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I just found out on Friday I have been diagnosed with Lyme's disease. I have to take an antibiotic for 30 days.
I spoke with my surgeon this morning and he said no surgery until an okay from my primary saying I'm cured. We also talked about the fact that I still am not totally keen on malsorption and the whole re-routing thing. He knows how I feel and he told me there is a good chance based on some info that is happening, that VSG may be approved by my insurance next year...(no guarantee at all). Call it wishy-washy call it what you may but its really hard because this is my body and a life long decision I have to make sure that it is 100% what I want, and honestly I can't say that about RNY so for now my surgery is off. I'm okay with it for right now, it may change completely in the future. Who knows....

After several rounds with my insurance company and my doctors office, I was not able to get approved for VSG thru my insurance company. I thought about trying to go to MexiCalli but my hubby was like no-way--no-how. So I decided to go with RNY since my insurance will pay for it. Though it is not my first choice, I know it will help me with my sweet tooth and since I am not a throw upper, I'll steer clear from the wrong foods. I believe that I will be sucessful and that I will rock the heck out of my pouch!!!!!

I think I better start getting myself familiar with what is going on in this neck of the woods. I am really starting to become more accepting of the fact that RNY may be the surgery for me. I feel like 6.5 months is a long time to wait. I know there are many that have waited longer. But I'm so ready to be able to breath clear when I tie my shoes, feel healthier, be able to get rid of my CPap machine...I could go on and on

Bewilderment- The act of confusing somebody or something, or the state of being confused or perplexed


Yeah that is me right now. I feel frustrated. I need to have WLS. I want VSG but it just may not be in my reach insurance wise, I am waiting to hear back (I won't be holding my breath) from BCBS Personal Choice today about a decision from the 1st appeal. From that point my doctor will either (1) Schedule a date for my surgery  or have another denial with the doctor and I will talk with one of their surgeons (insurance) and I will get to plead my case.   . So we will see, it really is something that insurance tries to push you towards a more expensive procedure.  I

Just got off the phone with my 12yr old's guidance counselor, he had to have another year of Reading Foundation before he can take Spanish. (He was really excited to take a language, but I agree that he needs additional strengthening in the reading comprehension and so forth, he can do Spanish next year so its not the end of the world,  just yet another disappointment in life!)

Still in the waiting game. I had to fax my insurance a copy of my signature showing that it was OK for Dr Soriano to proceed with my request to over turn my denial. Got it all done and faxed in. Over the weekend we went to a cook out and I got to see a friend that had RNY. She looked great! She originally wanted the sleeve but her insurance would not approve it. (Imagine that??) So she decided to have the gastric bypass and she is doing great. She had it done last August and she took my number and wants to really be there for me as I go thru my transition. I really do want the sleeve but honestly at this point if my Doctor can't get it approved then I'm really thinking RNY and the more information I have on it the less scared I am of the procedure itself.
My fibromyalgia is doing its thing. I started taking 300 mgs 2X's a day of Lyrica, although, I feel better, my legs swell up and I really don't like that. So my doctor called in a prescription of 225 mgs, yeah well it doesn't do the same for me as far as pain.  My knees are really bothering me too. My hubby is so good to me, he picks up the slack big time. When I looked at that recent picture of myself, I wonder how he stays with me cause I'm so big compared to where I use to be. But I know that he loves me for me....

Well I just got back from my youngest son's school chorus program and I listened to the messages from over the weekend and sure enough there was a call from Dr Soriano's admin Debbie saying that IBX (Independence Blue Cross Blue Shield of PA) denied my request for VSG.


Its not like I wasn't expecting it. I loved how the admin said call us when you get this message so we can go over your other options...Hello VSG is my only option. I realize that I could of got the lapband and I could of gotten RNY but I just really don't think they are my best fit. I pulled out Teresa's info on denial letters and I'm getting all my litature gathered and will proceed from here. One question, I guess I will put it out on the main board...do I do a 2nd request letter or does my doctor do it???

I know that my friends in here are with my for the long run and its encouraging to know. No one else can say they know how you feel except someone has had been there done that. I supose a little part of me hoped that my insurance would just go through...

The waiting game is can be so hard. My doctor's office works on the slowest time ever (of so it feels like to me!!)
They told me that they had submitted all my paperwork the e-mail I received back from them said ...  so I guess we are looking at 2.5 wks or so, I guess it really has not been that long it just feels like it. Anyway they pretty much told me that the first round was almost guaranteed a denial but hey...I needed to get the ball rolling right??? So I went to the MD shore this weekend and was mortified that mostly all of my summer clothes from last year don't fit. I'm also tired of the comments from certain family members about my weight gain. I know its there and they know its there, must we really talk about it?
Please, Please, Please let my surgery be approved and that the next correspondence I receive from Temple is to schedule my surgery (I can hope right????)



Hello Monica - Dr. Soriano is going to submit a letter on your behalf to your insurance company along with all of your testing so far - once we receive a response, either he or I will contact you.   Thanks  

Debbie Thomas
Administrative Assistant
Vascular Section
Temple University Hospital
 

 

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Sent: Wednesday, April 15, 2009 4:55 PM
To: Soriano, Ian S
Cc: Thomas, Debra; Crowell, Mack
Subject: Re: Meeting witn Blue Cross Blue Shield in regards to approvals for VSG approval

  As I understand it, today Dr Soriano is meeting with people from Blue Cross Blue Shield to see if he can get my surgery approved. I'm hoping that this meeting will go smooth and I find out I"m approved and that I have a surgery date. I feel like I am so ready for the new life. It will def be a new life with a whole new way of eating food. I know the journey will not be easy first dealing with the surgery itself, then the start of the healing process, the clear liquiods then full liquiods, then puree then eventually to soft foods then regular, then getting use to no being able to eat like I did before. Learning, learning and more learning. I want this so much, I want to be healthier, I want my knees not to hurt so much, I want to be in better health, heck yeah, I want to be in smaller size clothes and look better too. I pray that God is going to let this all happen and soon, very soon I can begin my Metamorphosis to a new Monica!!!

Wish me Luck!!!

Dr Sorieno is meeting with the head people at Blue Cross Blue Shield Personal Choice on Monday March 9th to plead my case. Hopefully he can get me approved and they will be calling me back with a surgery date. All pre-op testing is complete, I'm going to pick up my C-Pap machine on Thursday Feb 26th. Its funny with people at my job, at first I didn't want anyone to know I was having surgery, now I really could care a less. Ofcouse there are noisey people at my work that are already making comments behind my back like why does she have so many Dr's appointments? etc. My question is Why are you concerned with what I'm doing? Just do you ya know?????

Okay so its almost near the end of January and sooo cold. I've done most of my pre-op testing that Doctor Soriano has requested. I'm getting up early tomorrow morning to have my blood (fasting) testing done. I go for part II of my sleep study next Thursday. I talked to my Rheumy today because I am so tired at work lately I don't know what to do. I'm literally falling asleep at my desk. She informed me that she already got the first part of my sleep study info back and I have obstructed sleep apnea which is part of the reason why she thinks I'm always so tired.
I called Doctor Soriano's office today because I was still a little confused on what happens next as far as appointments and I wanted to make sure that they received my primary (Dr Ice)'s letter of necessity for weight loss surgery which they did. I have a stress test scheduled for Wed Feb 3rd, in the am then in the PM I will go to Temple and pay the $350.00 fee they charge for pre-op teaching class, psychologist and dietitians. I feel like the ball is really moving now in the right direction. WhooooHooooo