mcarmichaelo
My story starts pretty much the same as everyone elses with a few twist and turns. I am a 37yr old mother of 2, I have struggled with my weight for about 6 years now. I initially started researching WLS for my Mother and did not look at it as an option for myself My mother at the time weighed approximately 650lbs and she was very interested in the RNY me caring for her the way I do wanted to make sure I was just as informed about it as she was so in 2005 I started to research the different procedures. In 2006 my Mothers primary doctor would not clear her for surgery because of some heart and liver problems ( she still has not given me the full details on this only that the Doc would not clear her for the surgery). In 2007 I began to notice that my weight was starting to get out of control. I could not control my hunger, I could not exercise as much because of a previous injury amongst other things. In February 2007, I met with Dr. Overcash about having the Gastric Bypass on 2-27-2007 his office submitted my parperwork to the insurance company (as I said before I had done 2 years of research on this) I had all of my paperwork ready when I went in for the consult. On 3-3-07 I was notified that AVMED had denied the coverage needless to say I filed an appeal it too was DENIED. In April 07 I started
to have some major health problems that caused me to have to have surgery in May 07 I went through the process of being treated for my condition and 1 health problem after another started to surface. In November I was sent to a Gastro doctor because a Hiatal Hernia was found on one of the CT scans that was done needless to say this doc proceeds to tell me in no uncertain terms I will send you to a general surgeon to repair the Hernia but you need to LOSE some weight to help the GERD. I could'nt get ticked with him because I knew he was telling the Truth. I went home called Dr. Overcash's office again to set up a re-evaluation (now I had more Co-Morbids)n that was set for 12-14-2007. Everything went well at the appt and I was advised that my paperwork would be submitted to the Insurance Company the next week. When I got back home I pulled out my denial letter from the Insurance Company and saw that I had 365 days to file an appeal of there decision with the State Review Panel being determined to do this I filed an appeal on 12-17-07 (The Ins. Co NEVER gave me a clear reason as to why I was denied other than Coverage guidlines not met) I came on to OH and read a Lot of post from people that Ins. issues and took tips from that and I stated my case to the panel. 12-21-2007 (friday) my surgeon submitted my paperwork on 12-24-2007 I received a call from the Ins. Company telling me I was APPROVED (the reason they called me at work was to also call the rep at the review panel so they would close the case) To everyone looking at having WLS and having trouble with the Insurance Co exhaust all appeals and FIGHT them to the end it will be worth it when AVMED denied me they used a General Surgeon not a Bariatric surgeon to do so ANYTHING WORTH HAVING IS WORTH FIGHTING FOR MY NEW BIRTHDATE IS 01-23-2008.
