Sphinx

I called my PCP today to see about getting eval for a sleep study (waiting for a call back, might end up being tomorrow). My labs all came back normal re: other comorbidities and I am not hypertensive.

GERD actually is considered a comorbidity but just not for my insurance company. DJD is a comorbidity for a lot of companies, but not mine. Of course they don't consider RA as obesity related since it's autoimmune, but all I know is that if I weighed less I would definitely feel less pain! I left a message with my PCP today to ask for a referral for a sleep study. That's the only other thing my insurance will cover that I haven't been tested for. It's unclear if I even have symptoms because my husband has severe sleep apnea and uses CPAP which is kind of noisy, plus my pug bunks with us and he definitely snores...loudly! LOL But I agree-----stupid insurance companies! Argh! I know it would help my pain so much which would allow me to decrease some of my *expensive* meds! Oh well..........apparently, while my insurance company *does* require going through the weight loss program they don't require the 5% weight loss. So it'll be a fine line!

Hi, I'm Heather. I work on a Rehab Unit in a nursing home, short term stay s/p joint surgeries, falls/fx, s/p CVA and general reconditioning. Its a 20 bed unit (soon to be 25 beds come next month). I'm an evening shift RN on the floor. I am just starting the process to get banded. I am at the border line for whether or not my insurance will cover and don't even have my seminar until next month. I'll be seeing Dr O'Malley here in Rochester NY, a leader in the area. If I fall into where my insurance won't pay, I am considering doing self pay in Mexico. Other stuff about me, well I am married and have a 17 yr old step son, and 2 boys age 20 and 23. My oldest and his wife live with us with my 6 month old grandson, and my 20 yr old lives here while he goes to comm college. I have rheumatoid arthritis, fibromyalgia, interstitial cystitis, GERD and bipolar type 2 (unfortunately for all those dx none are considered co-morbidities for my insurance, naturally! It's nice to know there are other nurses here!

I don't see where the nursing forum is here?

I'm a nurse too I'm just at the beginning of my journey, though. I go to my seminar next month. I'm borderline at best for my BMI but thinking positively that my insurance will cover.....would be nice to have support from my fellow nurses:)

I saw my primary doc today and she gave me a referral! I was worried because I'm a new patient to her (5 months) and wasn't sure what her opinion of the surgery was. My former doctor suggested it a couple years ago, putting the idea in my head and thinking about it since then Too bad it's Friday and I can't call the surgeon til Monday, lol......I know I have a long journey ahead of me and want to jump in with both feet! Not sure about insurance coverage. Although I have numerous health problems, none are considered comorbidities (my BMI is only 38 so need a comorbidity). I do have reflux, which she says may be considered a "soft" comorbidity, my RA as well. She is running many labs to see if I may have any other things that could be taken into account. I am thinking positively about getting approved. I also have to do the physician supervised nutrition/weight loss of course. I am thinking positively. I know it's not going to happen tomorrow, and I'm ok with that. I am looking forward to this journey! I know it will be hard but I am ready!

I signed up for the seminar today (it's not til 9/27) after a couple days of stress when I couldn't even get registered because I don't have the textbook co-morbidities. When I talked to their insurance coordinator I accidentally transposed a couple numbers in my weight (I do that with numbers all the time!) so was able to get through the door. Who knows what will happen once I get there, as it stand now my BMI is just a shade over 38. I'm getting tests for co-morbidities so who knows what that will bring......but being unsure about it all can be very frustrating! Good luck to you! Seems like you've had a long time of it too, hopefully things will work out this time!

LOL! Yeah, I am pretty polite......not the most assertive person! When I try to be more direct it is often because I'm so mad, but when I lose my temper I sometimes start to cry which never works haha! Anyhoo....... The insurance coordinator called me back today. I swear I didn't do it on purpose, but when she asked my height and weight she said "Well, you're BMI is 40 so you should be ok". I'm like, ummmmm, I thought it wasn't? She said it was 39.8 but that would count as being 40. I know it's just a hair over 38 and I realized I must have told her something wrong, but decided to let it slide. So after we talked I figured out what I must have told her to get a result of 38.8 and called to make an appointment, and told her that. I know that's bad, but I just wanted to get in the door. So I am registered for a class September 27th. It will probably be a waste of time but ya never know.

I don't think insurance will cover if your BMI is less than 35, even with comorbidities. Don't know about private pay though! BTW, try posting this as a separate new topic, you'd likely get more responses, since this is tacked on the end of my post it might not get seen

Oy. Called the surgeon's office. The woman who answers the phone strikes me as a gatekeeper who doesn't necessarily know the score. She didn't even know if they had an insurance coordinator. She did "go and check" and transfer me to someone, but that person didn't answer. I left a message but didn't hear back. Will have to try again tomorrow.

Thank you for some much needed clarity. I guess I was just so confident that going shot down before having a chance really killed me. I believe the person at my insurance company was speaking of the surgeon as they need to send over a pre certification not a referral (I don't require a referral for any specialists with my insurance. So I will try to call the surgeon again and see I their insurance coordinator will help. As it stands I can't even register for a seminar! I also had my labs drawn today and once the results are in plan to see if my primary doc will refer me for a sleep study and x rays of my knees and hips. Haven't ha my hips done in a couple years and never had my knees done (never had knee pain until the past few months.....not surprisingly when my weight started creeping up again haha). So maybe something will turn up there. Well I have a phone call or two to make then off to the gym! Gotta keep working at it!

Thank you. The surgeon I was referred to is highly recommended and I was hoping that I could at least see him so they could work with insurance for me but I can't even get in

But if the doc won't see me how can that happen? Argh!

Oh and I just called my insurance and they said they may or may not pay but they have to get something from the doc for per certification but

Well turns out it's all for nothing. I called the surgeons office and I can't even get an appointment because I need to have degenerative arthritis (RA doesn't count), Hypertension, Diabetes or sleep apnea and be on daily medication for the above. She said my insurance wouldn't make exceptions for my other diagnoses. I asked about private pay and she said that the same guidelienes apply. I knew that these were the accepted comorbidities, but was hoping to start the process and try to work with my insurance based on my RA and whatnot (reflux, etc). I know that weighing less would help my RA pain but I guess it doesn't matter. Even if my labs come up with diabetes I have to be on daily meds, not diet controlled. I am really bummed. Not that I'd purposely try to gain weight but if I keep gaining as fast as I have been I may just reach 40. But I hope not.

I am excited but also cautious. It's unknown whether or not my insurance will accept my many dx as comorbidities. I'm having loads of lab work in case anything else shows up. I'm calling the surgeons office tomorrow. From what I can tell it looks like the next seminar or whatever it's called is at the end of next month. I hate waiting! I'll have to do the physician monitored diet, from what I can tell with my insurance if I do a comprehensive program as part of surgery preparation I only have to do 3 months not 6. The only other thing is that even though my BMI is 38 now, it's dipped below 35 a bit and I'm not sure what insurance will think of that. To me it just shows what a yoyo I've been. But we will see how it all goes and I am thinking positively! Of course saying all this right after I polished off a too large meal. Well, I have to work on that one. I get so hungry at work! (At work now). How are you doing?

I saw my doc yesterday and she gave me the referral

definitely means nothing by mouth....I'm a nurse and that's the official meaning of npo (it's latin)

Well I finally found my insurance company's coverage info (impossible to find on their website, finally received response to my email and was able to find it). For BMI 35 it lists comorbidities of hypertension, sleep apnea and type 2 diabetes. I'm not sure how flexible they'd be in allowing my arthritis,etc. it also lists 6 month dieting under dr supervision but then says OR 3 months program, not sure what the difference is. Call me crazy but I'd hoped that my dr just stating my dieting history would be enough but it very specifically says every dr visit must be documented. That's fine but what I wonder is if I do manage to lose weight, I I dip below BMI of 35 (I'm 38 now) if they cover me. If I did manage to lose that much weight (doubtful) and they don't cover me what happens when I gain it back? Cuz I always do. Believe me if I could lose weight and keep it off without surgery that would be awesome, but it's always a yoyo with me no matter how hard I try. Well it remains to be seen if my primary doc will support me too. I'll see on Friday. I also need to get psych eval but I'm sure I'll be ok. My bipolar is well managed and under control for quite some time. So wish me luck Friday

Well if it hadn't been for going to PT I'd not have gotten into exercising. I used to go to Curves but got out of it, it gets boring after a while. I know that going into any surgery is easier if you already exercise...I know it helped after my foot surgery. My appointment is Friday. She's only been my doc for a few months (my old doc left the medical field). I know her from being my kids' doc but only seen her for myself once and her PA once. I hope she will be open minded. I'm sure I'll have to talk to my rheumatologist too, but this is a start. I am excited!

Well I started exercising as part of physical therapy for my fibromyalgia (exercise helps). I got out of it then had to go back with shoulder problems. When I finished PT I started a type of bridging program at the gym I do my therapy at. You don't get therapy but full use o the gym for $25 a month. It's small and intimate and even though it's not really close to home I enjoy coming (never thought I'd say that haha!) like right now on the bike I can get on my iPhone and do stuff on like. Then there is a machine called a nustep shin is sort of like a recumbant seated elliptical that is way easier on my knees. I usually have my iPad and read and maybe watch a movie. Makes things go faster, if I don't have anything to do it is a chore! It does make me nervous that I'd have to go that long without coming, although walking will help some. It's just super hard to come back if I go too long. Like I said the exercise helps my fibro and even my RA, but walking will help prevent stiffness and I know how important it is to be up walking after surgery (I am a nurse). That's the other thing, because I am on my feet most of my 8 hour stuff it usually means more time off after surgery. But if I start putting away a little money now it will help with the loss of income. The other thing is, although I speak with my husband a lot about my weight (he is overweight too) I never mentioned my interest in the surgery except in passing. I've been afraid he wouldn't want me to do it. We talked about it last night and he is all for it! I told him it will be hard work and he said that's ok because it would force him to work too. The big thing is right now we enable each other. I told h that needs to stop and he agreed. I feel a lot better after talking to him Of course this is still just the beginning, have to see what my doc says and go from there. Thank you for the support!

Thank you all so much for your advice and support. I have just called and made an appointment to see my primary doctor in a couple weeks. I already have both a therapist and psychiatrist I see. It's definitely true that weighing less would decrease my pain. Being overweight does not cause RA, but the weight does put too much stress on already stressed joints. I also had surgery for plantar fasciitis almost 2 years ago and even with new orthotics last spring am feeling some pain and do NOT want to go through that pain again! Weight definitely makes plantar fasciitis worse. I am so sick of being this way. I exercise as much as I can, but it does nothing Which reminds me....after surgery how quickly do you recover in terms of going back to work and being able to exercise? I'm a nurse, so I know everybody heals differently, but don't want to go without exercising for too long. It's so hard to get back into it!