Does anyone know what you have to do to have WLS if you have Tenncare? Also I am trying to find the drs name at vanderbilt that does this surgery. I think the name was kelly something.

Has anyone else had this surgery and tenncare paid for it?

This is a touchy subject with me ..... I do not believe that if a person is on Tenncare that WLS should even be an option for them unless there is some kind of life threathing reason. Tenncare is another of those programs that is abused and misused!! If you are considering having WLS and are physcially able to get out and work at a job that provides insurance then that should be the ONLY reason to even think about having this type of surgery. Those of us who go to work daily and pay the costs for people who need Tenncare should NOT have to endure the cost for a surgery like WLS. I would be the first person to say that Tenncare should be available for children and the elderly, but NOT for people who are able to get out and work but for whatever reason chose not to do so. I happen to work for a company that changed our health plan so it wouldn't cover WLS anymore because of the costs associated with it, but I do know that there are many employers who do cover this surgery, so my suggestion would be to investiagate those employers and suggest that the person try to get on with them instead of looking to the state of TN and those of us who do work every day to pay for such a surgery.

Just my worth!

I agree with Becca, however I do know that Tenncare does pay for gastric bypass. It does not cover the other types of weightloss surgery, ie lap-band etc. I don't know how if you are on Tenncare you go about getting them to pay for it as I do not have Tenncare.

One thing is for sure ..... If I can report a person for misuse of Tenncare .... count on me doing so! Get a freaking job and quit looking for free handouts.

This does spark an interesting debate about WLS in general. Is it a life saving, necessary surgery or not? If it is, then TennCare should definately pay for it for covered persons, if not, then it's a elective surgery and it's a moot point. I work for a large company that does not cover WLS in any form, but will pay for 1/2 the cost of the Weight Watchers at work program, interesting, huh?

Tenn

As many of you know, I am generally against WLS...particularly for myself. I'm disturbed at the number of physicians' offices that are now running TV COMMERCIALS, for pity's sake, selling WLS like it was fast food </irony?>

However, I am willing to consider that WLS *is* a lifesaving procedure for many people who are obese to the point of near-immobility, and who have other health problems that are exacerbated by their weight. I agree that medical necessity should need proving to TNCare (which will morph into CoverTennessee shortly anyway, right?) but I believe they SHOULD pay for it in these cases.

It's also getting harder and harder to just jump right out and find a job that has worthwhile insurance coverage...I don't think the 'want surgery? get a job' argument is really reasonable across the board, though it may apply to some people.

To me, TNCare (or any other insurance company) denying the coverage of WLS to everyone is the same as those stupid insurance policies that won't pay for birth control but WILL pay for prenatal and maternity care or hospitalization/treatment after complications from abortion. Insanity.

If, on an individual basis, WLS is deemed medically necessary, then ANY insurance SHOULD cover it. Furthermore, the prescreening and consultative/counseling requirements should be MORE stringent and not progressively less stringent, as has been happening over the last decade. I do not believe that WLS should be made an easy alternative for people who want it for cosmetic or emotional reasons. It's too dangerous on too many levels.

</soapboxramble>

I agree that TnCare was abused and still probably is being abused, but I was working and my job didn't offer insurance so should I be denied TnCare, no I shouldn't. I was on TnCare for awhile, and I was paying a preminum for it, but I was taken off of it, I do have lots of health problems, but I went to the health dept. and got my care for what I have problems with. I don't think that it should be so made easy for anyone to get the WLS though because some can abuse that too, if you are having lots of medical problems and you are very overweight then I think any insurance should help pay for it, in the long run it will probably save them money. Becca not everyone that uses TnCare don't work, it was made for the people that couldn't get insurance through their place of employment, but of course people did abuse it now alot of people was kicked off that was doing the right thing.

Wow, is this chick great or what! LOL.

Of course, I completely agree.

I understand all about Tenncare and what/who it is for. I am ALL for helping those in need and am the first one to say that not everyone abuses the programs that are in place to help those in need. For the people who REALLY need it .... I think it is great! For those who are just to lazy and worthless to get off their lazy ass and get a job, but spend hours researching ways to get something for free to those people I say I am NOT interested in paying for your WLS -- and, those of us who bust our ass working everyday aren't going to stand for it. I also have researched WLS and considered having it myself, but decided againist it for a number of reasons. I'm not against helping people who need help ..... I'm againist lazy, free loading, self serving people who use others to get what they want when they are VERY capable of working like all the rest of us do. Having or not having WLS is not my issue .... that is a choice that each of us makes based on what is best for us. MY problem comes into play when the person who is wanting this surgery wants the good and hardworking people of the state of TN to pay for it. My issue with this is NOT the idea of WLS it is more about people having self respect and WORKING for what they want instead of looking for free handouts. Now if someone is ill or physcially unable to do that .... then that is a whole different story. Those ARE the people who NEED assistance and SHOULD receive it.

Okay ... I'm off my soapbox now.

I am in the process of getting approved for WLS. I have TennCare and have been dealing with them for several months now. The doctor that you are thinking of that is at Vandy is Dr Kelly Wright, Jr. He is also a liver transplant specialist. He is the doctor that I am attempting to get approved with. I have done research on him and have YET to hear anything negative on him. Everyone tells me that he is an excellent doctor. TennCare requires several things for them to approve this surgery. They require that you have a 6 month medical supervised diet attempt. If I am not mistaken, I think that weight watchers is considered medically supervised. It has to be 6 consecutive months. They also require that you have five years of documentation from your PCP to show that you have been over weight for at least five years. I have worked my ass off since I was 15 years old and paid my taxes. I have never expected a handout from anyone EVER! I was diagnosed with Multiple Sclerosis and my weight is not helping this problem. I am not ashamed to admit that I am on TennCare and wanting them to pay for my surgery. Thats what the insurance is there for. You are more than welcome to contact me if you have any questions. I will do what I can to answer them and help you. Good luck!!!!

Let's face it the U.S. health care system sucks period. While we rank 37th in the world in quality health care yet nationally we spend 82% more on health care per person than others easily ranking first. Plus we are the only developed nation in the world besides South Africa that doesn't provide health care for all it's citizens.

I think if a person has Tenncare, then Tenncare should pay for any medically necessary procedures that promote good heath. I have also read about Tenncare fraud and although I have no doubt that it goes on, I don't think WLS surgery in itself is fraudulent.

Side note about Government assistance fraud....recently I was at a rummage sale at a local Catholic church, and there was a customer there who was asking people if they accepted food stamps...there weren't any food items for sale anywhere there...now I ask you...WHAT'S up with these Catholics??? LOL...
JUST KIDDING!! But I do believe the person asking the question was serious.

Wow! Now, that is pathetic...

If a person is on Tenncare and has serious medical conditions that need to be treated then I fully agree that the procedure should be covered. What I do NOT agree with is that WLS should be covered for a person who does NOT have a life threathing condition. Wanting WLS because it is an easy way to lose weight is NOT a life threathing condition. I have read about people who are 700-800 lbs and are going to die if they do not have WLS .... for those people I agree that it is necessary and should be covered. For people who are looking for a easy way out .... it should NOT be covered! For a person who is on Tenncare and fully able to work, exercise and diet to lose weight then in my book it is fraudulent and shouldn't be allowed. To those people .... I still say, get off your lazy ass and get a job, so you can save up your money to pay for your own WLS and NOT look to those of us who pay the premiums for Tenncare to provide your WLS. I'm sure this doesn't set well with a number of people ... but, it's how I feel.

I have TNCare/MediCare -- It paid for my surgery 2 years ago.

However, I've heard through the grapevine... that it's become harder and harder to get approved through TNCare... Which I can completely understand. Far to many folks only having less then 100 pounds to loss are having the surgery. Hell, I even heard some folks are GAINING weight just to have the surgery.

Fucking crazy.

I agree with Heather, too about the WLS commericals. Grrr. It sure gives people the wrong idea about this surgery. It's not an easy way out. It's just a freakin tool to help you lose the weight, if you don't keep up with the right eating habits... You CAN and WILL gain the weight back. The surgery isn't a promise. It's always a struggle, every-single-day but as long as you use the TOOL correctly... You'll be a success.

I'm so proud of you Katie. You've come a long ways. Not just with your weight lost but with a lot of things. Heck your posts are even better (thinking back of all the drama). Big hug and kiss to you, keep it up.

Aww... Thank you, Mojo!
It's amazing how many things have changed for me. It's been a complete new outlook on life. Period.

You were at a Catholic rummage sale and a customer there was asking people if they accepted food stamps.
I'm assuming by your question that you're not Catholic but that you do enjoy criticizing them.
Why are you such a bigot???? LOL... Just kidding!!! But I do believe you were serious.

3 cents worth (2+1 cause I like to yak)

I do psychological evals for persons applying for WLS. Tenncare requirements are the toughest I've come across, rightfully so. I don't have an issue with folks wanting the surgery who need it due to extreme medical conditions, AND who have tried dieting/exercise to lose the weight AND who have really thought the decision through. I have much less tolerance for the client that comes in my office and says "well I gained 20 lbs so that I qualify and well...ummm....no I haven't tried diet or exercise." It scares the heck out of me to see the person unprepared emotionally for the changes they will be facing. And while I'm pet peevin', I abhore hearing "Well, I'll be happy once I lose the weight". Burns my butt. In no way should the # of lbs we weigh control our level of life satisfication, happiness, and being at peace with life.

I recognize it is a personal choice, I have no issue with that. To each his/her own.

Unfortunately, I've seen some very serious cases of folks not doing well emotionally and/or physically after surgery. Its heartbreaking.

well...I probably have my fair share of predispositions and stereotypical opinions about lots of things...including religion...but Catholics? No, not at all...or at least no more than most other non-fanatical religious groups....LOL. Enjoyment can be found at the expense of very diverse groups of people! What I WAS serious about was my indignation about the guy wanting to use food stamps at a damn rummage sale...

I have a friend who had it done and now she's in a major depression because she was on Medicare and Medicaid they are giving her a hard time about having the excess skin removed. I can understand her view on it. She was my size and now she weighs 167 pounds with the excess skin, and boy does she have it. It's so bad she can't even wear knee length shorts. Medicaid and Medicare are getting so strict about even doing the tummy tuck afterwards even though according to them she qualifies they keep coming up with reasons to put it off and reschedule her. Both my doctors are harassing me to do it. I have an appt in two weeks, I may just go off on him. She was a diabetic and although she no longer has diabetes she takes more medications now than I do and I am a diabetic. She stayed with me this last week and I have more energy than she does and run circles around her but I don't think she's excercising like she's supposed to be either. They also told her her back would get better. Her back has actually worsened and she's now going to have back surgery. I feel sorry for her as a big woman she put on shorts and bathing suits and went out and now she will not wear shorts or skirts anywhere near even the bottom of her knee cap. She wears long sleeved shirts to cover up the skin hanging on her arms. She says she feels better now but I don't see it since she's always laying around.

If they could promise me I'd get rid of my diabetes and my back would get better so that I could go back to work your darn tooting I'd rather be working bringing home 1200-1600 a month than living on just over a third of that. People think those on SSI and medicare/TennCare have it easy, some are doing it illigit but those that are on it for a necessary reason have it hard. I know several people drawing disability and working full time and getting paid under the table.

Are you Catholic? I'm guessing not, yet we assume he was?
I have seen people try and use food stamps for a lot of things.. including street drugs. Let's face it.. alot of people abuse the system because they make it too easy to abuse it and do not hold anyone accountable. I know there is a need for tenncare and there are people who can not work who need it, but if you are a healthy person who is completely able to work and you do not, then I have an issue with it. I worked too many years in a community where people abused the system, who were able to work and just did not. I know that not all jobs pay enough to afford healthcare.. in that case, tenncare is also needed, but at least that person is contributing.

My feelings exactly, but Kris just said it a little nicer than I did.

No, I'm not Catholic...and I was TRYING to make a joke about the Catholics not taking food stamps for rummage sale items, but I guess my sarcasm wasnt detected, lol. Maybe I need to improve my feeble attempts at humor...lol.

That's not a bad idea. Did you come up with that yourself or did someone else suggest it?

Does being an insulting idiot come natural to you or do you have to work at it?

Don't worry Barewoolf....some of us got your sarcasm.....I did!

Being an insulting idiot takes lots of work, insulting an idiot comes natural.

Next question.

I don't understand what joy you get out of being the way you are. It goes way beyond humor when one resorts to [/i]unprovoked[i] personal attacks. Urbane? Perhaps, in the interest of honesty, you might consider removing that word from your self description in your profile. A better word might be "boor". And another thing you might reflect on...possessing educational degrees does not make you truly educated. If it did, then you wouldn't go out of your way to be insulting.

Is that a real palm tree in that picture?

The upside to WLS is you will be able to wear the only available size t-shirt offerd at Belles (large).

The downside to WLS you will have to leave the board. What is life with out southernbelles.com

To gain or to artifically loose the weight. That is the question.

Ahh.. I get it now. My bad.




Actually, that is 3X.

It probably would be in YOUR little make believe world!

Is that a sun, a moon or a big yellow spot? Whatever it is I want one of them in my little make believe world.

I'm sure your little make believe world is so full of you that there is room for little else!

Come on guys..... we all know that this is just a little.... Lovers Spat....... cant we all get along!!!!!!!

Sorry I bit.. back on topic now.

Looks down at crotch area of body... hate to admit but you got a point.

THE BOSS LADY SAID.... BACK ON TOPIC... PLEASE!!!!

I am gonna guess that this was a sarcastic comment since Belles is about size acceptance not just a place for SSBBW's, BBW's and BHM's.
Not quite sure how WLS falls under artificial weight loss since the WLS is just a tool to assist in weight loss. Just as if someone was to create a menu plan to lose weight, or an exercise plan. All of these are tools and not all of them work for everyone. Also WLS just like any other tool for weight loss if not used correctly will not work. JMHO

I for one have never been to southernbelles.com, so i'm sure life would be no different for me without it. I have, however, been to THIS site, bbwbelles.com

I stand corrected........

I agree with BRATLY ... WLS is artifical weight loss, a person having WLS has WLS because they are unable to loose the weight own their own! So they go and have a surgery, so they are unable to eat or should I say over eat, cause if they over eat it makes them sick and a person starts vomiting so yes it is artifical weight loss, and if you don\'t learn to eat properly, in the end you will just gain the fat back!!!!!

Uhhh , yeah, what Dawn said.

HAHAHA!
That's the most immature post, I've ever read!

She called Dawn immature!

Actually it is possible to stretch the pouch out that is made in surgery to where you are over eating again. I still believe it is just a tool. If not used right it won't work. I have sat and watched ppl that have had WLS sit down and overeat. They didn't get sick and the reason being is that their pouch has stretched due to them not following the guidelines. Also in order to maintain the weight loss from WLS you still have to exercise and watch what you eat. Initially yes the surgery is what causes the weight loss. They usually say that the first 18 months of weight loss is purely the surgery. After that it is what the patient decides to put an effort in. I am past my 18 month mark and and having to work my ass off just as anyone that didn't have WLS to lose more weight since Im not quite where I want to be. To me artificial weight loss would be a means to lose weight in which the person does absolutely nothing of their own will to lose or to maintain the weight loss. Of course I realize that since we are all different we have different definitions. But hey variety is what helps make the world go round :)

HMM I was told by a doctor loose weight..OK fine I agree I need to loose it bad ..but then I am told I am not what they call big enough to qualify for me to have WLS and the insuirance pay for it..UGHH so what is it am I big or what??? LOL I am big but dang I didnt think the insurance company had like an weight limit ya had to be to have this...Oh welll...

Actually its not the insurance that sets the min. weight for WLS its the National Institutes of Health (NIH) that does:

"To qualify as an ideal candidate for gastric bypass surgery under NIH guidelines, a patient’s BMI must be 40 or higher. (A BMI of 40 is roughly 100 pounds overweight for men and 80 pounds overweight for women.) A patient with a BMI between 35 and 39.9, who has been diagnosed with a serious obesity-related health issue (e.g., severe sleep apnea, heart disease, or Type 2 diabetes), may be eligible for the surgery, as well. The NIH also emphasizes that understanding every detail of the operation and the changes within your own lifestyle that you will need to make is of extreme importance."

Im not sure if it was your doctors office that told you didn't qualify but if you fall under any of the above guidelines Id just get in contact with your insurance company and see what they say if WLS is something you want to do. I actually was told that I needed to lose 70 lbs in order for a local surgeon to do the procedure for me. After talking with my insurance they found me a surgeon that would take a patient as large as me. Anywho hope this helps.