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My Story 6/19/2005: Hi everyone! I am 28 yrs old and currently weight 379 lbs. I have my consult with my surgeon on July 5. Right now I'm just praying that my insurance company will approve me without any difficulty. I'm afraid I'm not "sick" enough for them because I don't have any major co-morbidities (no diabetes, PCOS, high blood pressure, etc.). I hope having a BMI of 65 and having tried numerous diets over the course of my lifetime will be enough for them to pay for the surgery! 6/22/2005: My insurance company requires a current thyroid panel and glucose test be submitted for my pre-certification. The nurse called me today to tell me my results were normal. I actually said to her, "that's not what I wanted to hear". I can't believe I said that! I'm sure she thinks I am a hypochondriac or something. The truth is I am overjoyed that I don't have diabetes....yet. My response to the nurse was because of the anxiety I feel about getting approved. I hope she doesn't put my response in my medical chart. 6/30/2005: My grandfather died today. My grandmother, my uncle, my mother, my two nephews and I were standing by his bed singing his favorite hymns when he went home to be with his savior. His funeral will be Wednesday, July 6 because my grandmother said that my grandfather would not want me to miss my surgery consult on the 5th. She told me that my grandfather was really happy that I had finally decided to move forward with the surgery and he wouldn't want anything to stop me now.  I miss you already Grandpa Bud! Please watch over me from heaven. 7/1/2005: I stopped at my office this afternoon to pick up a reimbursement check from my flex plan. While I was there the HR director asked me if Saundra (the benefits coordinator) had talked to me yet about the new health plan document. She hadn't, so the director asked me to sit down for a minute and then proceeded to tell me that they were amending the plan to exclude WLS! I almost passed out in my chair...until I heard her say that since I had already started the process they were going to grandfather me in. Oh thank you God! I was in a daze and didn't ask a lot of questions, but first thing Tuesday morning I am going to call and insist that I get confirmation in writing that this grandfather clause exists. 9/7/2005: My insurance company is giving me problems. They sent a letter to my surgeon stating they needed more information on my 6 month diet and exercise history. When my surgeon's nurse contacted the insurance company about what was required for the 6 month diet she was told information that did not match what we had been told before. Here is an outline of the misinformation I was provided: 1. Originally told the diet had to be either physician supervised or dietician supervised and that once a month visits would be sufficient. Today the story was it has to be both...and I have to weigh in weekly at the doctor and see the dietician weekly (at $80 a visit, not covered by insurance). 2. Originally I was told I did not have to belong to a gym to meet the exercise requirement. The insurance company told me my doctor could supervise my exercise along with my diet. Today the nurse was told I needed to hire a personal trainer or exercise therapist for the duration of the 6-months. I asked HR to help me and their response was "the insurance company is just looking out for your best interests. Do you really want them to approve a surgery that could be detrimental to your health?" Do they really believe that I am naive enough to believe this is about the insurance company caring about me and not about money??? 9/15/2005: My friends Jeff and Jaret sent me an e-card today with a special note "hire an attorney and we'll pay half the fees". How did I end up with such wonderful friends?? I have been in tears for hours. I have consulted with my surgeon's nurse and we have decided to wait until December 20 to re-submit to the insurance company. This will be 6-months from my latest doctor supervised diet. I will begin seeing a dietician, but not weekly (I can't afford it). In addition, the nurse called the insurance company and they agreed that they would count Curves as as monitored exercise program, so I joined today. Even though I will only have 3 months of Curves and 3 months of dietician visits when I submit in December, I will hire an attorney to fight that the requirements have been met. 9/23/2005: I am so angry and I'm turning the anger inward. I can hardly stand to log on to this website any more. I love all of you...you have been such an inspiration and a support...but right now I need to stop thinking about surgery every day for my own mental health. I will be back, I promise. 12/16/2005: I had my final visit with the doctor today and will be ready to submit to insurance as soon as my records are sent to my surgeon. I'm so nervous! I have decided to wait to hire the attorney until this latest submission is denied (my first submission was never officially denied, so this is not considered an appeal). 1/4/2006: My insurance company received my submission today. Good news! The medical review nurse who reviewed my case the first time no longer works for the company! Thank you heavenly Father! I am encouraged to hear someone completely new will review my file. Finally a glimmer of hope. 1/19/2006: My surgeon's nurse called today and asked if I was sitting down. Then she sighed. I was prepared for the worst when she said "you are approved!". I could hardly believe it. I started bawling right at my desk and I cried through all of the 35 phone calls I made to friends and family to share the good news. I should know my surgery date by early next week. Today feels like the first day of a new life and I haven't even had surgery yet! |
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