.... ALWAYS ALWAYS ALWAYS bend at the knees when lifting no matter how heavy you are!!!!:sports1: <------like so.

[wingsfly825]

In my opinion i would have to say no. I have had major back surgery( 2 discs fused and a cage where a disc shattered up my spine) and although my insurance didnt require the 6 months , my back was not a qualification for the surgery all my other issues were. If i remember you posted a while back , see how time flies so if you start your supervised diet for 6 months (if thats what your insurance requires) before you know it you will be having your surgery in june. Sometimes its much easier to work the system because fighting it may take even longer....just my opinion.

[BrendaC]

Have you contacted your insurance to see what they require? Every insurance is so different. Also do you have other co-morbidities? High blood pressure, diabetes,etc? Some insurances only require a BMI of greater than 40 while others require 2-3 co-morbidities. Don't fret it until you check with your insurance. Best of luck and hope to see you in band-land soon. Call your insurance today! Then as Teresa said go with the program.

[lyndele]

Hi, Azure,

My insurance company required 3 months... they all seem to have different requirements. My guess is that they aren't likely to waive their basic requirements - but if you have very compelling co-morbidities (and your surgeon knows how to document for the insurance co) then the approval should come quickly. The long delays seem to happen most often when the paperwork isn't spot on.

If lap-band surgery is what you want, my advice would be to start NOW to get through the process. I can tell that you're frustrated and unhappy - and I know how paralyzing that can be - but get started! You'll start to feel better as soon as you start "moving".

I started my process in September, 2007. My insurance company had just started covering WLS and the docs didn't know what info to provide so we dealt with a denial of coverage and appeals. I didn't have my surgery until June 08. It seemed like a long time as I was going through it - but if I hadn't done it then, I'd still be waiting now :)

So if this surgery is what you want, call your insurance company now and get things going. Don't worry about the "supervised diet" requirements - that just means that you document your attempt to lose weight. If you can't lose, well, you tried. That's the point of WLS, really - that dieting alone isn't successful for some us.

Good luck!

[mindwing]

Hi Azuredreams,

What a lovely moniker.

I understand your frustration. I don't have your back issues, but I do have Chronic Fatigue and Fibro, and am umable to do any cardio exercise. The effort of walking in place for one minute is almost too much for me, and I can only do it once a week.

I still don't know what my insurance demands. I applied at one hospital that only accepted completed applications and took no phone calls. That hospital demanded a 6 month supervised diet, which frustrated me.

But I decided to just do it while I waited for an answer. So I started keeping track of my diet on fitday, and printing out a 1 month overview for my doctor every month. At first I didn't lose anything, but I finally started losing.

As it turned out, the hospital doesn't take my insurance, so I am now applying at another hospital. This one takes phone calls, so I made sure they take my insurance first.

But I only have two more months of my supervised diet, so it will be completed about the time i get my first appointment with the surgeon. I don't know if it is required by my insurance, but it is almost done anyhow.

I probably wouldn't be losing weight, but I have been doing weight bearing exercises and trying to build as much muscle as I can before the surgery. I don't know how much of any exercise you can do, but every little bit helps.

So If I were you, I would just start keeping track of what you eat and seeing your doctor every month to discuss what is and isn't working and perhaps why.

Good luck

mindwing

[kristina]

i didn't have to have a supervised diet..my bmi was over 45..i am 5'8 and started at 300 pounds...so i didn't even have to have co-morbities...every insurance company is different. maybe u should call them and find out...then let us know, okay?

[rkincaid]

Hi azure, just wanted to let you know that I had BCBS in nc, and they didn't require me to do a supervised diet at all, and they approved my surgery after TWO days with my BMI being barely 40, and having no major co-morbidities at all.

I'd just check to see what the requirements in Oklahoma are first, before worrying about the diet. Besides, even if they did require the supervised diet, I'm sure you'll still need to take time to do all the other presurgical requirements anyway. Good luck!

[rose815]

Hey Asure

I have BCBS in PA. It required the 6 mo.supervised diet plus the 2-3 co-morbidities. So you can see that all BCBS across the states are different. I'd start now. The sooner you start the sooner surgery will be. I too had ruptured disks in my back. That is not considered a co-morbidity.
Take Care
Rose