Re: Statement for PCOS & Bariatric Surgery/Insurance comment
From: Connie (anonymous@obgyn.net)
Thu, 29 May 2003 08:23:02 -0500 (CDT)
The letter in this message is very good, I work in the Medical Insurance
Field, and it gove just about everthing that is required by the company
I work for.
A word of caution. Please research this option very throughly. It is a
major change to your body, most of these surgeries can not be reversed
and there can be major complication. I have considered it myself
because I have almost 200 lbs to lose to be at a "healthy wieght" per my
PCP, however I am not willing to risk the complications. I could tell
you both sucess stories and some very ugly horror stories. Be sure this
is what you want to do. It is NOT going to get rid of your PCOS!!!!
I would suggest trying the POCS diet book that just came out in the US
first. You can find it on Ammazon.com. I haven't tried it yet, but
will be buying it my next pay day.
At Thu, 29 May 2003, anonymous@obgyn.net wrote:
>
>Hello, I am responding to your message that you posted to the forum. Befor
>you assume or listen to anyone tell you your insurance doesn't approve
>bariatric surgery, try searching various search engines. There is 2 known ebsites,
>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 dire tly
>there ( <A HREF="http://aolsearch.aol.com/aol/search?query=bandsters">A L Search: Results for "bandsters"</A> and <A HREF="http://www.obesityhelp.com">w w.obesityhelp.com</A> ), they
>will tell you what insurance's have been approved, and what you can do to b come
>approved. I was told by my DR's office my insurance wasn't going to be abl
>to process any toward bariatric surgery approvals, but I stayed persistent
>searching the Internet, looking for forums and similar topics to that suppo ted
>the same situations we are getting. I researched this information completel 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 qua ify.
> 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 t
>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 pnea) 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 ove
>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 starte
>again:
>
>EDUCATE YOUR PRIMARY CARE PHYSICIANPrimary care physicians usually know
>little to nothing about Bariatric surgery. They may, therefore, say NO righ up
>front. Or they will argue the point. Or else they firmly believe you can st rt 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 a out
>obesity surgery. Don't take a million pages though. They won't take the tim
>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 our
>help, yet I know and feel that my health has and continues to deteriorate b cause
>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 re risks
>associated with gastric bypass surgery, just as there are risks associated ith
>any surgery. I realize that a lifestyle change and exercise are major
>components of bariatric surgery and I have already started making those cha ges. The
>experts at ObesityHelp, for instance, say bariatric surgery is necessary
>because it is the only proven method of achieving long term weight control or 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 gastr c
>reservoir, with or without some degree of associated malabsorption. This
>reduces caloric intake and ensures that the patient eats small amounts of f od very
>slowly, while chewing each mouthful well. Success of surgical treatment beg ns
>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 stan ardized,
>clearly defined procedures, with well recognized and documented outcome
>results. Prevention of secondary complications of morbid obesity is an impo tant
>goal of management. Therefore, the option of surgical treatment is a ration l
>one. Morbid obesity is a disease, not a disorder of willpower. The physiolo ic,
>biochemical and genetic evidence is overwhelming that clinically morbid
>obesity is a complex disorder. Contributing causes are inheritance, environ ental,
>cultural, socioeconomic and psychological. I have a couple of interesting a d
>informative handouts from ObesityHelp.com. I have taken the time to print t em
>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 compa y
>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:
>
>> My Insurance doesn't cover any kind of weight control or help
>> for Obesity. Xenical, Meridia, Gastric Bypass or anything.
>> It's very discouraging. I am not sure what to do now, my Doc
>> wanted me to start Meridia, but I cannot afford to pay full price
>> on it while paying monthly for each of my other Rx's.
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