glowin40
3/31/06 WLS journey begins. I am married and the mother of 2 and I have been overweight for over 20 years and I am looking forward to this surgery and getting healthy.
5/25/06 I met with the nutritionist today and she is going over the details of the diet after surgery and going over a low carb diet which I am already doing. The 2 week diet has me a little nervous.
5/30/06 I had my pysch vist today, she said I was normal. I know my friends and family are going to want a second opinion on that one.
6/13/06 I called the cleveland clinic today and they said the first letter was sent out to insurance company today.
6/20/06 It has only been a week since the first letter went out to insurance company but I am getting impatient, they say it can take up to 30 days.
7/06/06 I received a letter in the mail denial from my primary insurance company, which is not a surpirse since it is an exclusion on my policy.
8/4/06 I received a phone called on my cell, actually medical mutual left me a voicemail that I had been denied due to not enough medical documentation of a 6 month supervised diet. I have finished the 6 month diet with my PCP in JAN of 06.I am definitely going to appeal.
9/13/06 Medical Mutual called and told me they could not send my information onf to appeals because I still had not enough documentation for diet. She said I needed to fax it ASAP since they only had 30 days to give me an answer and time was running out.
9/15/06 My PCP is going to fax my progress notes on MON 9/18/06 and she feels with these notes I should not be denied.
9/30/06 Well MM got back to me in 30 days exactly with a second denial for surgery stating still not enough documetation of supervised diet. This also has exhausted my internal appeal process leaving my only option for and exteranl appeal for medical necessity. Since I have several co-morbidities I hope they will overturn the denial.
10/10/06 I talked to debbie at cleveland clinic about the external appeal she was going to check with the nutrtionist to see if we could provide further diet documentation along with a letter oif medical necessity for Dr. Schauer and my PCP.
10/11/06 I received a letter of medical necessity from my PCP and I have a letter from me also ready. This whole process is very frustrating. My PCP said if this is denied maybe I can go back and redo 6 month supervised diet and apply for the lapband. I hope the reverse the denial the gastric bypas would be a better choice for me.
10/20/06 I received a letter from Medical Mutual informing my my information has been sent out for external review and I should know in 30 days if the denial will be reversed.
11/06 I received a letter from MM I have been denied on external appeal due to the6 month supervised diet. As of 11/9/06 I am starting the 6 month diet over and going to reapply.
1/15/07 Well it is about 2 months into my 6 month supervised diet and I keep losing and gaining the same 2 pounds it is so frustrating, but I am hanging in there and sticking with it hoping to be approve in the spring or early summer.
3/8/07 I am 4 months into my 6 month supervised diet. My PCP had me try xenical but it made me very sick. I am continuing WW for support and accountability but I was gaining weight counting the points, I felt like I was eating just to get my points in. I am now counting fat grams instead of points, I am still not losing much weight but some. At least when I reapply in May I have tried a few different plans.
5/11/07 I went to the Cleveland Clinic and hand delivered my 6 month supervised diet. They said they would overnight to Medical Mutual and the girl who handles all there pts usually gets back to her in7-10 days.
5/18/07 I called Cleveland Clinic and Debra was on vacation, so I called Medical Mutual to see if they received the information of my 6 month supervised diet and they have no record of my current information. Now I have to wait until monday to check with Debra at the Cleveland Clinic so she can check on things.
5/25/07 I received my letter for approval from Medical Mutual. I have to wait until surgeons office opens on tuesday to get a date. At least I can enjoy the long weekend without stressing whether I will be approved or not.
5/29/07 I finally have a date for surgery June 20, 2007. I start liquid diet on June 6, and have pre-op dates for June 8 and 18.
