[Rachael]

I'm just starting out and I don't even know where to start. I just found out that my insurance covers Roux-en-y. So I'm starting from there. I'm so very worried I will not qualify.

I meet the basic requirements my insurance sets forth, BMI greater than 40, been overweight for 5 years, tried dieting - and that leads me to my first question.

It was just over 6 years ago when I started a hypnosis weight loss program. It was wonderful and I lost 140-150 pounds in the course of a year. However, I gained it back. Actually, I'm not really sure now if it was 5 years ago or 6, but whatever, I wasn't overweight for a time, but I gained it back. Does that count? Of course, I can provide records to show that I was significantly overweight for years prior to that.

Again, I meet the basic requriements, but in order to qualify, I must meet 1 or more of these 3:

Have diabetes

Have hypertension (and I thought I read hypertension poorly controlled on meds)

Hyperlipidemia

Sleep apnea.

Okay. Here is where I run into trouble. I do not have diabetes, that I know of. My blood pressure is borderline, but I'm not on medications. My lipids are borderline. I don't know about sleep apnea. I know that before I lost all that weight the first time, my son would complain about hearing me snore so bad he couldn't sleep. Then one morning, when he was sleeping next to me, I had a seizure. It scared the daylights out of me. I knew what was happening, but I couldn't stop it. I started the hypnosis program shortly after that. But no more seizures, and I don't know about snoring or sleep apnea, so that might be my only chance.

Although to be honest, I don't go to doctors much. For all I know, if I had a HgA1c done, it might be sky high. The last fasting glucose I had was okay, but that was at least a year ago, as were lipids.

If I don't have sleep apnea, I'm afraid that I won't qualify, even though I have arthritis, GERD and a very compelling family history of heart disease.

I guess my point is, if I can't get my weight under control on my own, do I have to wait until I am having severe problems to qualify for the surgery?

I don't understand. My insurance doesn't pay for any weight loss programs or gyms or anything, but it will pay for Roux-en-y (and ONLY Roux-en-y) IF you are already so far gone - I mean, whatever the risks of surgery, at my age of 51, 4'10", weight of 250, major family history of heart disease and borderline everything myself, aren't my risks of something really bad happening greater than the risks of surgery?

Anyway, sorry to be so long here. I am just wondering how hard it is to qualify. I read some of the other posts here in other forums, some seemed to get it easily, some not.

Even if I don't have diabetes (yet), worse hyperlipidemia (yet), uncontrollable hypertension (yet) or even sleep apnea (which I now hope to heaven I do), is there any way I can get around it?

For those of you who do meet those other requirements, would you feel "hostile" toward someone if they could qualify without having those?

I have an appointment with a bariatric center that takes my insurance - I think they must be where my insurance refers to, because it doesn't seem that they will let anyone else do it - becasue I feel I have the best chance of getting qualified if I go there.

But I am open to any suggestions anyone has because I want this so bad and I'm so sure that I'm not far gone enough.

Also, for those of you with husbands/boyfriends/significant others, have they been supportive?

I haven't even told my boyfriend that I'm doing this. I'm waiting to see if I even qualify to get sent to the program (oh, that is the other part - I have to work with a case manager and be on a supervised diet and exercise program with them for 6 months and lose 5% of my weight to prove I'm sincere first - and get a psych evaluation - you all know the drill, I'm sure).

Anyway, about 8 years ago, he left me because I was...fat. We were separated for 2 years. I did say something once then about having gastric bypass surgery and he started crying and begged me not to.

So I'm just going to see if I'm accepted into the program - then I'll have him come with me so he can see it isn't like it used to be (he was basing everything on 1 person he knew who had a open procedure many, many, many years ago. I'm going for a laparoscopic route, and I know surgery has come a very long way since then). But I'm really afraid to say anything to him. But after his heart attack last year, I don't want to be next. We work out every day, but I need more than that.

I really want this surgery. I know I can do it without it - I mean, I did it before with the hypnosis, eating low carb, low fat, low calories, lots of exercising, but it just isn't quite coming so easy now.

I'm glad to have found you guys, because I really need to talk with someone about this, but I don't want to until I even know if I can get accepted into the program.

Thanks for any suggestions you can give me.

[DocSanae]

Welcome to the board, thank you for joining us.
((((((HUGS))))))) May your journey go well.

As for your insurance requirements, since you've set up an appointment with your dr of choice, and the center is familiar with your insurance, they probably can give you the As you need to your Qs.
For for sleep apnea, that is diagnosed with a sleep study, so have it scheduled, either through the bariatric surgeon or your PCP.
While you are waiting for your appt with the bariatric center, it might be a good idea to ask your PCP to do some blood labs relating to the requirements, that way, even if your data was borderline last year, if some of the numbers have gone up, it means that you have the co-morbidities that you need to qualify.

As for your boyfriend, I suggest you take him along to as many info seminars and meetings as you can, once you get the ball rolling. Giving him the chance to listen to, and ask Qs first hand is the best way you can convince him that you are making the best choice for your health and life, as well as learning what to expect.

Hope this helps.

[fr1endly2]

hey welcome to the board!
glad you found the site for some support!
i look forward to getting to know you as
your journey begins!
have a seat and read all the posts
and get to know everyone
welcome

[Trulykath]

Even though YOU may not have co-morbidities, you need to push the family history or such (In other words, THESE THINGS ARE HEADED RIGHT AT ME IF I don't get a grip on this). Most offices have coordinators who are PROS at what is needed to get this pushed through!

[A new me]

Welcome to this wonderful site. This place is great. Advise, questions and etc.... Everyones surgeons and insurance companies are so very different. I have seen all different things from so many different people on here. Just take each step and do as they ask and fight it if you have to. Its oh so worth the journey. Best of luck on this wonderful journey.

[Rachael]

That is what I'm hoping. That is why I decided not to go to my regular doctor, though of course I'll let her know. My insurance, IF they determine I meet their requirements, will send me to a Center of Excellence - I could be wrong, but I'm assuming it is at the hospital where I'm making my appointment as I could find no physician listed on the provider list, yet this hospital does accept my insurance - Regardless, I'm assuming someone there will be much more agressive about getting me qualified than my own physician would be.

Thanks so much. You hit it right on the head. I'm not getting any younger and I need to get this taken care of RIGHT NOW before I have any of those things. My boyfriend's heart attack was such a scare to me - It could have been me - and I'm a single mom with no family at all. I have to be here for my son.

[clancythecamper]

It certainly sounds like your heart's in the right place and you're doing your homework. Many people call this a journey because it's definitely takes time, patience and hard work - mental, as well as physical. If the hospital where you have your appointment has support meetings for pre-ops that is a super place to start. As for spouse support, my husband went thru the pains of my obesity and watched me sit on the sidelines for so long, and then as I started considering the surgery and made multiple attempts at weight loss, he was supportive of my desire to make a drastic permanent change. Again, it's a journey. Best wishes and welcome!

[MsVickie]

First of all welcome to the site. Rachel, you will need your family Dr on board with you to have this surgery. Let me explain. They will have to take over your care after your surgeon no longer needs to see you. Now I dont know how Baratric Centers work as far as after care but usually after a year there done. Your family Dr. needs to be on board with this because of the other health care you may need with them concering other stuff. Most insurances will require you to submit family dr records along with a new history and physical. Are you concerend the family Dr dont agree with WLS? If so find a new one. Since is has been year many things may have changed with you. You need to get new labs and be checked for Blood Pressure etc. Its a good thing !

I understand your concern with your Boyfriend. In the end it comes down to you and it has to be your decision. Things have changed alot in the last couple of years with this surgery. Im sure they will have you go to a support group to start with. See if he will attend a information session with you to help ease his mind. I think its great you have lost weight before and it worked for you. You will know when its time for you to go foward with this. Its somthing that just happens and you know its time.
Keep us updated. You will find this is a great support forum.

As far as my husband being supportive? Yes very much so. He wants me to live 100 more years with him LOL.

[not quite Barbie]

1. Make sure your insurance doesn't require that your PCP refers you to the WLS surgeon, otherwise you'll be starting out on the wrong foot and have to redo it right.

2. Get your PCP to write a reccommendation for WLS even if your insurance doesn't require a referral.

3. Have your PCP fax your records to the WLS surgeon so they know your history. THey'll be the ones putting together the package for the insurance company so they need all your documentation.

4. Good luck, learn to be patient, never give up, include BF in your planning and decisions, continue to be patient, have faith - this is a looooong journey.

[Christy0283]

First of all, welcome to the site. I'm glad you found us. You will receive lots of love, care and support here. I wish you the best of luck with this journey.

Like others on here have said, you will know when the time is right and you will do what you have to do to take care of yourself. And I suggest that you let your boyfriend know as soon as possible. I understand your concerns, but the more information he has about the surgery, the more at ease he will be.

Keep us posted and again good luck!