maryc543
June, 2004 Today, I went to Columbia Presbyterian in NYC to meet with the nutritionist and the physicians assistant. I have to have a cardiac stress test, an abdominal ultasound, and a doppler study of my legs. I already did trhe sleep study last year, and had a million blood tests, a psych eval and my Primary write a letter of necessary. Is there this much pre-admission testing everywhere BEFORE you're allowed to make an appointment with the surgeon? I'm overwhelmed!
August, 2004 I met with Dr. Inabnet and have a surgery date... Tuesday, October 26th, 2004.. It will be a duodenal switch done in two surgeries, one in October, and one prob in April or May. Two weeks before surgery I do a low fat, high protein diet with liquis supplements, two days before surgery I am on a clear liquid diet, and then SURGERY! 4 weeks out of work, and then back to my life, but losing weight! I'm excited, and terrified.. Doctor and office said insurance approval should not be a problem, I hope they're right!
August 31, 2004 Received denial letter from insurer. Will appeal.
October 1, 2004 Received denial on the appeal. Secretary in doctor's office suggested I might want to consider another type. When questioned, they have only appealed one other time, and lost on first letter, and they stopped. Apparently, I am more motivated (?pissed off) and will continue. My surgery date is cancelled, and now they're looking at December. I will file the 2nd appeal this week.
November, 2004 Lost the second appeal after a hearng. Long letter from BC/BS telling me why DS is investigational. Waiting to hear from the MD.
September, 2006 After a long uphill battle with BC/BS of NJ, I won. They no longer consider the DS 'investigational' and will allow it. I am in the process of contacting my physician from 2 years ago, and getting this started again.!!!!!! I can't wait. This journey has taken too long to start, and I need to get moving!!!
Post Date: 10/19/06 11:59 am
There's been a few posts asking about experiences with NJ BC/BS...
Here's mine...
they are the evil empire... they have all the power and control.. and we must beg for what we need.
I have the policy issued to state employees... very comprehensive...
includes WLS.
In 2004, I met with a surgeon in network, completed all the pre-op testing, sleep studies, cardiac stress, etc, etc, etc. All covered. Met all the surgeons requirements, classes, meetings with dieticians, psych eval, etc. Got a date. Medical office staff sends in for pre-authorization. They turned me down for a Duodenal Switch.
(I have an extrememly high BMI, and research shows this is the best type for me).
OK, work the appeals process, lose twice, hire a lawyer specializing in obesity cases, 2005 go to the Pension Board for state employees where you can file the next level appeal, the BC/BS rep lied and stated that the DS was not approved for Medicare and Medicaid patients in NJ, which blows my premise that it's available for indigent and elderly NJ'ians, why not state workers? Lose.... file with the Office of Administrative Law for final level appeal, have NJ BC/BS cancel two different dates the day before the hearings. Finally, in Sept, get a notice they changed their policy to include the DS because "now it's not investigational".
These (fill in your own cuss word) have made me put parts of my life on hold for over 2 years fighting them....... Thank goodness my job and 'real' life keeps me too busy to plot against the 'evil empire'. Wow! it feels good to get that all out.
I now have a new date, and approval, for 11/14/06. I can't wait... and will never think of BC/BS as being patient friendly or easy to deal with.
Sept 26, 2006 Saw the surgeon today and have a date of Nov 14th.... just routine pre-ops.... and hopefully, this time, it's a go!
Post Date: 11/17/06 4:08 pm
I'm home and feeling pretty good, a little sore, but nothing to take meds about..
It was a lap, and they found a very large umbilical hernia which we'll have to deal with later..... I have 6 holes, a few more than I expected. Oh well,. I have one of those orphan type immuniological diseases, so they freaked and kept me in the PACU for an extra day, so I could have a tube kept in. We'll be discussing this before we do part 2 in a 100 or so pounds. That sucked. ...and as I told them, I was fine.
TAMMY, my angel, was wonderful. I called her all upset over Lynn Bee and her stricture just before surgery, and she let me talk it all out, then I was fine again! She contacted the hospital several times and even talked to me. I appreciate all this attention and good wishes.
Has anyone heard from my co-horts....PrettyDove and Sean?? I hope they are doing great! Oh well, I'm going to go nap!
Post Date: 12/23/07 6:37 pm
I had surgery Tuesday around 2pm, got out of the OR around 8ish, spent the night in the PACU (for oldsters, it's the new name for the recovery room) went to a step down unit around 9am Wednesday, and came home Thursday afternoon around 4pm. I had the second part of the DS, lap, in NYC w/ Dr. Inabnet. I'm bouncing back pretty well. I'm up and about, and although I didn't ask his permission, I drove my self about 8 miles to visit with some family today. I was NOT Ms. Excitement, but I could hold my own in a conversation. I'm back home and exhausted now, but trying to stay awake a few more hours so I get back into a sleep routine!
Part 2 of a 2 part DS is definitely a different experience. First, i didn't have to spend 2+ years fighting the insurance company. Second, I'm a lot healthier, and lighter, and the surgeon said that made it easier for him. I was able to get in and out of bed simply, didn't have the blood sugar highs and lows post op, etc.... PLUS, i knew what the pain meds would do to me... so I mostly skipped them. Lap, there was a lot of bloating and pressure, but little actual pain. I'm sipping like , I don't know, something that sips a lot!!!
Thanks to all who posted well wishes. I felt really great reading them!!!!
Finally a full Switch Sister!
