Rebecca E.
My story began in Feb of 2005. I began to question and wonder and ponder if this surgery was for me. I've been overweight most of my life. And at 23, it feels like my whole life. I first submitted my online profile to Lite Dimensions around that time and at that time I had a PPO that wanted a 6 month dietician-regulated diet. I thought that was just ridiculous so I went to my primary care Dr. who told me that in order for him to sign off on the surgery, I'd have to do a 6 month class approved by his group (even though I had a PPO!) My aunt had her surgery in June of 2005 and seeing her go through this kind of scared me so I was scared and frustrated with my Dr.
I gave up and tried to go back to Weight Watchers. Now I love Weight Watchers, and everything they have taught me about eating healthy, portion control, support and my leader...well she was amazing. But this time around, no matter how much I lost (or released as she used to say) I would gain it back the next week.
I got so discouraged and just accepted to be the happy, ok w/ my weight fat girl. And then I started having problems with my knees again. MRIs and X-rays were done, and the orthopedic surgeon told me honestly that a lot of the problem was the excess weight. (well DUH!) It's not easy on your joints to have to carry around 160 lbs more than you should be.
But how the hell was I just going to lose the weight so my knee stopped hurting? So I went back to my primary care and asked for help. In this time frame, my insurance changed back to an HMO (ugh!) and he then told me again, in order to get the referral, I had to complete the nutruition class approved by my HMO network. The next class started in May of 2006. Each class was 6 weeks, so I had to complete 3 rounds of the class. Every week. Going in and getting weighed showing that I was attempting a diet and not being successful.
I completed that at the end of October 2006, and was then told I had to get a psychiatric evaluation. So nice of them to have told me that in the beginning. And then I got a pre-service denial from my HMO network. (not the insurance) I said that basically even though my PCP knew I had to complete a psychiatric evaluation, he went ahead and submitted for the referral and it was denied since I hadn't completed all the requirements yet. A referral had been submitted for this and I called immediately to make my appointment. It was November 1st and I figured I'd be getting in the next week or so for the evaluation, and I'd be well on my way to having my surgery in January, before I went back to school. But no......My network would drive me absolutely up the wall before I finally got my authorization.
My psych eval was set for Dec. 15th. Yeah that's right a whole month and a half later. I was furious, but was told that he was the only one I could see for the eval. I accepted it and then pushed my own goal for the surgery back to my spring break (which is the last week of this month, 03/07.)
Dec. 15th finally rolled around and was an absolute mockery to the psychiatric profession. This so-called psychologist who was to evaluate my mental health and evaluate if I was mentally able to understand the gravity of the decision I have made to have gastric bypass surgery spent 40 minutes of my time talking about his wife, and how she totaled a Mustang about 20 years ago and how now all she drives is Toyotas. And then he told me about some of his other patients, some of which have anorexia or an anxiety disorder and how he told them they should exercise and it helped them. OH and then...he gave me 4 year old information on the surgery. Because nothing has changed in the last 4 years about the surgery right?
Oh I cannot describe the anger and disappointment I felt. I was leaving his office and his staff told me that I would have to come back at least 2 more times to complete my evaluation. I scheduled the appointments, thinking I had no choice, came home and cried for about a half an hour. I called my mom, best friend, aunt, and cousin and they all told me to call my insurance and file a complaint. I spent the next 4 hours on the phone, talking to the HMO network, the insurance company, my mental health coverage, my PCP's office, the patient liason of the facility where I met w/ this "psychologist", the records department @ my PCP's office. I was ready to leave my network because they were forcing me to see this guy again and I absolutely put my foot down and said "NO!!!!"
When talking with my insurance company that day, they told me I had the option of going through my own mental health coverage and they referred me to a mental health provider. I went and saw that Dr. (and he was a psychiatrist, not a psychologist) on Dec. 21 and got my psychiatriac clearance that day. They were supposed to send over my paperwork the next day. So I waited until the next week to call back to my PCP to see if they'd gotten the paperwork. They said no, so I played the go-between and eventually had to go pick up the paperwork from the psychiatrist and physically take it to my PCP's office.
I had only 1 person who actually wanted to help me. Her name is Angela and she works at my PCP's office and she did so much to help me push this through, when my Dr stopped caring, when the rest of his staff began to hate the fact I was calling 14 times a day, and when the woman responsible for all the referrals left. She had a supervisor access my records and confirm that my referral for Lite Dimensions had finally been approved.
My first meeting with Lite Dimensions and Dr. LePort's staff on February 2, 2007 for my New Patient Orientation. My Dr. Talk was the following week, and then my referral was submitted for after that. On Saturday Feb 17, I received this cute little DENIAL from HealthCare Partners. It said that my surgery had been denied at Fountain Valley Regional, but been approved at Long Beach Memorial. Why did that have to be sent in a DENIAL? Why couldn't it have just been an approval saying that I could only have it @ Long Beach Memorial. Although how can I expect much from HealthCare Partners. They've made this process the longest, most frustrating thing I think I've ever been through. I think it's their goal to try to break you before they approve you. Well ha ha HealthCare Partners...you didn't break me. I stood up for what I knew I needed and fought until I got it.
Well now I've been scheduled for my surgery at Long Beach Memorial on Wednesday, April 25, 2007 and I could not be happier. My one-on-one w/ my surgeon is scheduled for March 22, 2007 and then my pre-op labs will probably be during the beginning of April.
