Frustrated and a little sad............

[amlus 0]

So on my journey, I am a 41 BMI, just have flucuated over the last three years between 36 and 41. So, I have read in my policy that ins. wants to see above 40 BMI for three years. So, my doc (without even me suggesting) sends me in for a sleep study because I have "enlarged, huge tonsils", weight gain, headaches, tired all of the time, and snore loudly. Sometimes, I actually wake myself of snoring/choking. So , after I complete sleep study and technition tells me that she doen't think I have apnea but RESTLESS LEG SYNDROME and a weird R.E.M. disorder????? She says I had a little apnea but I mostly slep on my back, so that is to be expected! She I also said I fell asleep right away (which I did not and didn't seem to realize I had woken up at least 7 times in six hours.) Once I even woke up like on my own snore gasping. She said to wait 10 days for Pulminoligist to read results and write report, but that he usually agreed with her. Are you kidding me? I told my doc I had to pay the $1800 for the study completing out of my own pocket, so to be really sure and he was. He put me through other bloodwork like thyroid, low iron/anemia, etc. Doc said he was giving me all those tests to rule out, but was pretty sure I would end of doing sleep study and it would confirm apnea and my tonsils would have to come out!

Plus, I would sure like to know how they monitered oxygen levels in my blood, because no blood was ever taken. Anybody ever had the heart specialist reading stuff the techs did not? Anyone else ever experience anything like like? I am really bummed about all of this. I was getting my hopes up that I might actually feel rested in the mornings with treatment, but I guess I still feel crappy with no answers and two grand less. Any advice or comments appreciated because I am feeling really down now.

[amar63 0]

I have no words of wisdom, just wanted to say I am sorry to hear of the expense and disappointing news. Hang in there....

[Brockbabe82 0]

I'm sorry you are having such a tough time! Keep your head up and demand some answers! Keep us all posted

[amlus 0]

I haven't even started submitting lap band paperwork to my insurance, BlueCross Blue Shield but I have read that they wand the 40 BMI plus a three year history of 40 or more. My friend suggested a write about my family genetic disposition to diabetes (the rarer skinny people insulin resistant kind) both my parents, grandparents, aunt aunts have diabetes and/or heart disease.....and they are skinny! She also thought if I pull out my GERD and joint probs with my knee, I might have a slight chance with insurance yet. Anyone else ever get around the years of weight history thing?

Thanks for the responses guys, I am pretty frustrated and sad about all of this...........

[RobinAnn 2]

Oxygen levels in your blood is usually measured with a Pulse Oximeter which is non-invasive (it's a little pinchy cap they put on a finger).

Sorry you are having troubles with your testing.

[KarissaLynn 0]

Do all insurance companies require 3 years above 40? Or just yours? My weight hasn't been very consistent...although I know that it's always been at least 35 :biggrin:

[amlus 0]

Well, each insurance policy is different and this is what my Blue Cross Blue Shield wants to see. I'm just like you, fluctuated a little. I'll have to go further with surgeon/insurance and see what happens. Good Luck to you to! It's so backwards, insurance companies waiting until you are sooooooo unhealthy to finally cover this.

[teja 0]

what about CIGNA? ANyone know ?

[Cleo's Mom 257]

Amlus: They monitor the oxygen in the blood with all those connections they have on you. The clip on your finger monitors oxygen levels, I believe. First, get a copy of the report. Then have it looked at by a sleep study doctor, not just the pulmonologist. If you do have restless leg syndrome, there are meds for that. I never heard of the REM disorder but you need to have it explained to you and ask about treatment for it.

You paid $1800 for this so you have the right to answers and treatment.

Good luck.

[lsprrnbr 0]

what about CIGNA? ANyone know ?

I have cigna and I have to prove 2 years with a BMI>35. (I have a comorbidity, otherwise I would have had to prove BMI>40 for 2 years)

OP, wait for your sleep study results to come back from the doctor. The pulomonologist that is reading it is most likely a sleep specialist (that is how it is at the sleep lab that I worked for). Your sleep tech may or may not be correct in telling you that you do not have apnea. While experienced techs are usually pretty good at predicting the results, I have seen many, many times when they have been incorrect. Your symptoms do sound alot like apnea. RLS is no big deal. You can get medications to control that. The REM disorder comment is interesting. Could be a variety of things. Wait for your doctor to give you the results. As for the cost of the study, unfortunately they are very expensive. Insurance usually covers a pretty good portion of the expense. Good luck!

lsprrnbr

[isaviolinist 11]

I also have Blue Cross Blue Shield. One thing you may want to do is seek out a BCBS 'Bariatric Center of Excellence'. I was banded at Temple University Hospital in Philadelphia. I have some comorbidities, and I was able to provide 4 years of documented weight (I think my BMIs in that time period was 39 at the lowest to over 50 before surgery) but because of the relationship that my hospital and surgeon has with BCBS I was able to get approved in a very short period of time and with no problem. I don't know where you're having your surgery but maybe look into some other hospitals that are BCBS bariatric centers of excellence. Its worth a try.

[TopTier 0]

Almus, that stinks. And it's also one reason I don't like the technicians to "diagnose" from my results. No offense to technicians, but that's not their job.

good luck to you!