Tricare denying gastric bypass for 12yo with rare cond.

[The Walk of the Penguin Mich]

Dec 28, 2013 23:37:45 GMT -5 DVM gone riding said:

and as the case seen with that poor girl in CA surgery isn't simple and shouldn't be taken lightly, putting this child through another surgery that she needs primarily as a result of her first surgery could add even MORE complications. The medical insurance as the policy in place for very legitimate reasons. I am sure being tricare and one of the best insurances out there that they will review the case carefully and make a legitimate decision. at some point the girl will most likely get the surgery its just a case of when. I wonder if they are making it worse with such restriction of diet 900 cal isn't very much and her body thinks it is starving so it is trying to store them all. 

It sounds like the center of her brain that controls hunger is out of whack.  Her mother had to padlock the cabinets or she would wipe them out.

Even if all 900 calories are being stored each day, it is better than 4000-5000 calories each day.

[EVT1]

Dec 28, 2013 21:53:13 GMT -5 Miss Tequila said:

Dec 28, 2013 21:48:10 GMT -5 oped said:

I was asking you about your situation. I don't know about OP, but believe me, just because you never had a present at birth issue count as a pre existing condition, don't assume they don't. I know they can. 

I was replying to EVTs post. I have never had an issue with insurance and have always been happy with our coverage. Just a few months after changing jobs and insurance companies, my daughter had her kidney removed. We had absolutely no issues with the insurance company. My poin is that EVT shouldn't assume that everyone would be denied due to Pre-existing condition.

I didn't- I was responding to Shooby saying good luck getting surgery under Obamacare.

But aren't you at least happy you don't have to worry about pre-existing conditions at all anymore?  No more taking a particular job because you have to have that group coverage, having to deal with Cobra, praying you don't have a gap in coverage, or dealing with restrictions on coverage for those conditions if you do because there were no other options. I like it.

[Miss Tequila]

Dec 29, 2013 1:18:58 GMT -5 EVT1 said:

Dec 28, 2013 21:53:13 GMT -5 Miss Tequila said:

I was replying to EVTs post. I have never had an issue with insurance and have always been happy with our coverage. Just a few months after changing jobs and insurance companies, my daughter had her kidney removed. We had absolutely no issues with the insurance company. My poin is that EVT shouldn't assume that everyone would be denied due to Pre-existing condition.

I didn't- I was responding to Shooby saying good luck getting surgery under Obamacare.

But aren't you at least happy you don't have to worry about pre-existing conditions at all anymore?  No more taking a particular job because you have to have that group coverage, having to deal with Cobra, praying you don't have a gap in coverage, or dealing with restrictions on coverage for those conditions if you do because there were no other options. I like it.

I had absolutely no issue with my insurance. If my self-employed friends weren't all witnessing huge increase in premiums (none qualify for any subsidy) I might agree with you. I do think that certain people are benefiting from ACA, but I don't know anyone personally that is. We clearly know different types of people because most people I personally know (self-employed with individual policies) are complaining that their premiums are higher, higher deductibles, etc.

[chiver78]

looks like people are pitching in to help - www.nbcnews.com/health/rooting-her-strangers-donate-50k-texas-girls-life-saving-obesity-2D11819010

[billisonboard]

They need to also appeal the decision and see if insurance will pay for it anyway. Then they could "pay it forward" for someone in the same bind.

[justme]

Hopefully that happens, but the hospital said they can do it 6 weeks from now now that they have the money. If it's as dire as the family says it is, I wouldn't wait if I had the money. Not sure insurance policies on paying for things they latter approve if it's done before the approval? Though they said at the moment any extra will pay for the family to travel to be with her during the surgery.

[Value Buy]

Dec 28, 2013 12:22:54 GMT -5 Tennesseer said:

Dec 28, 2013 12:18:58 GMT -5 Shooby said:

I know. Just making the point that if you think healthcare is hard to get NOW, just WAIT until the rubber hits the road.

Your point has zero to do with the child's story.

Tricare.....

Is this the Government insurance for retired service veterans?

If memory serves me it is.

Is it a public or private insurance company?

[thyme4change]

Dec 29, 2013 0:59:26 GMT -5 The Walk of the Penguin Mich said:

Dec 28, 2013 23:37:45 GMT -5 DVM gone riding said:

and as the case seen with that poor girl in CA surgery isn't simple and shouldn't be taken lightly, putting this child through another surgery that she needs primarily as a result of her first surgery could add even MORE complications. The medical insurance as the policy in place for very legitimate reasons. I am sure being tricare and one of the best insurances out there that they will review the case carefully and make a legitimate decision. at some point the girl will most likely get the surgery its just a case of when. I wonder if they are making it worse with such restriction of diet 900 cal isn't very much and her body thinks it is starving so it is trying to store them all. 

It sounds like the center of her brain that controls hunger is out of whack.  Her mother had to padlock the cabinets or she would wipe them out.

Even if all 900 calories are being stored each day, it is better than 4000-5000 calories each day.

If her brain is telling her she is starving to death, won't she eventually figure out how to keep eating more, even after the gastric bypass?  It seems to me like they are treating a consequence of the problem, but the problem will still be there.

[The Captain]

One of the beneficial side effects of gastric bypass (in most cases) in a curb to the appetitie.  It also changes how you absorb nutrients and folks who have gastric bypass almost NEVER develope type II diabeties.  So there are some benefits.  Managing the recovery afterward and getting adequate nutrition are lifelong challenges, however.

When my asthma was uncontrolled I had to be on high doses of prednisone.  I experienced the side effect of increased hunger and weight gain in spades.  Whenever I needed to go on that horrible drug I would whip up a batch of cabbage soup (like two gallons of it).  That might last me three days along with everything else I was eating.  You really can't understand it until you experience it.

Most of the time we experience extreme hunger for only a few hours then the body adjusts and we are no longer hungry (if we haven't had something to eat for awhile).  With a condition like this girls she could feel like she hasn't eaten in days at the same time she eating her third pbj.

It would be a very unpleasant way to live.  In this case I'm not sure what is worse, the condition or the cure.

[justme]

Thyme - from articles I've read they're hoping that the smaller stomach will change signals sent to the brain so she finally does think she's full.

[mmhmm]

Dec 31, 2013 11:17:26 GMT -5 justme said:

Thyme - from articles I've read they're hoping that the smaller stomach will change signals sent to the brain so she finally does think she's full.

Precisely.  There's a definite connection between the gut and the brain.  In fact, more signals go from the enteric nervous system (the gut) to the brain than the other way.  From what I've read, altering the enteric nervous system through this surgery corrects the problem in the brain.

[mollyanna58]

I don't know if that's true in every case.  I know a woman who had gastric bypass and is still pretty hefty.  She eats small amounts at a sitting, but eats very, very frequently.

[The Walk of the Penguin Mich]

Managing the recovery afterward and getting adequate nutrition are lifelong challenges, however.

This is challenging in an adult, trying to make sure that the little you can eat is going to get you the nutrients you need to be well. I can't imagine dealing with adolescents, who are generally not known for having the best eating habits on the planet!

FWIW.....my stepsister, who had her gastric bypass done last March is back in the hospital again for about the 8th time. This surgeon really f&^%ed her up. She is bleeding and they don't know where she's bleeding from now.

[mmhmm]

Tomorrow, Alexis will have gastric bypass surgery.  Hopefully, it will allow her to live a somewhat normal life.  Let's keep her in our thoughts/prayers.

NBC News

[Shooby]

Haven't seen this thread in awhile, lol.

[ՏՇԾԵԵʅՏɧ_LԹՏՏʅҼ]

Mar 20, 2014 14:32:01 GMT -5 Shooby said:

Haven't seen this thread in awhile, lol.

What's LOL about it? The thread's had an update posted - I also hope this will have a positive outcome for the girl.

[NancysSummerSip]

Awesome. My cousin did his internship at Cincy Children's Hospital. He still works with sick kids, but as a cardiologist. It's a really good hospital.

[The Walk of the Penguin Mich]

www.nbcnews.com/storyline/texas-girl-obesity-surgery/docs-forced-alter-surgery-plans-obese-girl-n58751

Looks like a monkey wrench has been thrown into the mix.

[NancysSummerSip]

Sounds like they made the decision they had to make. I hope this starts her on her way to a normal life.

[mollyanna58]

The hospital tweeted progress reports to the world at large?  So much for privacy.

I hope the surgery helps the poor girl.