Tara S.

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I guess I'm going to try this old skool.

Wish me luck!

I was denied.

Their requirement of a 40+ BMI somehow changed to a 5+ year history of BMI of 40+.

My BMI has been just under 40 for the last 5 years.

Ugh.

My surgeon's office will appeal, but I don't know why.  I just don't qualify.

So, so, so sad.

When I went through my psych eval 8 months ago the psychiatrist asked me how my husband felt about the surgery. I told her, in absolute honesty, that he was loving, supportive, and was OK with me either way. He supported me because I wanted it, but didn't in any way push me to do it.

Honestly, we hadn't talked that much about it. We had talked about it when I applied for the lap band, but I was denied, and we didn't talk about it again. It was too painful a subject for me to talk about unnecessarily, so I didn't really go into details about my second attempt at approval. We had a brief discussion where I told him I had changed my mind and was going to apply for the RNY. I told him I was scared of dying and leaving him and our daughter without a wife and mother (plus I make the majority of the money in our family). He basically said not to worry, he felt sure everything would be fine, and to do what I felt like I needed to do, if that was the path I wanted to take.

Perfect response, right?

Yeah. Turns out that wasn't true. He recently told me that the truth is, he is miserable that I'm fat. He spends his time looking at women with "other, more athletic figures" and wonders what it would be like to be with them. He says that he's still attracted to "parts" of me (read: boobs) and that I have a pretty face. Oh, and he's super-attracted to a girl he knows that just lost 70 lbs, because he likes the "process" of improving yourself. He thinks that's groovy.

Wow.

I've been fat since the day we met almost 10 years ago. I've gotten fatter, for sure, but apparently he always wanted me to be thinner and just couldn't bring himself to tell me.

Why is this hard to talk about? Because it's such a conflict for the fat person.

I know I'm fat. I wouldn't want to have sex with me. I don't want a fat spouse. I appreciate that my husband is fit and works on his appearance. I don't blame him for wishing I weren't so fat. So I have the "it's only reasonable that he should feel this way, you would too" voice in my head.

But the conflict is that now I have another voice in my head who is pissed that his love and attraction for me has boundaries. That he will want me more if and when I change myself. I feel like when I'm thinner, and he tells me I'm beautiful, I'll always think "Yeah... now. But what if I gain again?" and I'll just be pissed and resentful that I had to mold myself to be something for him.

Don't get me wrong, I want this surgery either way. I'm miserable. My decision to do this has more to do with pleasing myself than pleasing him. I'm just worried that now we're both screwed because he was honest with me and I'll always resent knowing that truth.

Were his feelings unreasonable? No. Is my hurt and anger unreasonable? I don't think so either.

Can I get past it?

I don't know.

But I know I'll never, ever, forget that he said it.

So, when I was submitted to United last week I called them to confirm they had received the fax. They said there was no way it would be in their system yet, but to call Monday or Tuesday and check back. I decided *not* to stalk them, so I waited until today (Friday). I called just before 5 pm. The lady had me on hold awhile, and then said yes, they had indeed received it. Apparently the surgeon submitted me with an August surgery date, but I guess that's just a made-up date.

Anyway, so I then dared to ask if there was any status on it. I doubted there would be this early, but you never know. She sounded surprised that I would be interested (!) but looked around my account awhile then said "Yeah, it looks like you were approved"

!!!!!!!!!!!!!!

So, I asked "are you SURE?" and she said "Well, let me go check for absolutely sure..."

She then put me on hold for EVER (OK, 10-15 mins) and came back and said "Well, actually it looks like you weren't approved OR denied yet. It's still up in the air. But I would be surprised if they don't have a decision by Monday or Tuesday at the latest, since they have been working on it, and are really far along. In fact, I'm surprised they don't have a decision already given how far along they are on your case."

???????????

What does that mean?

Other than my "approved" is now a "don't know" again. :(

The thing that sucks is that I was all prepared to hear I was denied. When she said I was approved, and I spent 10-15 mins on hold thinking that was likely the case, I let the "hope" door open. Now I'm going to feel like it was taken from me if they come back with a denial.

Oh well, we'll just have to wait until Monday I guess. Or Tuesday. Or... whenever.

LOL. OK, rant over.

Got the call from the surgeon's admin... she faxed the paperwork over today!!

She's been preparing me for an appeal though, I can tell.  She has said several times "we can always appeal" and "you HAVE to appeal if they deny you".

Ugh... I just want it to be approved. I need this.  Without it I will most likely continue to gain weight until I qualify due to tons of comorbidities.

But at the moment I'm trying to not focus on it.  I'm a very impatient person, and I know it won't even hit the insurance company's system until early next week.

Tracking against my post a few weeks ago, where I was going to track reality against my assumptions for this process, I'm a week behind.  I said on 7/2 that I thought I'd be submitted by the end of the next week (7/11).  I was submitted the end of the week AFTER (7/18).  But I did have to squeeze in an extra office visit to my PCP and getting two letters.  I think that week got me a stronger submission.  Now according to my "schedule" I have to wait until (potentially) the end of August to find out!! :(

My sister officially just sent in her letter of support to my surgeon, and the admin is going to begin submitting me today!!!

Here is the letter my sister sent (with the names changed to protect the innocent).  She rocks!!  Even though she's an emergency doctor, I figure anything will help. :)

July 17, 2008

To Whom It May Concern:

I am writing this letter on behalf of my sister, Fattie McFatterson.

I have seen Fattie struggle with her weight for over ten years, and have witnessed the physical toll that has resulted from this struggle.

Fattie has put an extraordinary amount of effort into attempting to lose weight in the past, including using diet programs, working with personal trainers and nutritionists, joining fitness classes, and taking physician-prescribed diet pills.  However, though she put in the time and dedication expected for these interventions to take effect, she continues to struggle with her weight.

Now, as time has gone by, Fattie is starting to see more of the physical effects to which her current BMI has contributed.  We worry that if no further intervention is made, her weight will continue to increase, and this could have serious health consequences.  She is already starting to see increases in blood pressure, the development of gastroesophageal reflux disease, and has increasing back and knee pain, which can be directly attributed to her weight.

It is my fear that without this intervention, these problems will only get worse, and it is very upsetting to think that an intervention will only be made possible if Fattie's health problems reach a critical point.  As both her sister and a health professional, this is my greatest concern.

I personally feel that Fattie is absolutely ready for this surgery, and that it will affect her life in an incredibly positive way.  She has thought about, and thoroughly researched this surgery, and has been firm in her resolve for the last 3 years.  Though she continues to try to lose weight in other fashions, we both believe that bariatric surgery will be the step that is required to lead to true results and a huge improvement in quality of life.

I am happy to answer any questions you may have at any time – please feel free to contact me by phone (XXX.XXX.XXX), e-mail ([email protected]), or at the address listed above.

Thank you for your time, and I appreciate your thoughtful consideration.

Sincerely,

Cool M. Sister, M.D.

So now I just wait.  I just sit and wait.  That's hard, but in a way exciting, because at least my part is done, and it's a step forward.

Yay.

Called my surgeon's office to see if the admin I'm stalking is back from vacation.  She is, and she's planning to begin submitting me to United Healthcare tomorrow!!

YAY!

Although, we still apparently don't have a weight for 2004, she's going to do it anyway.  I don't know... sounds like trouble, but I guess we'll go with it and see if we need to dig it up somewhere else later.

But I'm happy and nervous all at the same time.

My sister hasn't sent her letter in yet.  I'm hoping she will by tomorrow.

Well, I'll post again when there's anything to report.

If you're wondering when these posts will be more positive, so am I! :)

My former PCP required me to COME IN for an office visit in order to have her give me complete medical records (she just wanted to be paid for her time pulling up my records. Ugh.)  So, I did that this morning, and got ALL my records, and faxed them to the surgeon's office.

I have lost weight.

Not a good thing.

I'm so borderline on the approval thing, that United could actually deny me if I lose any more weight. What a strange problem to have.  I have been really stressed and arguing with my husband, and it has lead to me not eating much.  I hate that I might have risked the long-term weight recovery because of a few short-term lost pounds.

Anyway, now the surgeon's office is waiting for one more piece of information, and when I called to get a status it turns out the office lady that requests them is out until Wednesday.  I know it's only two days, but it seems like a lot right now when I'm so anxious for it all to be submitted.

:(

Well, I'll keep chugging along.  Eventually we'll have everything ready to submit!!

 

FUDGE!

This is crazy.

Can't get medical records to save my life.

"I'll fax your three year weight history" apparently means "I'll fax one random piece of information from 2005".

Nice.

Well, still trying to get my sugar-honey-iced-tea together so the surgeon's office can submit to United.

Oh, and my sister (an M.D) is going to write me a letter of support.  And my PCP will be writing me a letter of medical necessity.

YAY!  I hope that helps.  Their requirement is a BMI of 40+.  Mine is 40.2.  So, I think it's very borderline.

Hope hope hope hope hope hope hope hope hope hope...

OK, I swore I would stay on top of this (back in December) and would make this happen as quickly as possible.  But I hit a road block in my insurance company requiring a five year weight history.  I couldn't provide a weight for 2003 because I was pregnant for the first nine months of the year (neonatal weights don't count!) and the (bleeping) nurse who took my post-partum weight at my 2 week checkup didn't write it down!! :(  And 2008 didn't count because it was just the beginning of the year.

I was so depressed about it that I went into hibernation mode and had both given up hope, and gained another 10 lbs.

Ugh.

But it's now July, so I can officially use 2008 as a year of my five years, so I'm golden!  I just had a general physical and made sure they documented my BMI (40-ish) and high bp etc.  Now I'm hoping the surgeon's office will be able to submit me by the end of next week!

YAY!

Here are my current assumptions:

 - I get submitted by the end of next week.
 - I find out by late August whether I've been approved.
 - If I've been approved, I know my surgery date by end of August.
 - If I've been approved my surgery will be sometime in September or October.

Now let's see how reality compares to that on the next post! :)