Sunday, June 18, 2006
I'm Michelle and a 33 year old divorced Mom of 3 boys but engaged to the most wonderful man in the world (getting married March 17). I've been struggling with my weight for 15 years and I am just starting the stages of looking further into WLS. I am going to an informational class at the hospital about WLS and will most likely begin the process from there.

Wednesday, June 21, 2006
Well, I went to the informational meeting about RNY and Lap band surgery last night at Methodist. The speaker was very entertaining and I gained more knowledge in addition to what I have already read about both procedures. Meanwhile, I have been looking into more and getting a lot of information about Doudenal Switch (DS) and have become increasingly interested. After a ton of advice, suggestions and talking with Tammy B. on the phone (who has had DS herself and is writing a book on it and knows all the ropes), and reading reading reading.... I am convinced that this is the route I want to go. I have an appointment for the seminar at U of M Fairview on July 5th and will meet with Dr. Buchwald following and tell him of my interest in the DS and go over my health history, etc. I was excited to find out that not only does my surgery cover the DS, but they will cover the this physician even though he is out of network because all 3 surgeons in Minnesota who do the DS are all out of network so they will cover it as 'out of area" at the same rate as in-network but I'll have an out of pocket max of $1,500 so I can't complain. I'm so excited and can't believe that there are not more surgeons who do the DS! It seems like the surgery that makes the most sense! More to come after July 5th when I have the seminar and consult with Dr. Buchwald!

June 29, 2006
I met with my physician today to go over weight loss/dieting history and she is going to write the letter/referral of medical necessity that my insurance requires and fax it to insurance tomorrow. After she gets the criteria from insurance, we'll get the ball rolling on the diet. She's also a licensed weight loss dietician (I think that's the proper term) so she will be great through this 6 month assisted diet thing.

July 2, 2006
My physician faxed me a copy of the letter of medical necessity she faxed to insurance and I was more than pleased. I wasn't expecting her to go into such great detail. Here is the letter word for word so that it might help others looking into WLS and need a letter of medical necessity by their PCP:

""To Whom it May Concern:

I have recently seen Michelle D***** for consideration of bariatric surgery for treatment of obesity. Michelle has been a patient of mine for many years and has been struggling with her weight for as long as I have known her. She has tried many diet and exercise plans including weight watchers, atkins, portion control and the use of metabolife. All gave her minimal weight loss and she gained her weight back quickly as soon as she stopped her diet.

In addition, Michelle has a strong family history of obesity, diabetes and heart disease. Her own history is consistent with a diagnosis of impending metabolic syndrome. The results of her last lipid panel and blood glucose were borderline.

Her BMI today is over 40. She has worsening symptoms of xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx{prefer to keep this portion of the letter private}xxxxxxxxxxxxxxxxx thought to be related to her increased weight.

I strongly recommend consideration for bariatric surgery for Michelle. I feel it would benefit her greatly in the improvement and maintenance of her health.

Sincerely,

XXXXXXXXXX, CNP
Women's Health Nurse Practitioner"


July 2, 2006 (continued)
So, in light of this letter, I have decided to write a letter to insurance to ask for consideration that they waive or reduce the six month diet. Insurance has told me the reason they put the 6 month diet in place is so that "the surgery will be as successful as possible". In light of the fact that I've been on multiple diets over the last 15 years - the last 5 years has been Weight Watchers on and off - I feel I know the tools to make the surgery successful, I just need the surgery to KEEP the weight loss successful. I am prepared that the insurance company will more than likely reply with a no, but it can't hurt can it? At least I tried! I will be faxing the letter tomorrow. With the 4th of July Holiday, I don't expect a quick answer so on I go with the diet as usual.

July 3, 2006
I faxed the letter this morning. I guess insurance is closed until Wednesday because of the holiday so they won't even see it until Wednesday if I'm lucky. I don't expect them to waive the 6 month diet for me, but I did plead a pretty good case and said a prayer over the letter so I can only pray for a miracle. Until then, Happy 4th!


July 6, 2006
I went to the Seminar at the U of M yesterday with Dr. Buchwald and then met him after for a consult. He is really nice, direct and funny. I found myself laughing at him often. I told him I wanted the DS and we went through health/weight history, etc. and he gave me his card to call his Secretary/Assistant Danette to get on his schedule. So, I left a message with Danette and she called me back today. She had contacted my insurance and knew about the 6 month diet and the psych evaluation, etc. and although I'm trying to appeal the (IMO) ridiculous 6 month diet, I'm going to assume I have to do it which means I won't have everything complete until January 14 at the latest. Insurance told me that once I have finished that and my psych eval, I will be approved for the surgery so Danette told me to call back the second week of August to schedule a date for January since she isn't scheduling that far out yet. If Insurance waives the diet, then I'll call her back for a closer date. Can't wait to get a date!

July 16, 2006
I went to my PCP on Friday for my first appointment for the 6 month diet. She is having me following a diet put together by Pyramid.gov. It reminds me of the old Weight Watchers plan from the early 90's where you check off the grains, fruits, protein as you eat them - anyone remember that diet? lol This first month, its a 1200 calorie diet. Yeah, I'm sure I'll be able to stick to that like I always have. lol She said when I see her next month on the 11th and if I tell her I'm "starving", she'll prescribe Phentermine which is an appetite suppressant. I guess I'll go through the motions....she did give some good suggestions that will be helpful even after the surgery so I can learn some things I suppose.

December 13, 2006

It's been a while since I updated.  I've been plugging away going on my monthly physician assisted diet check ins.  I have just this month and next month left and I'm done with that portion.  I've lost then gained then lost and I am now 2 pounds less than I originally started.  She's had me try Phentermine which helped me lose 8 pounds in a couple weeks, but it made me feel jittery and anxiety ridden so I couldn't take that anymore.  Now she has me trying Meridia but I got sick with a nasty cold/virus right after she prescribed it (about a week or so ago) and I'm just starting to feel better so I will start taking it again probably by Friday.  I still want the DS, but bad news.  I called my insurance because something was nagging at me to ask again if the DS was covered - someone else there had told me it was but when I called yesterday, I discovered it is not.  ::sigh::  I am going to still fulfill all that insurance requires and submit it and just see if I get lucky.  I'm getting married in 4 weeks and then will be added to my husband's insurance which is Medica.  They tell me at Medica that the DS is covered and I asked if I have to have a minimum BMI (I've been told that Medica requires a minimum BMI for the DS of 50 (or 55?) across the board but 2 people I've talked to on the phone with Medica through my fiance's work did not see that stipulation so if my insurance falls through, I'll just try through his insurance.  Either way, I want to have weight loss surgery and DS will be ideal but at this point I am willing and have decided that if I get denied by both insurances for the DS, I will go with the RNY.  I have been doing the diet thing 15 years and nothing works and so I think that WLS is the tool I need.  I'm leaving for California on January 10 (getting married there on January 12) and I hope to have everything insurance needs before I leave so I can come back with an answer.  What a great coming home gift it would be to get an approval.  I'm praying and hoping that I will be!  Please say prayers for me!  This has been a longer journey than I expected but I know it will be worth it in the end!

January 31, 2007

Well, I'm a married lady now.  That's the good news! :)  The not so good news is I was unable to get everything completed in time before I left for vacation but now everything IS complete and just waiting for it to be gathered to be submitted for approval.  It is looking like I will have to have the RNY.  At this point, I am at peace with that.  Also, a part of me wonders if that is for the best.  There are no studies loooooong term with DS since it is still new (newer than RNY) and I am only 34 years old.  I'm still waiting for a 100% clear cut answer from insurance but last I heard, they do not cover DS.  Dr. Buchwald's calendar is booked through May.  I've already been on this journey since last June, went through the 6 month diet insurance requires, the psych eval, etc., and I still know WLS is the best for me.  If I'm having the RNY, no need to wait 6 more months.  The reason I chose Dr. Buchwald was because he is the only surgeon in Minnesota who does the DS with a lower BMI but if I'm going to have the RNY, no need to wait forever for a DS doctor.  So, I called Park Nicollet.  I had gone to their seminar back in June and they are sending me the paperwork again so I can submit that and go through them instead.  The woman on the phone told me their average turnaround time is about 3 months, but because I've got everything complete, my turnaround may be much sooner.  So, I'll keep this updated.  I hope to be on the loosing side soon.

February 10, 2007

I mailed the paperwork to Park Nicollet Wednesday so I hope to get a callback soon to get the ball rolling.

 February 13, 2007

It'll be a week tomorrow since I mailed the paperwork.  Still waiting to get that call from Park Nicollet.  :::tick tock tick tock:::

February 21, 2007

FINALLY!  I got the call today and my appointments are now scheduled.  I see the Nurse and then follow that with the Psych testing on March 7, then have the Psych follow up on March 14.

March 13, 2007

I had my appointments with PNC on March 7 and my Psych follow up was cancelled for March 14 because I already had my own Pscyh Eval for Bariatric surgery so they said I didn't need it.  I have 3 final appointments scheduled for March 28 and that's it. :)

March 16, 2007

I got a hold of someone at my husband's insurance (which I have been added to and effective April 1) and finally got an answer as to what their requirements are for approval for WLS.  All they need is a letter of medical necissity from my PCP (which I already have) with info on my BMI and any weight history documentation and health info  that may be pertinant to my obesity.  I said "Thats it?  No physician assisted diet?  No Psych Eval?"  She said nope!  I've got two confirmations from two other people on the boards with the same insurance.  I have my final 3 appointments with PNC and then they should be ready to submit by the time insurance kicks in April 1.  And no, insurance doesn't consider it pre-existing condition even though I got all this stuff done ahead of time. I asked.  It really looks like an end is in sight!