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[Trystinsmom 7]

Hello all! I’m Heather and new to this forum but not new to the process. I have spent the last two years going literally through hell trying to have my sleeve surgery. I went through two separate programs only to be denied x2 with letters written by PCP and surgeons for final appeal, by my insurance company because I am obese with no Comorbidities. It has been a roller coaster of emotions and let downs. Last year I married my boyfriend of 7 years and had decided I was going to just be a cash patient and have my surgery in Mexico. My husband was very unsupportive and freaked me out so bad that 4 weeks prior to my surgery I decided to cancel. My husband isn’t overweight and one of those who believe that if I worked countless hours in the gym that I would “be skinny” and thinks that I’m cheating or trying to be lazy by having the surgery. He just doesn’t understand. I recently was diagnosed with RA and after speaking with my RA Dr. I decided that I was finally going to stop letting people discourage me from having this surgery, including my husband, and finally try to take control of my health and do this for myself and my babies. I once again will be a cash patient. I found a surgeon in my area that will accept all of my paperwork from the previous programs that I tried. I have my appointment with him on May 15. I have saved up most of the money for the required payment. I’m keeping my fingers crossed that this will finally Work out in my favor! I will need all the support I can get!

[Dointhis4me 12]

Good luck on your journey!

[Orchids&Dragons 9,046]

Best wishes that everything goes smoothly! Are you sure you'll still need to be cash? I would have thought RA would be considered a co-morbidity since losing weight would help with your mobility.

[FluffyChix 17,409]

Wait. I'm confused. You weigh 280lbs? If so, I guarantee you're >40BMI. That alone quals you. If you are <40BMI, then RA IS a recognized co-morbidity for insurance. So why are you cash pay?

Welcome to the boards and sorry for your struggle btw.

[MermaidInAZ 29]

9 hours ago, Trystinsmom said:

Hello all! I’m Heather and new to this forum but not new to the process. I have spent the last two years going literally through hell trying to have my sleeve surgery. I went through two separate programs only to be denied x2 with letters written by PCP and surgeons for final appeal, by my insurance company because I am obese with no Comorbidities. It has been a roller coaster of emotions and let downs. Last year I married my boyfriend of 7 years and had decided I was going to just be a cash patient and have my surgery in Mexico. My husband was very unsupportive and freaked me out so bad that 4 weeks prior to my surgery I decided to cancel. My husband isn’t overweight and one of those who believe that if I worked countless hours in the gym that I would “be skinny” and thinks that I’m cheating or trying to be lazy by having the surgery. He just doesn’t understand. I recently was diagnosed with RA and after speaking with my RA Dr. I decided that I was finally going to stop letting people discourage me from having this surgery, including my husband, and finally try to take control of my health and do this for myself and my babies. I once again will be a cash patient. I found a surgeon in my area that will accept all of my paperwork from the previous programs that I tried. I have my appointment with him on May 15. I have saved up most of the money for the required payment. I’m keeping my fingers crossed that this will finally Work out in my favor! I will need all the support I can get!

I'm so sorry you're having such a hard time all around, but most of all for your husband's lack of support. You have to remember you're doing this for yourself; not anyone else. There are, and will be, people who want to discourage you but you just have to keep on going because it is about you, your health, and your happiness. I really hope the new doctor follows through. Let us know how it went.

[Trystinsmom 7]

3 hours ago, FluffyChix said:

Wait. I'm confused. You weigh 280lbs? If so, I guarantee you're >40BMI. That alone quals you. If you are <40BMI, then RA IS a recognized co-morbidity for insurance. So why are you cash pay?

Welcome to the boards and sorry for your struggle btw.

My BMI is actually over 41 but my insurance requires a min BMI of 40 plus 2 comorbidities such as diabetes, high blood pressure, sleep apnea etc. I Appealed when diagnosed with the RA and submitted documents and even a letter from the RA doctor and my pcp and they still denied me. They accepted the RA as one but I need another. I don’t have any of the things on their list other than the RA. I don’t really know what else to do to fight the insurance company. Seems like these days they just are looking to deny any way the can.

[Lily’sMom 28]

Have u been tested for sleep apnea? That might be a way to go. You may have it and not even know it.

[amyandgreg1234 11]

I would just go to Mexico and skip all the BS!

[Frustr8 7,886]

Any indigestion/heartburn?😲 GERD very much qualifies! Have it myself so it's a certainity😝

[allwet 868]

17 hours ago, Trystinsmom said:

Hello all! I’m Heather and new to this forum but not new to the process. I have spent the last two years going literally through hell trying to have my sleeve surgery. I went through two separate programs only to be denied x2 with letters written by PCP and surgeons for final appeal, by my insurance company because I am obese with no Comorbidities. It has been a roller coaster of emotions and let downs. Last year I married my boyfriend of 7 years and had decided I was going to just be a cash patient and have my surgery in Mexico. My husband was very unsupportive and freaked me out so bad that 4 weeks prior to my surgery I decided to cancel. My husband isn’t overweight and one of those who believe that if I worked countless hours in the gym that I would “be skinny” and thinks that I’m cheating or trying to be lazy by having the surgery. He just doesn’t understand. I recently was diagnosed with RA and after speaking with my RA Dr. I decided that I was finally going to stop letting people discourage me from having this surgery, including my husband, and finally try to take control of my health and do this for myself and my babies. I once again will be a cash patient. I found a surgeon in my area that will accept all of my paperwork from the previous programs that I tried. I have my appointment with him on May 15. I have saved up most of the money for the required payment. I’m keeping my fingers crossed that this will finally Work out in my favor! I will need all the support I can get!

Heather this all for you and your life. Never let someone else decide how your life will be lived and how long your life will be because lets face it this about life and death. When you cut right to it being obese is a death sentence that you spend everyday slowly living and getting worse so slowly that we miss how much of our life we are giving up till its to late. Dont give up on yourself and dont let others decide what happiness you deserve.

[Stephanie_A 1]

It took almost two years for me to get all the prerequisites completed and get my insurance to approve it. It was a long process but I’m glad I did it. Hang in there. Also this surgery is something that you have to do for you. I didn’t tell anyone (with the exception of my mom and best friends) I was doing it until it was scheduled. Honestly I didn’t want anyone’s else’s opinion because it’s my body and I get to decide what I want to do with it. On the flip side of that it’s really really important that you have a strong support system post surgery. Everyone that I told about the surgery was beyond supportive and continue to be. That’s makes so much difference. I hope that your husband comes around and supports your decision. Best of luck to you

[Frustr8 7,886]

Heather you can count on me in the cheering section. For various reasons also it has been an almost 3 year battle for me also. Things are looking up, I may see a June Surgery shining in my future. First consulted with a Bariatric Surgeon in August 2015. But I haven't and won't give up, many reasons, stay my friend and I'll,tell you some of them. Even wrote a poem yesterday , you can find it on Surgery-"its the easy way". feel free to,look it up. Welcome again!😝

[Trystinsmom 7]

6 hours ago, Frustr8 said:

Any indigestion/heartburn?😲 GERD very much qualifies! Have it myself so it's a certainity😝

I do get indigestion every once and awhile..lol. I can honestly say I absolutely LOVE my PCP. We tried everything and tested everything. After I did the 6 month required nutritional counseling and “diet plan” and got my first denial..my pcp did an array of blood tests for cholesterol, sugar, a1c, triglycerides, liver kidneys heart and thyroid...everything! Nothing! All was normal! He was trying his hardest to document 1 more thing that would qualify me. The problem is...I have been overweight my whole life since childhood, but other than the RA..I don’t have major health problems! I have a hard time with my portions because I might eat once or twice a day...but I don’t make bad food choices..I just eat too much at one time. We don’t eat sweets, we eat organic, I’m the only overweight one in the house! My biggest downfall is coffee and soda. I drink but I don’t even Give that to my kids! That’s as bad as it gets here! I go all day without eating that I eat too much when I can finally sit down and eat. And one because of this RA, it’s not under control yet and I can’t do anything but hurt all day so i stopped being able to be so mobile and have gained an excessive amount of weight in the last 3 months. Of course the rA doctor says I need to lose weight...it’s a never ending battle.

[Frustr8 7,886]

I'm sure your surgeon will order an EGD, most bariatric surgeons in the US do, and suspect,Canadian surgeons do too,
Okay,with an EGD you go to sleep, thry,put a Fiber optic tube,down the eosphagus, through your stomach,and,into the,beginning of your small intestine. Sounds scary, it,is not really, very smooth and entertaining to watch a video of. Actually the YouTube videos of sleeve and bypass are much more a upsetting thing.
While,they are down there they do a good look'around, take biopsy samples ect. I had one,in December. 2017 by my gastroenterologist, the second in my lifetime,my first was June 2015 by a general surgeon. This one went smooth as silk, my doctor was gentle, skillful and didn't even make my throat sore, the g s in 2015 really did. Both times I got a report with color pictures of different area in my gi system. I'm telling about this because you probably will have a hiatal hernia, 85% of us do, also possible they will find signs of GERD many,obese people do, and if you do, congratulations, you have your second comorbidity and insurance might cover things after all. If not, well you were prepared to,pay already. My results
moderately severe GERD
moderate sized hiatal hernia
small gastric ulcer,notready to perforate
My baby,ulcer, named Hector, was not,from h. pylori, which causes a lot of,them. Hector instead was from excessive use of NSAIDS. I have,had osteoarthritis since,i was 25, also have R A but haven't had a flare recently. Common for me to take 4 or equivalent,of Advil,every 4-'6 hours. Well,it tamed the pain down to a tolerable range, but,now I am paying for it. We,keep,Hectot sleeping, with Dexilant, the,Ferrari of PPIs, would cost $350 monthly,without insurance and that's at Walmart the cheapest place in my,town. CVS and RiteAid would be out of sight.
So maybe,in June I will have,my,bypass surgery and be able to lose and sustain weight loss, which I can't do now.

[Trystinsmom 7]

22 minutes ago, Frustr8 said:

I'm sure your surgeon will order an EGD, most bariatric surgeons in the US do, and suspect,Canadian surgeons do too,
Okay,with an EGD you go to sleep, thry,put a Fiber optic tube,down the eosphagus, through your stomach,and,into the,beginning of your small intestine. Sounds scary, it,is not really, very smooth and entertaining to watch a video of. Actually the YouTube videos of sleeve and bypass are much more a upsetting thing.
While,they are down there they do a good look'around, take biopsy samples ect. I had one,in December. 2017 by my gastroenterologist, the second in my lifetime,my first was June 2015 by a general surgeon. This one went smooth as silk, my doctor was gentle, skillful and didn't even make my throat sore, the g s in 2015 really did. Both times I got a report with color pictures of different area in my gi system. I'm telling about this because you probably will have a hiatal hernia, 85% of us do, also possible they will find signs of GERD many,obese people do, and if you do, congratulations, you have your second comorbidity and insurance might cover things after all. If not, well you were prepared to,pay already. My results
moderately severe GERD
moderate sized hiatal hernia
small gastric ulcer,notready to perforate
My baby,ulcer, named Hector, was not,from h. pylori, which causes a lot of,them. Hector instead was from excessive use of NSAIDS. I have,had osteoarthritis since,i was 25, also have R A but haven't had a flare recently. Common for me to take 4 or equivalent,of Advil,every 4-'6 hours. Well,it tamed the pain down to a tolerable range, but,now I am paying for it. We,keep,Hectot sleeping,with Dexilant, the,Ferrari of PPIs, would cost $350 monthly,without insurance and that's at Walmart the cheapest place in my,town. CVS and RiteAid would be out of sight.
So maybe,in June I will have,my,bypass surgery and be able to lose and sustain weight loss, which I can't do now.

Wow!!! That’s EXACTLY what I am dealing with now...I started having issues with taking the Aleve and ibuprofen to the point I would get horrible abdominal cramps after taking them. So now I have stopped taking them daily and alternating. When the pain gets too much to handle of course, I have the narcotic pain medication which I will break in half but I have 4 children (2 are mine 2 steps) so no time to be down...I just suffer through the pain and use a lot of OTC homeopathic creams. I’ve always wondered if I had some issue in my stomach but my PCP seems to think my stomach issues were related to the NSAIDS so he never saw a reason really to send me to gastro. Perhaps I should give him a call in the morning for a referral?