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Re: Statement for PCOS & Bariatric Surgery/Insurance commentFrom: anonymous@obgyn.netThu, 29 May 2003 00:16:48 EDT
Hello, I am responding to your message that you posted to the forum. Before you assume or listen to anyone tell you your insurance doesn't approve bariatric surgery, try searching various search engines. There is 2 known websites, I can share now, but keep on searching search engines and look for the key word. bandsters, you can click on these web pages and it will take you directly there ( <A HREF="http://aolsearch.aol.com/aol/search?query=bandsters">AOL Search: Results for "bandsters"</A> and <A HREF="http://www.obesityhelp.com">www.obesityhelp.com</A> ), they will tell you what insurance's have been approved, and what you can do to become approved. I was told by my DR's office my insurance wasn't going to be able to process any toward bariatric surgery approvals, but I stayed persistent searching the Internet, looking for forums and similar topics to that supported the same situations we are getting. I researched this information completely to be prepared on how to negotiate with my DR's office and my insurance, and I finally won!!!!! I have to go through several evaluation to make sure I qualify. Don't give up so easy, keep focused and firm and I guarantee by this time next year you can be considered for the surgery too. Before you try to go to your DR again with this be prepared, here is a few qualifications for this surgery: You are between 18 and 60 years old. Your BMI is 40 or above. You have a BMI of 35 or above, but are suffering from obvious health problems with and associated with severe obesity, such as diabetes, joint problems, heart disease, or snoring, regular cessation of breathing (sleep apnea) etc. You have been over weight for more than 5 years. You have made serious attempts to lose weight, which may have been successful, but the weight came back. You are not suffering from any disease which could have caused your over weight. You are prepared to make drastic changes in your eating habits and lifestyle, and to go on monitored by the specialist treating you. You do not drink to excess or use "Mind-Expanding" substances. You weigh at least twice as much as their ideal weight; You weigh at least 100 lbs. more than their ideal weight. You have a body mass index (BMI) of 40 or above. Also here is something that may help you as well at least to get you started again: EDUCATE YOUR PRIMARY CARE PHYSICIANPrimary care physicians usually know little to nothing about Bariatric surgery. They may, therefore, say NO right up front. Or they will argue the point. Or else they firmly believe you can start a diet and you will be all set. An important step in getting insurance preapproval or even having a consult with a bariatric surgeon is to educate your PCP. Make an appointment with your PCP. Go to that appointment armed with data about obesity surgery. Don't take a million pages though. They won't take the time to read a lot of pages. While your information has to be comprehensive, it needs to be condensed just a few pages. Here is a sample letter to your PCP: Dear Doctor, I am asking for your assistance in obtaining weight-loss surgery. It is difficult and embarrassing for me to come to you asking for your help, yet I know and feel that my health has and continues to deteriorate because of my obesity. I have tried many weight-loss plans, including _______, _______, ________, etc., (list all diet plans you have tried). I now suffer from ______, _____, _______, etc., (list ALL your comorbid conditions) I have researched bariatric surgery in depth and I am well informed. I know there are risks associated with gastric bypass surgery, just as there are risks associated with any surgery. I realize that a lifestyle change and exercise are major components of bariatric surgery and I have already started making those changes. The experts at ObesityHelp, for instance, say bariatric surgery is necessary because it is the only proven method of achieving long term weight control for the morbidly obese. Bariatric surgery is not a cosmetic procedure. Surgical treatment of morbid obesity does not involve the removal of adipose tissue (fat) by suction or excision. What it accomplishes is reducing the size of the gastric reservoir, with or without some degree of associated malabsorption. This reduces caloric intake and ensures that the patient eats small amounts of food very slowly, while chewing each mouthful well. Success of surgical treatment begins with the patient setting realistic goals and progresses through the surgery and lifelong follow-up by the bariatric surgeon. The different, accepted surgeries have been worked out over the last thirty years, and are now standardized, clearly defined procedures, with well recognized and documented outcome results. Prevention of secondary complications of morbid obesity is an important goal of management. Therefore, the option of surgical treatment is a rational one. Morbid obesity is a disease, not a disorder of willpower. The physiologic, biochemical and genetic evidence is overwhelming that clinically morbid obesity is a complex disorder. Contributing causes are inheritance, environmental, cultural, socioeconomic and psychological. I have a couple of interesting and informative handouts from ObesityHelp.com. I have taken the time to print them out for you. I ask that you take a few minutes, at your leisure, and read them. Thank you for helping me. If you need anymore info on how to set up a letter for your insurance company just email me at <A HREF="http://www.daehlia@aol.com">http://www.daehlia@aol.com</A> Good luck to you, Daehlia In a message dated 5/27/2003 6:15:44 PM Central Daylight Time, lane4242@hotmail.com writes:
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