Dawn H.

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The Dr. office called today and the insurance company called them to let them know I have been approved!  Now its just waiting on the letter so the pre-op stuff can begin.  Im soooo excited!

There was a big mix up at the insurance company as I have posted before at first they denied me stating WLS was not covered under my plan.  I had to get the HR department from my work involved to help get things straight but today they called.  The gal informed me that the surgery was "covered under my plan"  I ask her to see if it had been approved and she said "yes it looks like they reviewed it today and it has been approved."  I kinda dont want to get too excited, I'll believe it when I get the approval letter.  I just cannot say enough to anyone going through this to keep active in the process, it is hard telling what would have happened if I had not called them as often as I did.  I also must say that I never was made to feel bad about calling, they were always very professional at UMR.  So now I am anxiously awaiting a letter!

For whatever reason I just knew that this would not go without a hitch.  I just knew all of the things that happen to so many others here were going to happen to me to.  I am greatful for OH because I was prepared that it would most likely happen.  I am not sure why yet, the gal at the insurance company said a letter has been sent explaining why and what the appeal process is.  Just one more hoop! 

My Dr. offic faxed all of my documentation on 1-20-09 at 1330, fax confirmation stating that all 53 pages were received!  I called the insurance company 1/22, 1/23, 1/24 & 1/26 they did not receive the fax!  I was not shocked because many here at OH have warned me this would likely happen.  So, when I spoke with the insurance company today I confirmed that the fax number used by the Dr office was correct and then requested that my Dr. refax them.  The nurse from the Dr office called me after she faxed all 53 pages again and told me she had a successful confimation number.  I then waited 15 minutes and called the insurance company again!  The gal I spoke with went to the fax machine and found the fax there, she assured me she would make sure it got processed appropriately!  I think I will call again later this week.  Thank you to everyone who encouraged me to call the insurance company.

I would have thought this would have been done last week but....NOT!  I called my surgeons office yesterday to find out and sure enough they had not submitted it yet!  They did however call me back today and it has been submitted.  It can take 15 business days for them to make their decision!  I thought I might have surgery in February, but now I think it is looking like March or even April!  I guess as long as I have! 

Today I had my last vist with the Nut for my supervised diet.  I can hardly believe it is finally here!  Now I have completed every preop requirement that insurance has asked for, I just have to wait for the surgeon to submit it all to my insurance company and wait!  I hate not having control over this! 
 

I had my 5th nut visit on December 15.  I gained 3#.  I am struggling with sticking to the 1350 cals a day she wants me to stay on especially with the holidays.  I just hope this does does not cause problems with insurance.  I have everything I need, just need to visit the Nut one more time, scheduled 1-12-09.  Then hopefully  things will start moving toward insurance approval and surgery.  I am getting tired of jumping through hoops.  I'm ready, if they called tomorrow I would be ready to go.  I was not able to say that 2 months ago, but  I am now ready.  I hate to wish time away, but I wish my wait was over!

I have GERD...bad.  It has caused a chronic cough with is very annoying to me, my family and my peers.  I have seen my PCP about it and have followed all of his directions about raising the head of the bed, taking meds, not eatin  too close to bed time and  on  and on .  I know exactly what to do to keep my symptoms to a minimum but I still cough cough cough.  My coworkers talked me into seeing the Gastro Doc, we are all nurses and know all the horror stories of symptoms gone untreated ect.  The Gastro doc agreed with my PCP, I have severe disease.  He said there we 2 options for treatment, both are surgery.  He explained the first one, then said "but what I would recommend for you is RNY, it will take care of the reflex and take off the extra 80# you need to lose."  I told him what I was working on with Dr. Hoekstra and he was very pleased with that, he will write a letter recommending the surgery which will only help with insurance approval.  All this being said, the greatest thing about this is that the nurses I work with are probably the least supportive of my decision to have surgery of any one!  This helps validate that I am doing the right thing, I thank them for their help!  LOL

Today I had my 4th Nut visit.  It went well, I actually lost 4 pounds.  I was very happy about that and so was she.  I also got my letter of Medical Necessity from my PCP along with some of my medical records needed to show 5 years of being MO and took them to the surgeon.  I made copies, for some reason I just do not trust anyone.   Only 2 more Nut visits to go then they should be able to send off to my insurance for approval.  I am shooting for surgery at the begining of February 2009. Hopefully optimistic!  Dawn

I went to see my PCP on Monday 10-27-08.  Their scale had me up 10 lbs from the week before at the Nut!  Oh well different scales read different numbers.  He is going to write a letter of Medical Necessisty and also show that I have been MO for the past 5 years, all things my insurance comany requires.  I am getting closer, but feels so far!