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on October 15, 2006 7:11 pm
April /19/06
I met with the psychologist and nutritionist today and each state she approved me for gastric bypass. I met with Dr. Garth Davis already and his approval was contingent on theirs.
I have started an MD supervised DIET and am in my second week. This is a requirement of the insurance.
Wow, what a great surgeon and office staff. I have communicated with them and they have agreed to proceed with my surgery after 4-6months of supervised diet. I will have my surgery in the fall about October or November. The reason for this decision is my personal circumstance plus the fact that they feel my records showing comorbities and Necessity Letter coupled with a few months of supervised diet will result in payment by FEP Blue.
I have gotten better this week with the DIET, but last week I acted like I was having one big last supper all week. I get it now that this is not about dieting but preparing for surgery. This is hard though, not eating sweets. Life basically sucks for me now and eating sweets is so comforting. BUT I will do my best now and sticking with the eating plan especially no sweets. I am working with my therapist now on how to control my emotional eating and doing a lot of seaching of self to find alternate coping mechanisms and start using them. I will also start attending the support group meetings monthly.
WOW, learning exactly about what post op eating will be like was an eye opener. I have been reading a lot of OH postings and profiles about what people eat but seeing it in print was huge, especially the first month. I cannot imagine blenderized or pureed meats or any other food for that matter. It sounds gross. This is all the more reason to get the emotional eating under control even though I will have the TOol of the POUCH.
Now, I must WAIT which is especially hard as I am unemployed and feel I must wait till post op to find a job in my field. I lost my last job due to missing too much work in my probationary period. I know I will need two to three weeks off post op and could not do that with a new job. More frustration.
I was asked today to name my support people. I really do not have any but the closest two are my ex husband and my "best friend". Neither really get why I cannot lose weight on my own, but lo and behold my ex gets it much more now that we are not together. It is quite sad to say I have no one, but have really isolated myself in the past few years.
10/15/06
I am almost finished with my six month diet and so glad I had to do it. I have researched WLS, talked with many people, had lots of second thoughts, had the fantasy I can do this myself one more time. I have taken the Emotional Eating online course at MasteringFood.com and highly recommend it. I have noticed changes in my need to eat and am so much more aware of why I eat. I joined Curves and go 2 to 3 times per week plus I got back to swimming which I love. I have lost 30# now and am down to 290. I weighed 321 when I started the diet in May. I know my body is healthier now and will be ready for surgery.
I am now ready to have this surgery. I decided to ask my brother and his wife to drive in from Memphis for my surgery and he said yes. I don't know why I have such trouble asking for help. Now I feel safer knowing my only family will be with me. I hope to have a date soon for sometime before Thanksgiving.
I recently sent my pictures from my heaviest weight to OH and they posted them for me. An OFF forum friend made the comment that I did not look tall in my picture. I am 5'9" and have always been taller than many women. When I looked at my pictures again, I can see how the fat body obliterates the tall body.
Photos
 330/360 Me standing 5'9" 330 #. Seated photo taken in 2000, my highest weight 360# |
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Surgeon Info:
Surgeon: Garth Davis M.D.
Insurer Info:
FEP BCBS, Karen Martin
FEP BCBS of Texas has a policy that clearly states they cover Gastric Bypass as long as BMI greater than 40 and presence of comorbidities, at least one. FYI they do not cover gastric banding of any kind. They require a letter of medical necessity from referring MD. They do not do predetermination which is why I cannot answer the question about approval letter. The physcian's office will not know if they will be reimbursed till after my surgery. They also say they can choose to use BCBS of Texas policy when deciding to approve or not. This policy requires 12 months of MD supervised, nutritionist meetings, DIET as well as five years of primary MD documentation as to my weight and what he recommended I should do, et. There are other requirements in addition to these. I learned after going through three representatives and two supervisors as well as three separate contacts my surgeons office had with them that at first you learn only what the policy states about the letter of medical necessity. It takes a couple of supervisors to get to the part about the 12 month DIET. Persistence is of no help as there is no predetermination at all. I am basically in the hands of my surgeons office staff to say when I can have the surgery. This will be based on the documentation they have in my file at that time they approve it. They then must wait till after surgery to bill and hope they get paid after providing the documentation. The other thing is FEP BLUE TX will not put anything in writing pre op, yes or no, neither one. It is frustrating to say the least. The main recommendation is to keep in touch with the surgeon's office staff often about how you are doing with the DIET, make sure they have copies of the nutritionist reports signed by an MD. Ask them to go through the info in your chart to make sure they have everything they need over and over.
