WLS "Pathways"

Apr 30, 2009

OK my other blog will get lost after this im sure.  I have not been on here in way to long and  so its time to update.  So its a long one, but I really need to get it written down before I forget.  Ok, here goes on the last year struggle to get surgery.  First of all when your going to a military hospital of any kind there really is no "insurance approval" once your primary doctor refers you your approved.  Well sort of.  You have to go thru a bunch of necessary steps and at the end do an interview with the bariatric nurse and she gets to have the final yes or no if you can have surgery or not.

So here is where my last year took me:

~March-April 2008~
I finally got my doctor to refer me to the bariatric surgery program.  Catch was there was a huge waiting list.. So I wait..again.

~July 3, 2008~
Had to attend this Hospitals "Informational Meeting" to get into the program. It didnt matter what I did anywhere else I still had to attend.  So ok, I go, found out a few things about how this hospital works but basically surgery procedures, risks, etc I already knew.

We are told to call the Tricare appointment line right after the meeting, but when we all go to do that we are shocked to find out that the required "classes" are not even in the system and that they dont begin till Oct.  AND we have to call BACK September 15th to get in. I was not happy.  I went up to the surgery department to find out what was going, at first they didnt even have a clue then after they consulted with someone else I  find out that yes, i would have to wait and just call back.  Not happy at all, never was I given any hint or suggestion that I would have to wait so long. I asked if my name could be put in list so they can call me and was told there was no way they could call me to make the appoitnment that I would have to call the appointment line myself on the day classes became available.   I made a complaint to the Tricare Office but it was in vain at the time.

~September 15, 2008  exactly 9:00 am~
I got my kids off to school and called. Did not think 9am would make much difference from 8am.  So I call, then I am informed that all of the classes are full and that they dont know when more classes will be scheduled. WHAT??!!!!  Are you kidding me??  No one ever said there was any wait list we were given the information to "just call and schedule"  Never was I told that I was competing for limited spots.  Immediately I got into my car and went down to the Patient representive office to make a formal complaint.  I felt as if i was not getting fair treatment.  They took my name down and were going to get back to me.  I explained everything and even told them i would be willing to go on a waitlist if possible.  I was told to wait about a week and she would get back to me.  She also promised me that since i was the first to complain about this that I would be top of the list if anything was done.

~about 2 weeks later~
I went into the office to find out if there was any progress so far.  They still had no answers as to even how long I would have to wait for a new class or if i could be on a waitlist for the upcoming one.  I was also told that "if" there was a waitlist I may or maynot be given priority, even though the other representative had promised that to me.  I was furious, but kept it professional because I so badly wanted to get into the program.  And that when I did get in after that it could be up to 6 month or more wait because they were so backed up.  I asked to be released from the military hospital to be permitted to see a civillan and was told thats not possible.  She also told me that in this area there are ZERO tricare approved network doctors and that was why I couldnt be released from care at Madigan.

~another 2 weeks went by...no answers nothing but "i dont know".  At this point I started to research on my own to see if any civillian Doctors took Tricare and I had found one.  Researched him and found him to be one of the best doctors in the state.  I called and explained my whole situation on how i tried to get surgery in 2005 and then how i was now trying again.  They had an appointment the very next week.  Note:  Not only was this Doctor "In Network" But he is a Board Member for the Main Tricare Board of Directors in D.C. (WOW ..lied to again, surprise surprise)

~October 2008~
So I go to the appointment, meet the Doctor and I am impressed.  He is upfront about every step of the surgery even has this thick color code tabbed binder he gives me.  One of the chapters in the binder is an exact list of what he expects to be done before he can give me a surgery date.  OH..and he has a zero time wait list, once pre requisites are complete he can usually get a patient in surgery within a week or 2.  WOW...

So I went back to patient rep to tell her and at that point she tells me that they created a wait list and I am on the list.  I kindly told her I had found a Tricare Approved Network Surgeon and that I would be having the surgery  with him so she could take my name off the list to allow someone else on the list.

I also made an appointment immediately to have my PCM give the referrals needed for the tests i needed done, bloodwork etc.  I had that appointment within a few days thanks to Patient Rep Help.  I went to see the PCM and she was more than happy to assist me and she put in EVERY referral I needed, even my off post one for my stomach problems.

~November 2008~
I am nearly complete on my requirements and so at this time I am trying to get a referral in so I can see the civillian surgeon. I had to go to Patient Rep again but this time I asked for the Supervisor.   I was informed that Madigan would have to "disengage" me to civillian care and that for that I needed special permission.  She did tell me that it was best to not have an emotional letter, have it more on facts etc.   Again Frustration but I took a few days and wrote a letter to that person, made it more informative and full of facts instead of emotion and begging.  I felt the letter was done well and waited to hear back.

~December 2008~
No Response to my letter

~January 2009~
Still No response to my letter BUT..just as I was about to give up and find another way I got a call from Tricare Appointment center..THEY CALLED ME...  HUH..WAIT A MIN!!!!  They couldnt call me initally but they can call me now?? VERY STRANGE

BUT...
They were calling to set up my appointment for the initial meeting with the Pathways Program Head Nurse.  

FINALLY  We are geting somewhere

~January 2009~
I attended my first appointment which was a overall informational class about the pathways process, whats expected of us, etc. etc.  It was actually very educational.  My husband was supposed to attend with me but as usual he was stuck working.
She gave us this letter that had all the required classes listed and said to give her a few days to put the referrals in and that we could call the appointment line to schedule most of the classes.  The only ones not initially scheduled were the 2nd Bariatric Nutrition because you have to actually attend the first one to qualify to get scheduled for the 2nd one.  And the psychiatric eval could not be done until all other steps were completed and you have met with the nurse again to go over the progress.  It says that the process will take about 2-6 months to complete but still no estimate on how long surgeons waitlist is.    Ok I can deal with that for now :)  A few days later I actually had Tricare call ME and set up every appointment they could with no problems.

~January 27, 2009~
Attended Stress Management Class

~February 3, 2009~
Attended Goal Setting Class

~February 10, 2009~
Attended 1st Nutrition Class then followed it by the Madigan run WLS Support Group.  This Class we learned about eating healthy and making changes Before surgery.  At the end of class we were automatically scheduled for 2nd Class

~February 11, 2009~
Attended OT class to learn about how things will be physically post op.

~February 24, 2009~
Attended the 2nd Bariatric Nutrition Class which taught us about how we will need to eat Post-op and for the rest of our lives.  Also gave us information needed about what supliments and vitamins will be needed for life.
Attended Support Group again.  Found out about Thursday nite peer led support group held at Madigan (or so i thought)

~February 25, 2009~
Met up with Nurse again to go over my progress and get my final referral for my psychiatric testing and eval.

~March 10, 2009~
Took the very long very boring psychiatric emotional tests.  Took me about 3 hours

~March25, 2009~   
Had the eval with the Psychiatrist, was very nervous and didnt want to screw it up.  She was clear with me about how she was sure I was ready for the surgery and ready to make the change but with all the stress going on in my life she felt I needed to find myself one on one counseling to help cope through it better"  I was asked to wait about a week for her report to be done before calling to make my final appt with the nurse.

~April 25, 2009~  
Final appointment with the nurse.  Go over all the pathways progress and how my eating habits are going. Get weighed in of course.  Went over what I have for support system (ya ok i may have fibbed a little, I didnt work this damn hard and go through all this effort just to have it be in vain) I also gained 3lbs since the last weigh in. OUCH!!!  I have been a good girl and my clothes are loosening up.  I told her that.

Im Approved!!!  She gave me a packet for surgery that I had to bring with me to beable to schedule my appt.  I did not want to wait anylonger so I left her office and went directly to the Clinic to make the appointment.  Made the appt just before they closed and made a promise to myself to lose more weight before that appt.

~April 29, 2009~
Pre-Op Appointment with Surgeon.  Check in was almost ruined because somewhere I had forgotten about the no child rule.  My husband was stuck at work, respite care dropped my son off early... They absolutely refused to let me check in and wanted me to take the next avail appt.  Then 2 different nurses proceeded to lecture me like i was a defiant child because I had brought mine. They made me feel like i was never allowed to make a mistake like i was no longer worthy of having this surgery.  Oh and then one of them got on her high horse about how this surgery is "Elective" and i dont "Need IT"  Pannack set in.  I was tryin to call my husband and when I told him what was going on he wanted to know if they would let me in if he could get there in 10 min.  Took them EIGHT (8) minutes just to get me an answer then they gave him about 12 min to get there or I would have to wait until May 13th.  Well I wanted a certain date so that my Mom who is a nurse can fly out to help me.  She only has one window open all summer.  then I got this huge lecture on how theres no way I will get the date I want, just not possible.

Anyway, my husband comes, i meet him outside, i run and i mean run into the building, get into the elevator and oh crap..went the wrong way with only 90 seconds to check in. The nurse was very clear if i was checked in by 11:30 i was good, if it was 11:31 no deal.  I got there with about 15 seconds to spare and no breath left.  But I got there.

They take me in to do vitals and then have the head nurse come in to chat with me to make sure I understand why they have that rule.  Well I understand the medical side but other clinics had made exceptions in emergencies so why wouldnt it be fair to assume they all did.  Well I learned my lesson.. wont ever let that mistake happen again..wow....

Oh and heres a shocker.. my blood pressure was elevated...gee ya think!!! I wonder WHY!!!

Soooooo.....
I get into the room and the PA (Student PA) comes in to ask me a bunch of questions.  Then heres one to make ya laugh so u dont go postal.  He asks me  "Why did you do the pathways program before making your appt?"
um gee "Because I have to!!"   lol  

Anyways, so the Surgeon comes in to meet me"

He Is very nice, very informative!!  Upfront about everything and lets me know that he will deploy a few days after my surgery and that his team will be doing my follow up care.  My mom has been a Surgical nurse longer than I have been out of diapers so I know how that game works.  I also know the risks so didnt need all of them explained in detail, like the risk of having to go from lap. to open surgery. 

So we get to the date part.  He says hes scheduling into June, im sure he thinks Ill beg for a sooner date but.. I ask if actually we can go for later in June. Big Smile!  YES!! Not a Problem.  He explained to me how I would be down to about 200 lbs in about 6 months then it will probably plateau so at that point its up to me to make it work in my favor or not. 

YES...GOT THE EXACT DATE I WANTED.. So to the nurse who didnt believe..........

OH and 2ND best news of all that day.. I LOST ALMOST 7 POUNDS!!!!

0 Comments