Changes

Hello. My name is Grace (hi Grace) and I have been overweight since I can remember. As a child, teenager, and even today at the ripe old age of 30 I have decided to take this lap band journey. I have been reading the forums and blogs for about a month and decided it was time to show my face, so to speak. I am at the beginning of the process. I found out today that since I was accepted into my insurances Bariatric Surgery Case Management Program and barring my failure to complete the paperwork or an unknown medical issue I should be approved. It is a process and most of it is the medical tests which is no surprise. The thing that I am worried about is the 5% weight I have to lose before surgery. 3% before I can even have the surgery scheduled. I am currently 312 lbs at 5' 7". This means that I need to lose 9 lbs before the paperwork is submitted and another 7lbs before surgery. Now obviously, as I'm sure you all know, weight loss is NOT my greatest skill. I have tried dieting since I was 14 years old with little results. I will turn to these forums to help me stay on track and focused on the goal. I know that having the lapband is not a magic device where the pounds will melt away. I know from reading and research that it truly is a took which I have to work hard with to get the results I'm looking for. So I will try to keep my eyes focuses, start to change my relationship with food now, the way I eat and what I eat. I accept the challenge and know that in the end the rewards are endless. The best reward is my health. I deserve to be healthy. My kids and husband deserve a healthy mother. I am worth this. In the past my issue was losing the momentum. I'm hoping that having this goal will help the motivation. Thank you for reading my LONG post, I tend to get wordy. I can't wait to take this journey and to have you guys by my side. I will also be here cheering you on!!

Today I spoke to the bariatric nurse at the surgery center who said that since I have been approved to enter into the case management program this means that as long as I complete my checklists within 6 months and there are no unknown medical conditions that would interfere, I have ben approved to have the lap band! They said that after I meet with the surgeon the insurance company will give the go ahead for surgery. I also have an insurance case manager who confirmed this. So now I'm waiting to schedule my medical test appointments to complete the checklist. I also gave to loose 5% and go to 2 suppor groups. I'm excited, but don't want to get my hopes up too much. It seems this dream will soon become a reality! Shop now I'm going to do what I have to to get this done. I know it will be hard, but it will be worth it!!

Hello, I'm new to the forum and just starting the process of being considered for the surgery with my insurance. I was wondering if anyone has GHC in WA and could maybe give me some insight as to how their approval, or disapproval, went and what the considerations are. I have called the insurance company twice, but they keep telling me I have to talk to the doctors. Anyone have any tips that have worked with this insurance?

Since there aren't a lot of people on here to seem to have dealt with ghc in WA, I guess I'll share my experience so far. I received approval for the bariatric surgery case management program. I have an intake interview with the nurse (phone interview) on Tuesday. I have received a check-list which I need to complete (I think within 3 months) which includes enrolling in Accomplish, completing the pre-surgery testing, talk to my pcp about contraception, and attending weight loss support groups through ghc. I will get more answers on Tuesday as to which tests I have to have done and when those will be done. I received information in the mail today about Accomplish, which is their pre & post weight loss program/nutrition program. Everything with Accomplish is done over the phone which is nice since I live an hour away from the clinic, but feels a little impersonal. Oh well. I am ready and willing to do whatever it is they require to get approved for the surgery. I am trying to stay positive and keep all the steps straight in my head. I am assuming that after I talk to the nurse Tuesday I will have a better idea of what to expect. I will keep an update here in case anyone else uses this insurance and has questions. I should point out that I have PEBB GHC.

Oh wow, CONGRATS! and of course good luck! I'm very happy for you and hope to someday get where you are!!

Yesterday I confirmed that my doctor sent the referral into my insurance company so I assumed it would be at least a week until I heard anything. Well today I received a call from the ghc bariatric surgery office scheduling an interview with the head nurse. I was told that she is going to discuss my surgery options and explain the entire program. I don't want to assume, over-think, or stress on this. I'm glad that they got my referral and I'm hoping that the phone interview is just another step in the right direction. Maybe they just want to confirm that I'm serious before making me drive down to Bellevue, which is over an hour away from where I live. See, here I go worrying about it. Thankfully I have some other things going on with work and at home to distract me. Unfortunately one of those things is my carpal tunnel, which was just diagnosed and is slowly driving me mad. Just when I thought I was as crazy as I could possibly be, I go ahead and surprise myself

Hi, I am hoping that insurance will cover it, but I have to jump through their hoops, which I am going to do. I have to join an exercise/diet program that the insurance has as well as all the testing and counseling, and support groups which the closest one is an hour away. I'm hoping that next Tuesday I will know more after I talk to the head nurse. I'm ready to get started everything that I have to do. Did you hear back from your insurance?? I do the same thing, I keep looking at before and after pictures and am determined to not let them discourage me. Good Luck to you and thank you for your post!

Good Luck! I can't wait to be where you are, but like you said, we all have to work hard to get there. I hope everything goes well for you!

I have just started the process and can use all the help I can get, would you mind sending it to me too? gracierose9581@hotmail.com

Today was my appointment with my pcp. I am not sure what I was so worried about. I guess I figured he would find a reason to say he wouldn't refer me to my insurance provider's program for the lap band/bariatric surgery. Boy, was I wrong. He was very much on board. We went through my chart and documented all the problems that I have had that are attributed to my weight. Tomorrow I am going to have blood work to check some things that he didn't at my physical earlier this year just to make sure we aren't missing anything. The nurse said that I should hear in a week if my referral was accepted. If it is then I would start the process for being evaluated and considered for the surgery. I also found out today that I am shorter than I thought which brings my BMI up to 48.6. Unfortunately for me my insurance requires a BMI of 35-49 with out of control diabetes, or two other comorbidities. For sure I have one, high cholesterol, and it looks like possible hypertension. The other qualifying problems my insurance accepts are heart disease, pickwickian syndrome, and obstructive sleep apnea. My pcp was very supportive and said that any other insurance company would accept me on my BMI alone, but lucky me I have ghc so there will be several hoops. PCP stated that he has had a lot of people not qualify, but he has had others that do and he believes he had ghc accept someone who's BMI was lower. I guess there isn't anything I can do until I hear back from insurance. Considering my health history and family health history, my weight issues since elementary school, and the constant dieting you'd think that I'd be a shoe-in. Oh well. I have to be patient and patient I will be. According to the paper I printed off today from ghc I also have to maintain a diet and exercise program, maintain a 5% weight loss until surgery,attend support group meetings, keep all appointments and of course follow all the counseling and nutrition classes. I'm so ready! Bring on the red tape baby, cause I'm willing to do what I have to in order to being a new, healthy life!!

Thanks, today I'm feeling a little down, but I think that's just because I am waiting to hear if I can even be considered for the lap band surgery, I know that there will be up days and down days, All I can do now is wait to see if the referral is even accepted. Then if that happens then comes the seeing if I qualify, I'm so impatient! As for the picture, I'll post one eventually, Again, thank you for the comment because it reminded me that yesterday was a good day and that I need to stop worrying.

Like many other people, I have never blogged before so please excuse any mistakes I may make. I'll start with my story. I have been over weight since I can remember. I know that in first grade we made posters with our height and weight on it and I weighed more than anyone else. I went on my first official diet at age 14. My mom and the program (I think it was called Formu3) lied about my age so I could 'officially' take part. That phase passed and although I was bigger, I tried to stay active. The beginning of putting on serious weight began in high school. In college I began kick boxing which I loved, but I still gained weight. When I was 21 I started Weight Watchers and lost 10 lbs and gained that and more back. The next year I did the same thing. I've since had two kids and am now at the heaviest I have ever been at 311 lbs. I just turned 30 and realized that something has to give. I have tried fad diets which only seem to work for a time. With both of my children I had gestational diabetes and high blood pressure. Thankfully the diabetes went away once my children were born, but my blood pressure is not as good as it was. I have done a lot of thinking and research and decided that I want to do the lap band. I not only want to watch my kids grow up, I want to participate in their lives. I don't want to be tired all the time and out of breath. So the decision has been made on my part, now comes the doctors and insurance. I have an appointment with my PCP early next week. I spoke to my insurance company and they said that I have to have a BMI of 35 or over (mine is 47) and 2 significant medical problems attributed to obesity. I will need to have a test to see if I have sleep apnea, but I don't know if I will qualify since I don't have diabetes at the moment. I have a family history on both sides, including my mother, of diabetes, high blood pressure, obesity, cancer, and heart disease. I don't know if this will be considered when my insurance, GroupHealth Cooperative in WA, takes a look at my case. I'm not even sure if my PCP will refer me, but I'm hoping that he will. I'm anxious to get things started because once I come to a decision to do something I want to get it done NOW. I've read about the time it may take and am willing to do what I have to. I want to change my life and will do what is necessary to do it.. If my insurance will not cover it, I will have to try to find a way to pay for it myself. So maybe this is too long, or drawn out. I have only told two co-workers and my husband of my plans as I am not sure how my family will take it. If I am approved I will talk to them about it, but for now it is between us, so don't tell them, ok?? I trust you, no worries Anyway, if you read this thanks. I needed a place to put my thoughts through this journey to my new life.

Thank you both for the advice. I'm trying to gather everything so when I go to my PCP I have all my ducks in a row so to speak. Brenda, I live in Bellingham and if my insurance pays for it (GroupHealth) I will have to go through their approved surgeon. When I moved here 5 years ago my doctor at the time said my cholesterol was high and said I could try to control it with diet, but if I couldn't then he would put me on meds. I changed doctors (dumb move) and my cholesterol was never mentioned again. When I went in for my physical in January I asked my current doctor about checking my cholesterol and he told me not to worry about it!!! So needless to say I will bring this up and demand to have it tested again. If he refuses (no idea why he would) then I will go back to the doctor I saw when I moved, which coincidentally is the only doctor who has ever mentioned my weight problem and I have been over 200lbs since I was a pre-teen. I am just nervous I guess of them saying no. I think that I will at least have some questions answered after I see my dr next week. Thanks again for reading!