michelle S.
I attempted to have surgery in Oklahoma and insurance denied it. I quit my job, left my family and friends and moved to Dallas TX a year ago as I was told surgery is easier to obtain approval here. I have deveoped more health problems since moving here and sure I can meet requirements as I met requirements in Oklahoma but employer denied the benefit. My PCP is not supportive and knows little about the procedure. I have fired him and am looking for new PCP and a REPUTABLE surgeon in Dallas that can do roux n y procedure. I desperately need help!!!!!! most doctors here do the lap band and I am fear that is not the appropriate surgery for me. All suggestions welcome.
11/14/04
Great news!!! My employer has offerred new insurance plan effective Jan 1 2005 and it covers wt loss surgery if Bmi is over 40!!!!! I have been on cloud nine and am now looking for United Healthcare PPO surgreons in Dallas. What I sacrificed by leaving my family and friends now seems to have been justified. My family and friends are as happy as I that now I can have improved health and be around for a while. Will keep you posted!
1/4/05
Ok I met Dr Capehart and am completely blown away. She spent 2 hrs explaining everything and I walked out of there knowing I could put my life in her hands. I think I surprised her too. I walked in with MRI, xray and sleep sturdy reports. I had letters from my PCPs (1 from Oklahoma and 1 from my new doctor in Dallas), a letter from GI doctor, letter the first surgeon from Oklahoma wrote 3 yrs ago and a letter I wrote 3 yrs ago outlining a lifetime of failed wt loss and declining health. I had 1 yr worth of progress notes showing the new comorbidities that I had developed in the past yr. If that wasn't enuff I had all the policy information for wls and contact info. I think I was the first patient to have a full chart before ever seeing the doctor. hehehe I also had the psych eval with Dr Kluge and was also pleasantly surprised by him. He is very informative and provides indepth psych testing. Only complaint was the chair available when I did the written and computer test was not to comfortable but I survved. Besides nothing is that comfortable now a days. Before I ever left Dr Capeharts office she told the nurse to get on the phone for approval and instead of 1/31/05 I may be able to have it the 24th!!! Woot wooot. 2 1/2 weeks away.
1/5/05
Called insurance and they say they have the paperwork but have 30 days to make a decision. I will call daily and think I can push that down to a week or so. I told the boss I may be having surgery by the end of the month and she is fine with it. I didn't tell her what it was for, in fact I haven't told many ppl besides family and those I am closest too. I'm afraid to have too many ppl that won't support it and don't want to deal with all that. No fear yet, I grin alot, I have broke down and cried a couple times, not because I am scared but because I finally feel I have a chance to live past 45, there is so much I have missed out on and I see an opportunity to grab ahold of.
1/8/05
I HAVE A DATE!!!!! 1/24/05 WOOT WOOOT
I prepared heavily and my efforts are resulting in surgery much quicker than most. Talk to your PCP, have the sleep study if needed, have XRays of back, hips, knees and ankles, if you have been obese for a while chances are you have degenerative changes in your joints. GET THE DOCUMENTATION from your doctors BEFORE you go. I walked in with all the reports, letters from doctors and a years worth of progress notes showing all the co morbidities and the treatment I went through. If you need help with what to get together just email me, I will be happy to help you too.
1/10/05
Grrrr still calling daily but don't have the letter yet. But I get a new tidbit with each call, they have all they need, nurse has reviewed it and it has been sent for policy coverage review. This means we wait, I know the insurance covers the procedure and I submitted more than enuff documentation. Still need the final approval and the waiting game is killing me.
1/11/05
Ok, I have rearranged the living room, TWICE. Cleaned out every closet. NO not having a breakdown, I have quit smoking and as the surgery approaches my cravings to give in are high so I am doing anything possible to stay busy. I have talked to my family and have started making all the last minute arrangements. I know that these days of standing on the sideline and struggling to do what others take for granted are numbered. JOY oh the JOY!!!! I can't comprehend how different my life will be in less than 2 weeks and I CAN"T WAIT!!!! I have met some nice ppl in the chat room and they are truly angels to bear with all up pre ops, answer our questions, give encouragement, and bits of precious advice. Thank you guys!
1/14/05
Well its 9 days and a wake up from surgery and still no letter from insurance. I have been on a rollercoaster, the fact I have no patience and I am feeling so run down isn't helping. My surgeons office doesn't seem concerned but the insurance has been so hateful, confusing and indifferent. I did call the state insurance board to find out wht regs for how long the insurance has to acknowledge my request and was told they have 15 calendar days for preauth. That means they have till the 18th to make decision. Thats 5 days before surgery. My family doesn't know whether to make arrangements to be here the 24th or to wait. I'm crying alot, I feel beaten down by everything that has happened in the past few days. I seem so close but until I have that letter and know there is an end in sight, I just can't relax. If I can make it through this I can do anything.
1/20/05
Well 3 words say it all
I AM APPROVED!!!!!! I must dance now, update more later......
1/21/05
Well I went to the hospital for preop lab and EKG. I had a friend who had this surgery a couple months ago die this week from post op complications. My emotions have been high but I am still ready to proceed. I have done the research and know this is the right choice for me. As an morbidly obese patient the same risk are there just not as clearly defined as a surgery date. Diabeties, heart disease and pulmonary issues are there lurking waiting for a chance to attack. At least I am taking charge now. I talked to my family about all the things they need to know if something does happen and started calling all my family and friends to let them know how much they mean to me. I am nervous about the surgery but am at peace with my choice and ready to be a loser. Say a prayer and I will see you all on the losing side.
1/24/05
I'm leaving for the hospital in about an hr. I didn't sleep last night but not tired. My best friend arrived yesterday to spend 2 weeks with me and since he arrived I have been filled with a calm, inner peace, acceptance what ever you want to call it. No fear, nervous anticipation yes but not afraid. Everyone has called and is amazed at how calm and happy I am. I can't imagine how different my life will be in such a short time but trust me I am ready to find out. The messages and good wishes mean so much and although I haven't had time to respond to everyone I have read them all and appreciate everyones prayers and blessings. See you on the other side.
2/1/05
Well here I am. I got out of the hospital on the 27th. The hospital stay was ok. I don't think the morphine pump was working because I never felt comfortable even after pushing my PCA pump button. I started vicodin pills on day 2 and actually had more relieve then than with pump. The staff at Doctor's hospital were incredible, in fact a couple of the girls had the procedure done themselves. Although its only been 10 days since surgery, I already see changes. My blood sugars went from 188 on admission to 104 on day of discharge. Within 5 days of surgery, I lost 2 inches in my ankles and 1 1/2 inches in my calves. Today I can see difference in size of my tummy and rear end. My friends are also able to see a difference. I did dump on a protein drink sunday and what a miserable feeling, it was too sweet and I knew it as soon as it went down. I have missed "real food" a couple times and rushed the diet a couple times. I felt so bad I have decided that although yogurt and broth are boring, its nice to eat and not hurt. Well I will update more later.
