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on January 31, 2006 12:00 am
1/16/16
Over two years ago, I began this process. I checked with United Health Care to be sure I was covered. They assured me, on several occasions, that I was. Like a good obsessive compulsive, I kept records of everyone I spoke to. I did scores of research, spoke to many people who had the surgery (including my 63 year old sister, who was very successful), and decided I wanted this for my life. At 47 years of age, 5'6" and 245 lbs, I had chronic heart problems, Type II diabetes, was insulin-using, had high blood pressure, and other aches and pains too numerous to mention. I did all the testing to ensure I was healthy enough to undertake the procedure, my PCP was 100% behind my decision, submitted everything to a local surgeon who has one of the best reputations in the country, was accepted, was submitted to insurance. Guess what? Oops! I was given the wrong info. I had never been covered for this procedure from the very beginning. They were very sorry, and they admitted, by their own records, they had given me erroneous information. But too bad, so sad. I was devastated. I went in to a deep depression for over a year and then decided I would pay for it myself by any means necessary. Began saving. At the end of 2005, I walked in to work one day and my coworkers asked if I had seen the new benefits for 2006 yet. I replied that I had not. When I opened the book, I saw that bariatric surgery WAS covered in 2006. I burst into tears. It seems our CEO had the surgery out of his own pocket, and was so overwhelmed at how it had changed his life that he wanted all of his employees to have the same opportunity. So, at a time when most insurance companies and businesses were cutting OUT the insurance, my company added it as a benefit. I do not know how I became so lucky.
It came at just the right time. I spent the last year losing 25 lbs. "Great!" you might say. Not so great. As any insulin-using diabetic knows, when your blood sugar is out of control and you are not taking enough insulin, you can drop weight easily. But you become sicker and sicker, because your blood sugar is high and you feel terrible. That is how I have lived my life for 13 months. I could no longer tolerate weighing 245 lbs. The more under control my blood sugar was, the more weight I gained. I am extremely insulin resistant. So I decided I would rather die than be 245 lbs. Very sick thinking, I know. My surgeon is involved in studies now that show that Type II diabetes is resolved in 95% of the cases of the Roux en Y surgery not just because of the weight loss, but also because of a particular hormone that the bottom of the stomach produces that no longer effects the patient on the other side. In many cases, insulin needs are reduced significantly the day after surgery, so it cannot be due solely to the weight loss. I know everyone is different, but I want the possibility of that for my life. I also have significantly decreased heart function and there has been shown, nation-wide, to be up to 95% improvement in heart function as well.
Needless to say, I am ready. I have once again gone through all the steps necessary, and my paper work has been submitted to UHC. My surgeon has accepted me without reservation and, despite the fact that my BMI is now around 36, I believe that my co-morbidities will speak for me.
Please pray. This site has been a God-send for me for months, reading your stories, and living with you through your trials and your joys. I want to be here with you. You are the strongest people I have ever met.
1/20/06
Checked today with Patsy at my surgeon's office to see if there was any news and she said none yet. I think the waiting is the hardest of all.
4 of the seven people on my shift are joining a weight challenge at work that will run concurrently with the time right around my surgery and immediately post op. Not all of them really understand this process and I think they feel I am taking the easy way out. They don't have a clue. One woman had a tumor in her stomach a few years ago and had to have half of her stomach removed. She is one of these people who knows everything about everything, so of course my situation is going to be EXACTLY like hers and she knows EVERYTHING I will be going through. I finally had to bring the diagram of the stomach in to show her how different mine is going to actually be. That my stomach will be the size of an egg. That out situations were totally different. That she knows NOTHING of what I will be going through, especially since she is and has always been thin and has little or no patience for anyone who is not thin. She is actually on the weight challenge team so she can buff up for summer. I am having this surgery so I can live a few years longer (hopefully MANY years longer). But it does no good to try to explain it to people like this because I feel they will never get it. I can only prove my purpose and dedication by my strength and results.
Very tired tonight and trying not to let all the thoughts of what it will possibly feel like to be thin overwhelm me.
1/24/06
My Psych evaluation was faxed to the surgeon's office today, and that is the last piece before Nancy sends the letter of determination to UHC. I have heard that UHC can be speedy with their approval, and I only hope that is the case here. After I am approved (only positive thinking allowed), I have to attend a day-long seminar where I meet with the surgeon, a nutritionist, and an exercise specialist. On that day I will get my surgery date. I am hoping for early March.
1/27/06
I think just waiting is the hardest after all this time of pushing to get everything done. Nancy (the nurse at Dr. de la Torre's office) says UHC sometimes takes 4-6 weeks to approve for surgery. I have read many profiles where people get approved after several days or a week, but you never know. I think the Dr.'s office gives the longest scenario so you aren't disappointed if it doesn't come through immediately. I think I might start calling UHC next week, though. Sometimes a little persistance pushes things along. In the meantime, I seem to be gaining a little weight now that I am trying to get my blood sugar more in check prior to surgery. That is the vicious cycle I live. If I work to take the propery amount of insulin and eat better, I gain weight. If I take less insulin and eat crap, the lbs. fall off. Of course I also feel terrible and am doing harm to my body at the same time. I can't wait to be on the other side.
01/29/06
Patsy from Dr. de la Torre's office was at the Health Fair at my workplace on Friday. She gave me some information that was very positive. She said UHC rarely takes the 4-6 weeks for approval and that it is possible to have it in a week to 10 days. She gave me the timeline for how things work at their office and, if insurance approval would come in within that time, I could be having my surgery as soon as the last week of February. That is such encoouraging news for me. I am saying my prayers and keeping every finger crossed.
01/31/06
Well, I re-learned today that, when dealing with insurance, things cannot go without a hitch. I came home to a message from a woman at UHC. She said she had my letter of pre-determination and my file, but I needed to contact a pre-care number first before having done any of this. So she was going to forward all of it to someone else to look at and I should call the pre-care number to get the process started. The fact of the matter is I DID call the number on January 3 and was told to go ahead with all the pre-testing, etc. Arghhh!!! So I called the pre-care number and found out that they had received all my information an hour before, and that it had been bouncing around UHC for about a week. Imagine that. I spoke to the actual person who is handling my case and she said she would do everything she could to expedite it. She did say she had to call the division that handles the psych evals and see if they had everything they need? Don't really know what they need other than the eval. I went to a UHC network psychologist who was listed as performing bariatric psych evals, so I hope there is no glitch there.
Had lunch with a dear old friend of mine who had surgery with Dr. de la Torre and she is doing very well. She is also very helpful as far as giving me as much helpful info as she can. She told me today she has lost 124 lbs. and wants to lose maybe 10 more. But she says if she doesn't lose another ounce, she is very happy. I am so very happy for her.
Hopefully February will be the last month in my life that I will be so horribly unhappy with my weight and my health. I look so forward to the other side. My thoughts and prayers are with Dina, who is having surgery later this month.
Be the first to leave a comment.Over two years ago, I began this process. I checked with United Health Care to be sure I was covered. They assured me, on several occasions, that I was. Like a good obsessive compulsive, I kept records of everyone I spoke to. I did scores of research, spoke to many people who had the surgery (including my 63 year old sister, who was very successful), and decided I wanted this for my life. At 47 years of age, 5'6" and 245 lbs, I had chronic heart problems, Type II diabetes, was insulin-using, had high blood pressure, and other aches and pains too numerous to mention. I did all the testing to ensure I was healthy enough to undertake the procedure, my PCP was 100% behind my decision, submitted everything to a local surgeon who has one of the best reputations in the country, was accepted, was submitted to insurance. Guess what? Oops! I was given the wrong info. I had never been covered for this procedure from the very beginning. They were very sorry, and they admitted, by their own records, they had given me erroneous information. But too bad, so sad. I was devastated. I went in to a deep depression for over a year and then decided I would pay for it myself by any means necessary. Began saving. At the end of 2005, I walked in to work one day and my coworkers asked if I had seen the new benefits for 2006 yet. I replied that I had not. When I opened the book, I saw that bariatric surgery WAS covered in 2006. I burst into tears. It seems our CEO had the surgery out of his own pocket, and was so overwhelmed at how it had changed his life that he wanted all of his employees to have the same opportunity. So, at a time when most insurance companies and businesses were cutting OUT the insurance, my company added it as a benefit. I do not know how I became so lucky.
It came at just the right time. I spent the last year losing 25 lbs. "Great!" you might say. Not so great. As any insulin-using diabetic knows, when your blood sugar is out of control and you are not taking enough insulin, you can drop weight easily. But you become sicker and sicker, because your blood sugar is high and you feel terrible. That is how I have lived my life for 13 months. I could no longer tolerate weighing 245 lbs. The more under control my blood sugar was, the more weight I gained. I am extremely insulin resistant. So I decided I would rather die than be 245 lbs. Very sick thinking, I know. My surgeon is involved in studies now that show that Type II diabetes is resolved in 95% of the cases of the Roux en Y surgery not just because of the weight loss, but also because of a particular hormone that the bottom of the stomach produces that no longer effects the patient on the other side. In many cases, insulin needs are reduced significantly the day after surgery, so it cannot be due solely to the weight loss. I know everyone is different, but I want the possibility of that for my life. I also have significantly decreased heart function and there has been shown, nation-wide, to be up to 95% improvement in heart function as well.
Needless to say, I am ready. I have once again gone through all the steps necessary, and my paper work has been submitted to UHC. My surgeon has accepted me without reservation and, despite the fact that my BMI is now around 36, I believe that my co-morbidities will speak for me.
Please pray. This site has been a God-send for me for months, reading your stories, and living with you through your trials and your joys. I want to be here with you. You are the strongest people I have ever met.
1/20/06
Checked today with Patsy at my surgeon's office to see if there was any news and she said none yet. I think the waiting is the hardest of all.
4 of the seven people on my shift are joining a weight challenge at work that will run concurrently with the time right around my surgery and immediately post op. Not all of them really understand this process and I think they feel I am taking the easy way out. They don't have a clue. One woman had a tumor in her stomach a few years ago and had to have half of her stomach removed. She is one of these people who knows everything about everything, so of course my situation is going to be EXACTLY like hers and she knows EVERYTHING I will be going through. I finally had to bring the diagram of the stomach in to show her how different mine is going to actually be. That my stomach will be the size of an egg. That out situations were totally different. That she knows NOTHING of what I will be going through, especially since she is and has always been thin and has little or no patience for anyone who is not thin. She is actually on the weight challenge team so she can buff up for summer. I am having this surgery so I can live a few years longer (hopefully MANY years longer). But it does no good to try to explain it to people like this because I feel they will never get it. I can only prove my purpose and dedication by my strength and results.
Very tired tonight and trying not to let all the thoughts of what it will possibly feel like to be thin overwhelm me.
1/24/06
My Psych evaluation was faxed to the surgeon's office today, and that is the last piece before Nancy sends the letter of determination to UHC. I have heard that UHC can be speedy with their approval, and I only hope that is the case here. After I am approved (only positive thinking allowed), I have to attend a day-long seminar where I meet with the surgeon, a nutritionist, and an exercise specialist. On that day I will get my surgery date. I am hoping for early March.
1/27/06
I think just waiting is the hardest after all this time of pushing to get everything done. Nancy (the nurse at Dr. de la Torre's office) says UHC sometimes takes 4-6 weeks to approve for surgery. I have read many profiles where people get approved after several days or a week, but you never know. I think the Dr.'s office gives the longest scenario so you aren't disappointed if it doesn't come through immediately. I think I might start calling UHC next week, though. Sometimes a little persistance pushes things along. In the meantime, I seem to be gaining a little weight now that I am trying to get my blood sugar more in check prior to surgery. That is the vicious cycle I live. If I work to take the propery amount of insulin and eat better, I gain weight. If I take less insulin and eat crap, the lbs. fall off. Of course I also feel terrible and am doing harm to my body at the same time. I can't wait to be on the other side.
01/29/06
Patsy from Dr. de la Torre's office was at the Health Fair at my workplace on Friday. She gave me some information that was very positive. She said UHC rarely takes the 4-6 weeks for approval and that it is possible to have it in a week to 10 days. She gave me the timeline for how things work at their office and, if insurance approval would come in within that time, I could be having my surgery as soon as the last week of February. That is such encoouraging news for me. I am saying my prayers and keeping every finger crossed.
01/31/06
Well, I re-learned today that, when dealing with insurance, things cannot go without a hitch. I came home to a message from a woman at UHC. She said she had my letter of pre-determination and my file, but I needed to contact a pre-care number first before having done any of this. So she was going to forward all of it to someone else to look at and I should call the pre-care number to get the process started. The fact of the matter is I DID call the number on January 3 and was told to go ahead with all the pre-testing, etc. Arghhh!!! So I called the pre-care number and found out that they had received all my information an hour before, and that it had been bouncing around UHC for about a week. Imagine that. I spoke to the actual person who is handling my case and she said she would do everything she could to expedite it. She did say she had to call the division that handles the psych evals and see if they had everything they need? Don't really know what they need other than the eval. I went to a UHC network psychologist who was listed as performing bariatric psych evals, so I hope there is no glitch there.
Had lunch with a dear old friend of mine who had surgery with Dr. de la Torre and she is doing very well. She is also very helpful as far as giving me as much helpful info as she can. She told me today she has lost 124 lbs. and wants to lose maybe 10 more. But she says if she doesn't lose another ounce, she is very happy. I am so very happy for her.
Hopefully February will be the last month in my life that I will be so horribly unhappy with my weight and my health. I look so forward to the other side. My thoughts and prayers are with Dina, who is having surgery later this month.
