Deborah N.
I am 46 yr old, with a BMI of 49. I am tired of feeling tired and sick, not able to do things others do, not feeling good about myself at all. I am just starting to research the Gastric Bypass surgery. I have HAP HMO. My PCP is supporting me 100% and so is my family. I will be starting the paperwork this week, 6/26/06. I am hoping to update frequently. I think this is a good support system too.
A little more about me. I am married, 17 yrs to my best friend. We have alot in common, I think that is what has kept us together. I was a stay at home mom, and doing daycare for relatives for 22 yrs. I have 2 children, Darcy is 25 and Daniel is 21. I am so very proud of my children. I am a twin, and number 6 in a family of 6 kids. My mom had alot of health issues. It seems I am following in her footsteps. But hopefully this will change. I have tried losing weight it seems, all my life! I have always been heavy. My twin however was the opposite. I am in a 30-32 right now and she is in a size 3. Doesn't seem fair does it!!! I have a wonderful PCP who literally saved my life a few years ago when I had Cushings Disease. It is a pituitary tumor, at the base of the brain. It wrecks havoc with your whole endocrine system. I had been to dr's and dr's and more dr's and no one found what was wrong. But he did.
Like I said he is supporting me 100%. I consider this a begining of a journey. I will update as it progresses.
Below is a picture of my husband and I the year I was diagnosed with Cushings.
July 6th, 2006
I recieved the info from HAP. As we have been told by other members, you must have the folowing:
1. Have HAP (duh!)
2. Be 18 yrs of age
3. Have BMI over 35 (mine is 50) and have 2 life threatening comorbidities. (I have poorly controlled diabetes,sleep apnea,Hypertension,High cholesterol,and thyroid just to name a few.
4. A psychiatric evaluation
5. Documented compliance with weight loss program including diet, excercise and behavioral modification for a minimum of 1 year.
6. Must be performed at a HAP facility
Prior authorizationby the HAP Associate Medical Director.
That was the readers digest version!!!
I got letter from Wanda at Henry Ford giving me the necessary codes. I have an appointment with my PCP Wednesday to get all the paperwork started. I don't think I have any documentation of a medical weight loss program except for all the appointments to check for weight loss and blood tests that my PCP has done over the years. So this may be the start of a long wait...but I am willing to do what I have to do to get this surgery. I think it is my only hope of losing weight. Each diet I have gone on, I have lost, but like everyone elses stories, the weight didn't stay off. I am not living the life I want to live. I want to be able to go for walk, play with my grandchildren (when I have them) go on trips, do yard work, be free of taking a bajillion meds, and feel well. I am alays tired. Don't want to do anything outside because I can't stand the heat. Can't go up and down the steps without breathing so hard, I think I will never breath normal again. Don't want food to be the focus of my life! I feel like a pin cushion from giving myself insulin shots a couple times a day. Most of my comorbidities, I am told, can be cured from having this surgery and the weight loss.
I love this site. It has shown me people that have struggles just as I have, have turned their lives around. The profiles are amazing. The stories have brought tears to my eyes, some from happiness, some from the pain people have endured.
I truly believe this is the right decision for me!
July 11, 2006
Contacted HAP again to find out exactly what I need, as in what exactly does the doctor have to say/write and what documentation I need. She was very nice. I asked about the 1 yr medically supervised weight loss program, exactly what that means, and she said documentation from a doctor the attempts at losing weight, how he followed the progress and checking blood tests and all. He definitely has doen that, many times over. I am optimistic, I have to be, to get thru all this. So what I think it boils down to also is, my PCP, has to write an awesome letter stating who, why, what, where and when!!! I asked what was the first step...she told me for the doctor to do the referral and put in as much info as he can that is relevant. Then after that is processed if HAP needs more info they will contact the doctor. Then I would go for all the pretesting.
I think I am obsessing with this.....all I do is search the internet for more and more info...anything and everything I can find. The good, the bad, and the ugly. I know this is not going to be an easy journey. I am ready for the challenges. I HAVE TO!!! I cannot stay this way....for my life, my health, my family.
July20, 2006
Well I thought my referral was sent in last week....but I got a call from PCP. There is no where in my charts that say how tall I am. So I have to go there and be measured so they can fill out all the paperwork. So another wasted week. I sure am gonna need alot of strength and patience for this one. BUT I CAN DO IT!!!
August 2, 2006
Well I was denied last week for surgery. My PCP called as soon as he got word. He started the sppeal process. I am also sending in an appeal letter. In the meantime I went to a seminar about WLS with Dr Hendricks in Wyandotte at Henry Ford. I really liked him, but can't have surgery with him. My insurance only covers at Henry Ford Downtown. I have decied to go with the open RNY. I have a feeling this is gonna take awile...but thats ok. I will do what I have to.
August 15, 2006.
I haven't updated since there really wasn't anything to say.....kinda down in the dumps. I am mailing my appeal letter out tomorrow. Here is a copy of it.....
To whom this may concern,
This letter is in response to the rejection I have received from you in request for gastric bypass surgery. I am hoping that by writing this letter you will see me as a real person in dire need of your help, rather than just a claim number that can so easily be dismissed. Furthermore, I am hoping you will reverse your initial decision and allow me to have this procedure.
I am 5’2 and weigh in at 265 pounds. My BMI is over 48, and this puts me in the morbidly obese category. Morbid: gruesome, characteristic of disease, etc. Every morning when I wake up I get to think of myself as gruesome. I also get to think of how I have a disease, and the one thing I believe can help me is being denied to me by you and your company.
Let me tell you how the rest of my day goes. In the morning I take nine different medications. One medication is for the hyperthyroidism I have been riddled with for over 20 years. Another is for high cholesterol, while three more are for treating my hypertension. I also take three medications for treating the diabetes that was no doubtedly brought on by my excessive weight. Lastly, I must take 2 different medications to help stifle the depression I suffer from, and will most likely continue to suffer from as long as I am still considered “morbid.”
Throughout the course of the day I will experience difficulty breathing due to my asthma, joint pain upon the simplest movements, and back pain from the bulging discs I have. The back pain is constant and made worse by all of the weight my body has to support. I will inject myself several times during the day with the two types of insulin I need to also help control my diabetes.
Now it is nighttime, and I have to strap a mask onto my face or I will stop breathing while I am asleep. As I try to fall asleep with this uncomfortable contraption on my face, I think about the four life - threatening diseases I have. I am only 46 years old. The average life expectancy of Caucasian women is 76 years, and I often wonder how I am going to live to see 60. Am I going to die from a heart attack brought on by my high cholesterol? Will I die from a massive stroke caused by my hypertension? Or will diabetes be the end of me, since it causes everything from blindness to renal failure? What if my CPAP machine was not functioning? Would I fall asleep and not wake up?
No person should have these thoughts running through their head as they try to sleep. Many ask how could I let myself get this way, and I tell them I do not know. I have tried numerous diets. Weight watchers, Atkins’ Diet, and the 1500 calorie ADA diet have all brought about little success with more failure to follow. I have looked into weight loss programs offered by hospitals, and they are all the same. You must eat their specially prepared meals, costing more than 140 dollars a week. When there are also other people in your house to feed, it makes these programs financially impossible. There are many sources that state only a drastic measure can help a person of morbid obesity. This only further cements my belief that gastric bypass surgery is the answer for me.
I understand that health insurance companies are corporations, and a corporation’s goal is to turn over a profit. Understand this: for the rest of my life you will pay more money for my numerous illnesses than you will pay for this surgery. I have been told by many that after their surgery they have seen a disappearance in their hypertension, asthma, apnea, high cholesterol, and/or diabetes. Many have also experienced the departure of their depression, due to their newly and greatly improved outlook on life.
I understand this surgery is not a simple answer, it requires a lot of work. I am prepared to put in the time and effort that is required. I have been reading and talking to many people about this surgery and feel I am more than adequately prepared for what is entailed, both before and after. I also feel I have something that many may not have: a wonderful support system. My family and friends back me up 100 % in having this surgery, and I know that support will continue through the entire process.
I am asking for you to help in improving my outlook on life. No, I am asking you to help save my life. Again, I am only 46 years old. I have a wonderful husband who I would like to grow old and gray with. I also have 2 children, and would like to be around to see them have children.
Thank you for your time,
Debbie Nichols
I am callin my PCP in the morning to see if he has sent is appeal paperwork in. The reason HAP gave me, for denying the surgery, was with a BMI of 49 you had to show documentation of a 12 month medically supervised diet. Am thinking to myself, if I gained more weight, to get up to 50 BMI...do they cover it automatically? Makes ya wonder. Of course then that is extra weight you have to take off. I know people that have changed insurances just to get the surgery.
I will update when I hear something.
September 3, 2006
I got my return notice saying HAP got my appeal letter. I also got a letter that says they will notify me within 15 days if it is going to take longer than 30 days to make a decision. Hap has started a program called Healthtrack. They have a nurse/case worker contact you and try to help you get things under control with contacting your PCP and giving suggestions to help improve your health. I told her that I had applied for surgery and told her i was dissappointed about the denial. She said they do that for a reason. I am sure to see if you are really serious about the surgery. We all know you have to commit to this. We talked on the phone for an hour. No telling if this will help. Cross your fingers for me.
I have now developed a rash all over my body. Changed one med thinking it was that and it got worse. Stopped taking the Biotin thinking that might be it....and it is still getting worse. NO CLUE!!! I feel terrible....my skin is all itchy and red, full of bumps. My pcp has referred me to a Dermatologist but of course I have to wait for an approval from HAP. And this is a holiday...grrrrrrrr....
Hope everyone enjoys the Labor Day Holiday. I am working...but making double time and half...so thats a good thing.
September 13, 2006
WOOHOO>>>>I am jumping for joy!!! I am approved pending a psych eval. I think it has been about 3 months since I started this. After 1 denial and 1 appeal letter from my self and my PCP, it's happened. I am on my way to a healthy life.
September 18,2006
Well HAP is famous for the "run around" and I am no exception!!! I have been calling since last thursday to get a Psych Eval appt. and each day I am given a different answer. Finally today, after being passed around for 15 minutes (my break time at work) I got the secretary of the Doctor, Cathy Frank is the Dr., and she started taking all my registration for Henry Ford information.....but I had to get back to work. I don't need to be losing my job now. So I will call in the morning. I have never been to HF so they had to do this.
And as I talk more about the surgery...I am getting alot of opposition. I am gonna do like I said and not tell anyone else. Of course they tell me all the stories that they heard when something went wrong. Not knowing if the person didn't follow the Dr's instructions or something. I am staying positive!!!
September 19, 2006
Wow...I just talked to the nicest person for a change. She actually knew what she was doing and talking about!!! I have an appt for October 24th for my psych eval. And I already sent a letter to Wanda to ask what the next step was. She said that Dr Frank would send her paperwork and then I can call for an appt. Then I can finally meet the surgeons. Whether is is Dr Genaw or Dr Carlin.....I have heard great things about each.
October 25th, 2006
WOW....times flies when you are having fun...NOT. Had my psych eval yesterday. Have no clue if I passed, the doctor said to give it 2 weeks and if I didn't hear anything to call HAP. She had told me I wasn't approved..???? I wasn't going to argue with her but I have a piece of paper that says I was. We will see. I am not giving up, if denied again I will appeal AGAIN. She said she was playing the devils advocate by saying..."What makes you thin you can get thru this if you haven't sucessfully completed other diets." Told her I KNOW this is what I need. I have all the support I need. And the drive to get it done. Will let ya know what happens in 2 weeks.
October 31, 2006
Well.....good news!!! I passed my psych eval. I was notified today by Chantel, who is setting up the next step. It is an informational meeting. I am to bring my support with me. I am so excited. My appointment is December 19th. Almost 2 months away. Guess they are very very busy.
On a sad note, we had to put our family dog, Lucky, down today. He will be missed so much. He was the best dog anyone could ask for. He was like a little man inside a dog's body. So smart.
And to add more stress....we are hoping to get my mother in law some help with her dementia. She is currently in a facility to treat her dimentia/psychosis. We just want her to enjoy the life she has left. With other people in same situations, no worries about taking care of house and what not. She has had a long life and deserves some tender loving care. But my husbands nephew is making it very difficult. Grrrrrr!!!!!
December 20, 2006
Wow....times fly when you are having fun. I did what I said I wasn't going to do...and that is not post every week. But things got kinda crazy around here. Well I went for my nurse/dietician consult with Henry Ford. Wanda was awesome...and the dietician is so nice. I truly believe they care. And I am looking forward to working with them. I have an appointment now with Dr Carlin on Wednesday December 27th!!!! And the Excericise therapist later that day. I am hoping to get some excercise tips to help my back and let me get some excercise in before surgery to help the healing. My back hurts pretty bad. I got to meet a few people that had the surgery and they did AWESOME!!! Giant KUDOS to them. I Can't wait for it to be my turn to be where they are.
I have a ton of shopping to do....we were pretty tight on finances due to my husband not getting any workmans comp for the last 15 months OUCH!!! But his case is settled and we got all that back pay so looks like I will be turbo shopping! Now hopefully we can get his pension started and get on the road to financial recovery. We feel so much better as it is.
Wishing all those struggling with getting approved and those awaiting surgery......GOOD LUCK!!
