ObesityHelp

Not that my feet have touched the ground yet since learning I was approved this weekend, but today was even better.  I am scheduled......yes SCHEDULED...... for surgery on May 18th.  Woo-hoo!

When I called my surgeon's office this morning to let them know about the approval letter, I was told the insurance coordinator I've worked with (or should that be "worked for" since I had to do all my own legwork? .....snort); She is out this week.  But they have another woman who does the same work and she had me fax over my letter & said she would call me back.  I'm not fooled.  I know they called to verify it.  Whatever.  They have their procedures to follow.  It didn't take long, she called me back within 30 minutes and proceeded to tell me I would have a couple of appts prior to surgery and started calling off dates.....does that work for you, she asked?  Hell yes!  Any date works just fine.  LOL. 

05/04/09 - Bariatric University @ Surgeon's Office
05/04/09 - Start OptiFast Liquid Diet that night
05/05/09 - PreOp Testing @ Wise Regional
05/18/09 - Surgery
06/03/09 - PostOp Followup

Only irksome thing is when she got my file from the other lady's desk she said the other coordinator had noted in my file to send me to a facility in Dallas for the surgery pre-op testing.  This is the same crap I already went thru when I had to have pre-op testing before my EGD.  This particular facility is 60 miles, each way, AND out of network for me.  I don't want to pay more out of pocket expenses as I have reached my max OOP limit already this year, unless I go out of network.  After the last hoopla over this OON facility you'd think she would have removed whatever flag she had in there and not try to send me there again.  But there it was, the other lady said I was flagged to go to that one.  Even she said it seemed odd since my EGD was done at a hospital 60+ miles away.  Hello?  The hospital is in my area near where I live and work.  It's the surgeon's office and this Dallas testing facility that is a huge distance for me, not to mention the traffic in getting there and back home.  Atrocious!  And why not get it all done in one place anyway?  Duh.  There's no understanding some people.  I asked her if I couldn't go to the hospital where I was having surgery and just get it done there since logistically it is better for me.  She said yes but that Dr. Kim preferred the other facility.  It's OP testing.  A chest x-ray, some blood work.  Gimme a break.  What preference could there be between facilities?  I'm thinking kickback from the new facility he now 'prefers'.  Whatever.  Not this patient, not out of network, and not out of my wallet whenever possible.  The hospital and their facilities that I prefer are in network and less than 3 yrs old.  Hello? 

Like I said that was kinda irksome but no biggie as it was quickly resolved.  The next thing really bothered me though.  She verified my surgery by saying, "OK, you're having the lapband, right?"  Uh, no I'm not.....(and I'm thinking of maybe switching surgeons since you folks can't seem to keep my file straight, and want to send me to Timbucktoo for simple testing and now you have me down for lapband?).  I've had my meetings with the surgeon; I saw him write down RNY gastric bypass in my file chart.  This kind of continuing goof up shit just adds to my nervousness, ya know?  Please God, don't let me wake up to find I've been 'switched'!   Seriously, I know at least that can't happen because he doesn't do that kind.  But he does tend to push lapbands more than the RNY and has come across as slightly grudging on doing the RNY.  But then I remind myself to back off the criticism.  He is a very highly skilled surgeon with numerous accreditations and awards & has just received another top honor from the ASMBS.  You can't be a hack shop and get that.  He knows his stuff and I truly believe he really does care about his patients and wants them to succeed.  We are his real advertising.

OK, deep breath out.  For any newbies reading this, it can't be said enough.  You have to continuously be your own advocate every step of the way.  That's why I'm working my insurance plan as much as I plan to work my tool.  I will succeed at this and get my life back.  It's mine to live and I plan to enjoy it for all the days I have left on this planet.

OMG!  Can you picture me right now?  I am doing cartwheels.  OK, maybe not physically but mentally I am.  OMG!  I cannot believe what I woke up to this morning.  Yesterday being Saturday, I was busy with normal weekend chores and errands, the kids were off in different directions, hubby was busy with his fishing boat restoration project.  No one ever thought to check the mailbox.  Well, that is until my eldest, night owl, son apparently thought of it sometime last night because there was a pile laying on the island in the kitchen.  As I thumbed through the mostly junk mail, there popped up the ominous, plain white envelope from BCBS of Illinois.  Those who have followed my blog know I was pretty  much  convinced I would have to take my fight to a lawyer to get my benefit coverage.  So, with that knot of tension in my stomach, I opened the envelope and began reading.  This is my third letter so naturally my eyes jumped to the important part: 

"Decision:  Certify / approve benefit reimbursement for proposed bariatric surgery."

I know it's been said a thousand times already but words truly cannot express how happy I am right now.  I am down right euphoric!  And yes, I started crying.  This time tears of joy and relief.  I have a chance at a renewed life. 

PS.....My surgeon wasn't copied on this letter so I get the honor of calling and letting them know myself.  You can be sure that will be first thing Monday morning.  Now my next struggle will be to get a surgery date and the preparations for that.  I have to keep telling myself to stay calm.  There is a ways to go yet.  Aw what the hell, it's Spring and it's cloudy here and about to rain.  That leaves me only one thing to do ........."I'm singing in the rain, just singing in the rain!  What a glorious feelin', I'm happy again......!" 

Friday 04/24/09:  I called BCBS in Chicago this morning and left a message that I realized she had called me in error yesterday....and I hoped that meant she possibly had news for me on my appeal.  I asked again for a return call to cofnirm receipt of the "missing records" and additional weight history.  Made this call in the early morning time hoping I would get a call back before the day was out.  No such luck.  Sheesh!  What if that erroneous call on Thursday was because she'd slid my paperwork into someone else's file?  What are the chances?  Hmmmm.......

Since the phone # listed on my 2nd denial letter went straight to a voice mailbox every time I called no matter what time of day I called, I called the BCBS/IL regular customer service line 3 days ago to ask for the regular phone # to that office. (Appeals are in Chicago I learned; Customer Svc is in Jacksonville.)  I was told by customer service rep.....are you sitting down?.....There is no other phone number for me to call to get a live person in Chicago.   I have to call that one and wait for that person to call me back.  I was incredulous that there isn't a main line to call for the Chicago office where the Appeals Board supposedly resides.  I know this is a lie.  They do this to protect themselves.  Just as they only provide a post office box for mail.  They don't want anyone finding them for fear of .....gasp!....face-to-face or live phone to live phone interaction with other humans!  Trudy stated she "checked with her supervisor".  There is no other number whatsoever to call.  Sigh.  So of course I called the Chicago # and left a voice mail message requesting a call back to confirm they received the missing information.  I might add that the voice on the recording does not convey a tone of 'I'm-here-to-help' either.  Quite the opposite.  More like a disgruntled employee shuttered away in some far, dark and obscure office away from all other co-workers so they can heap unbridled verbal abuse on the poor, unsuspecting insurance member who dares to call her office!  

OK, time to snap back to reality.  This whole waiting game and fight for approval has put me so close to the edge.  And as if the previous events of trying to get approved for surgery haven't been fun enough, Lo and behold!.....my cell phone rings.  This is the number I left on "grouchy's" voice mail.  Of course this occurs during a busy part of my day today and I glance at the # and think, I don't know that one.  I almost didn't answer but something in the back of the mind......so I snapped it open and said 'hello'?  The mystery caller states, "Is this Constance so -n-so?"  (I've actually already forgotten the name they said.)  I replied, "No, it isn't".  Mystery caller says, "This isn't Constance so-n-so?"  I reply again, no I am not and I think they have called the wrong number.  Mystery caller says, "Have I called 901-xxx-xxxx?"  I informed her she had indeed called the wrong number (and did not reveal my own or name).  Call ended.  Just as I am closing my phone, my mind is saying, "That voice was oddly familiar."  I look at the phone # recorded in my cell history and DAMMIT!   It was the appeals lady I have been waiting on!  Crap, crap, crap!  If I had only thought of it quick enough I could have hijacked her calling me by mistake to get an answer on my case.  And then I thought, 'Wait - maybe she is working thru a stack of files or something.  Maybe she will call me again in a few minutes when she gets to mine."  So I waited.  I waited for 2 more hours till it was time to go home.  She never called.  Why am I not surprised?  Sigh.  OK, I will be calling again tomorrow.  I'm sure I will get the same gravelly, disgruntled sounding message but what the hell.  Gotta keep calling till I get an answer. 

Just a quick note to update my blog.  Today I received the medical records from JPS from 2005.  Yup, I was morbidly obese then too.  Not that I doubted it but have to prove it to the insurance company.  Am praying this will be the last time I have to beg for my surgery.  Am praying they count my medical records as five years.  I have weight history from my various doctors from 2005, 2006, 2007, 2008, and 2009.  I count five years.  Do you see five years?  The insurance coordinator seems to think they will see it as only four years.  I also re-submitted my psych eval they claim to have not gotten along with lab results from 2007 showing my TSH level is normal.  I'm pretty certain my GYN checked my TSH level last year in 2008 before I had surgery in July for my complex hyperplasia so I called her office today to see if I could get a copy of that.  Thought if I could get it I would send that in too along with the other stuff.  But no answer.  Just a machine.  Uh-oh, it wasn't lunch time either.  I don't know for sure but she may be on her annual trip to the Phillipines.  As I understand it, she goes every Spring to do humanitarian (medical) work there for about a month.  Oh well, didn't want to hold up things even for a day so I faxed my stuff on in to the Appeals Review person provided in my 2nd letter.  They stated if I could provide the information they would re-open my appeal.  Everyone say a prayer for me.