So ticked off...Argh!

[DammitJanet]

I finally screwed up my nerve to call up to cape fear to get info on the bariatric surgery. You are simply not going to believe this. I did some checking online first and saw that Cape Fear Valley is a medicare approved facility for bariatric surgery. Sounds good right? Oh that would be giving the system too much credit! Medicare doesnt approve any gastric bypass or lap band surgery at all! Now medicaid does but because Medicare is my primary...we all know what that means dont we? Im screwed once again!

Oh well...I hope to hell the system enjoys paying me disability payments for a long long time as I do nothing but get worse and worse as I end up with heart disease, strokes, cant walk, bed bound, in wheel chairs, need that damn chair to help me get up from a seated position...and on and on. I am going to bilk them for every dime I can now. God only knows that if I could actually lose the weight, I might actually feel better, then be able to GET the damn knee replacements and feel even better...and gasp...get off disability! But no...I will get worse and worse and stay on...no problem. Their choice. But I dont even want to hear one tiny word from them about what medical aids I need or what medications I need to take...not one word!

 

[Shari]

Sometimes the system does NOT make any sense.

I don't know how this works, but any chance you can appeal any of this?

 

[mstang67chic]

I was wondering that myself. I know this is the "system" we're talking about here and logic is nowhere to be found but.....Could your doctor help you with the appeal process and give a statement that your condition would be greatly improved by the surgery? I know you're upset but is it possible?

 

[DammitJanet]

Nope...not even possible. I have gone round and round about this before about another service and it is just part of the idiotic way things are written.

 

[1905]

Is there some way you can get on medicaid instead? -Alyssa

 

[DammitJanet]

I cant get plain medicaid because I get medicare because I am on social security disability and you cannot opt out of Medicare part A or B if you want to get Medicaid. Medicare is not considered to be a "welfare" type of insurance but Medicaid is so that if you are eligible for even a dollar of Medicaid then you have to apply for all other insurances you can including Medicare ...and those are primary.

 

[Hound dog]

Oh, Janet! I'm so sorry. You know, the medicaid/medicare "overhaul" only made everything more of a major PITA. grrrrrr

On the other hand, gastric bipass is not a fun procedure, even after the healing process is done. My phlebotomy instructor had the procedure, and while it worked for her without complications.......... She has no choice but to eat tiny "meals" (I swear no more than a couple of bites) every 2 hrs on the nose, or pass out on the floor from low blood sugar, and drink non stop water all day to keep hydrated. Nor could you imagine the handfulls of vitamens and supplements she has to take because her body no longer absorbs enough.

Think all of that is bad??? Then the poor woman has a never ending case of diarrhea.

Yes, she lost 120 lbs in a year. She looks amazing.

But just thinking about all that and if I ever faced the need.......I honestly don't think I'd opt that way. I think the price is too high. There has got to be a better way.

((hugs))

 

[1905]

Would your doctor consider a payment plan? Or could you take out a loan? This is ridiculous and seems funny in hindsight, but my friend put a mastectomy on a credit card.-Alyssa

 

[SONS GONE WILD]

My husband was looking into the surgery. We have private pay insurance and they won't pay for it either. His doctor put him on Januvia. I don't know a lot about it, but believe it may be a diabetic medication, but a side affect, at least for some, is a very small appetite. Don't know how much weight he's lost yet, but we can definitely tell he's losing. Just a thought . . . and some of these pharmaceutical companies will donate medications to those who can't afford them. . . wishing you the best. . .

 

[meowbunny]

I'm so sorry.

 

[gcvmom]

That's just beyond frustrating. That's crazy.

 

[Christy]

That's disappointing. You'd think they would want to treat obesity since it causes so many other health problems. I struggle with weight myself, and have type II diabetes.

 

[DammitJanet]

See...whats really stupid is I lost a lot of weight about 5 years ago when I first went on topamax. Maybe its six years now...cant remember. Probably closer to six when I started losing. I started at about 320 and my lowest was 220. I may have been able to go lower if I had started therapy around then but the 200 mark was a roadblock in my mind.

However, that is when I lost insurance, the public psychiatrists balked at my normal medications and put me on risperdal, zyprexa and lithium and all my progress was lost. I ballooned back up to near 300 in record time and now my old medications simply dont work the same anymore. I dont even have the will to attempt it. I dont. Not when I know that at anytime I can be stuck on medications that can reverse my attempts. I end up on prednisone from time to time too.

I keep telling people I want weight neutral medications but the docs keep advocating the gastric bypass. Now that Im willing, insurance isnt. Oh well.

 

[Marguerite]

The crazy thing is, Janet, with the medications, including the risperdal, that piled the weight on you, it would be medically induced weight gain, and yet you can't get the medical system to help you lose what they made you put on.

As an alternative to surgery, I'm going great guns on my diet pills. I was talking to a doctor friend of mine tonight, she said t his particular pill was originally developed as an antidepressant but it didn't work too well and had the sided effect of causing anorexia, so they changed their marketing and development and now it's available as a diet pill.
In the past when I've dieted, the weight loss slows and almost stops. Now, the weight at times seems to be falling off me. I'm only losing about a kilo a week on average (that's 2.2 lbs), but after 12 weeks that's 12 kilos, or 25 pounds. If you're heavier to start with, the weight drop is faster. With these pills you do need to diet at the same time, but it's not as difficult to do so. I take the pills and also have eliminated all fat, all sugar and all refined carbs. I've limited carbs in other ways but eat unlimited vegetables (apart from potatoes and white rice), one piece of fruit a day and small amounts of brown rice and wholegrain bread. The only fast food I allow myself is a small amount of sushi. Otherwise, it's all fresh, home-cooked, low-fat casseroles.

Would your health system consider this option? At least as a start?

Marg

 

[TerryJ2]

So sorry Janet. Very frustrating.
Wow, Marg, that's a good tip. Would that work for you Janet? Or because you're bip, do you have to stay away from it?

 

[DammitJanet]

The topamax used to work but doesnt anymore. I even switched to zonogran to see if that would do it...nope. I tried staying off topamax for 3 months...nope. Being taken off the topamax to begin with killed it for me.

 

[totoro]

My head is just spinning thinking of your situation... Wouldn't it be nice, since the system and our "health care" helped you with the problem! That they could take you somewhere and treat you, ALL OF YOU!!! Every issue, and set up the medications, programs, treatments... to help you, mentally and dietary.
Like a mental health SPA and they pay for it all....and you wouldn't have to leave until you lost all of the weight that you wanted...
I know they have places for overeaters, food addicts etc. But I don't think that is the problem. I just hate it when they are more than happy to cause a problem, but when you ask for help! NO WAY.
Yeah, just lose weight! As I am watching K pack on the Depakote pounds...

Keep hanging in there and fighting!!!

 

[1905]

Marg,
What's the name of those diet pills?-Alyssa

 

[DammitJanet]

Well I got a phone call back from another surgeon. Seems that maybe all is not lost. Maybe....just maybe...things can be approved if I can jump through enough hoops. Problem is that I have to prove to medicare/medicaid that I have been under a doctor's supervised diet and exercise program for six months. Ummmm....I have tried every diet out there and I cant do one more. I also explained to this woman that I am under a doctors restrictions as far as walking/standing go. She suggested that I walk or go to a gym for exercise...lmao...ok...yeah right. Im on disability people! I can only stand for 20 mins a day per doctors orders. I consider it a major feat if I can make it through the grocery store. Is getting groceries considered exercise? Does washing dishes in one load count? How about folding clothes?

She wasnt amused. I mean do normal people get these operations? I would think only sick people...disabled people...get things like this done. I waited this long because if I could have done it any other way I would have done it! She made it seem like I would have to prove that I really didnt get this way on purpose. It was this odd condescending tone.

 

[GoingNorth]

Janet, nearly all ins co's out there require some sort of 6 months or one year medically supervised program before approving any type of bariatric surgery.

It's both to reduce the size of the liver and to insure that the patient is willing/able to handle the lifestyle changes the surgery will require.

Medicare WILL cover bariatric surgery if you have sufficient comorbidities, and certainly the arthritis, respiratory difficulties, etc., will count towards that.

Basically they are not trying to make you jump through hoops but rather making sure you realize that the surgery is another tool to use towards weight loss as opposed to a magic bullet.

hth
toK (who is battling 40lbs of Zyprexa and Depakote weight gain herself, ugh!)