Amy O.

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So much has changed in my life in the past year. I've met an AMAZING, wonderful man who asked me to spend the rest of my life with him. I love him more than I thought I could ever love anyone . Our wedding will be in October, and after that I will finally have insurance again :)  I have contacted Aetna (his insurance) and have also found out that his insurance DOES cover the sleeve!! I could cry. Future hubs says he loves me just the way I am, but will be behind me in whatever option I choose. 

So here's the email I got from Aetna :)


"Thank you for using your secure member website to contact Aetna.  To
help protect your confidential information, please continue to use our
online form to contact us.  The online form provides greater security
than standard Internet e-mail.

Are weight loss surgery procedures covered?
Your plan includes coverage for weight loss surgical procedures when it
is considered medically necessary.

We determine coverage based on your plan benefits and clinical criteria.
For details on clinical criteria, see Clinical Policy Bulletins, which
can be found online at www.aetna.com.
1.  Go to www.aetna.com.
2.  From your home page, select 'Health Care Professionals'.
3.  Select "Policies & Guidelines" on the left hand side of the page.
4.  Next choose "Clinical Policy Bulletins".
5.  Select 'Medical CPB'.
6.  Click the "I accept" box to proceed.
7.  In the box entitled 'Search CPBs', enter policy number '0157'

Please review and discuss the clinical policy bulletin with your doctor.

Is precertification required?
Yes, the procedure must be precertified by your doctor with Aetna's
Patient Management department.  If your doctor does not precertify this
procedure, your benefits could be denied. 

Please have your doctor contact Aetna's Patient Management area at the
toll-free number for precertification listed on your member ID card. 

Your claim payment
After the procedure, and before any claims payment, our clinical claim
review area will review your surgeon's submitted claims to ensure they
meet our clinical criteria and that the specific procedure Patient
Management precertified was actually performed.

The information provided above is not a guarantee of coverage.  Coverage
is based on all the terms and conditions of your plan as well as
eligibility at the time services are received.

Please make sure to visit Ann, our Virtual Assistant.  She can guide you
to the information and tools you're looking for on your secure member
website, Aetna Navigator.  Ann is here to help you, any time, day or
night, 365 days a year.

If you have questions, you can reach Member Services by logging on to
www.aetnanavigator.com and selecting the "Contact Us" feature.  You may
also call the toll-free number on your member ID card, if applicable.

Sincerely,
Internet Response Team
Aetna
23080088"

Sorry I've been MIA for such a long time, just not much news to report. I've still been here lurking but not posting very much. Here's the lowdown on whats been happening in my life:


I quit my job, because it pretty much sucked. I was stuck sitting at a desk all day with minimal to no work which was great for me getting caught up through hulu on all my TV shows but it made me sink pretty low on the personal achievement/satisfaction scale. It also didn't do very well for me on the actual scale either!

So... I called my old boss and asked for a spot back at Ciena with him. Two major pluses to this, one being that I really did love the job to begin with (just when NASA called and asked me to work there I thought it was going to be amazing... what a letdown) and two... once I get bumped back from temporary to full time employee status I will have great benefits again! Which means.... yaaay I will finally be able to get my surgery!!!!

So while I'm waiting for that to happen (could be anywhere from 3 months to a year) I have started doing my 6 month weight watchers diet. I talked to a girl at work who just had RNY done and she said that weight watchers was all she had and she was approved right away!

Right now though i'm stuck with NO health insurance which scares the crap out of me, so I am going to try to apply for it through the Maryland High Risk Pool to get it. I applied for private insurance and was declined through two different companies so it looks like this is my only route to go for right now. BUT things are looking up! Hopefully by the time I get through my 6 month diet I will be hired back on and we can FINALLY get this show on the road!! *Fist Pump*

...makes me want to bang my head against a wall

Can someone tell me how I am 24 years old, but somehow talking to an insurance agent make me feel like i'm a 5 year old who did something bad? When asked why I needed insurance and what I wanted it to cover I was made to feel like I was trying to steal money from their company and was told I would immediately be denied because of my weight and to "not get my hopes up". I was also told "why don't you lose the weight then apply". OMG WHY DIDN"T I THINK OF THAT?! If I could do that dummy I wouldn't be trying to get insurance from you in the first place! I'm so angry/sad/disheartened. So this is probably it for me :(  My only hope is to drop my insurance once open enrollment comes around and just try to get individual insurance (elsewhere) as my primary. This sucks so bad.

OMG I love Dr Singh! Definitely going with him for my surgery. Now the next thing on my list (tomorrow!) is to call UHC and verify a couple of things:

1. Will I have to do a 6 month diet? (Dr Singh said that because they are a UHC center of excellence that the 6 month diet is sometimes waived)
2. Is there an amount of time that a new customer of theirs has to wait before they can have an elective surgery?
3. Since I've had constant health coverage for the past 18 months, will my pre-existing conditions be covered?

Ahhh so excited, I wish I could call them now :)

So i'm leaving work in about an hour to make my way down to Baltimore (I work in Greenbelt) to go to St Agnes for the informational seminar with Dr Singh. I'm so excited! And nervous! LOL is that weird? So, if it goes well, after that I still need to look into getting secondary insurance that will hopefully cover it. I found a good UHC plan online for 228 a month. I will need to call and talk to them and make sure I can get the surgery covered with that insurance but as long as they do it looks like I will be spending my saturdays working at the store in Annapolis to cover my new insurance costs. I'm ready. Sacrificing my saturdays is a small cost of getting my life back :) Has anyone had any experience with secondary insurance and WLS? Maybe i'll post on the forums, people here always have such good information.  Well anyway... wish me luck! Hopefully this is the start of a wonderful journey with me and Dr Singh!

I'm back after my minor setback last month. I've been thinking it over and I really believe this is what is best for me. So after I missed last month's seminar with Dr Singh, i've signed up again and am scheduled to go to the next week's seminar. I still need to buy my additional insurance, which will be a strain on my already tight wallet but will be so worth it. I have read all about pre existing conditions and their exclusions but one good thing is that i've had constant health insurance since the day I was born which (according to HIPAA laws) would cancel out any pre existing condition exclusion there would be concerning my weight. I need to get on the phone with UHC and make sure of this, but it was pretty clear from the articles I have been reading online. So... here is to me (hopefully) becoming a "loser"!!

I talked to our HR department and got some disheartening news.... because our health plan was aquired out of state, it does not have to follow state laws.  SO, we are back to square one.... I have to get new health insurance. I have been researching everything I can find about RNY... truthfully it's scaring me a little. It seems like it's so drastic. I know it's what  I need to do, but the thought of getting cut open scares me a little. I'm going to another seminar next wednesday, and it's with the doctor that did Jenn's RNY so she is going to go with me for moral support. I also have an appt with my neurologist earlier on Weds and i'm going to talk with her about the idea. I know my pseudotumor is progressively getting worse because I can see my vision declining. I'm also starting to see dark spots every now and then and that scares the hell outta me. She is going to get on my case about gaining the weight back (plus more). I also need to figure out how in the heck i'm going to tell my mom about me thinking about getting this done. My mom hasn't really ever struggled with weight like I have, she's been a size 8 for a long time. And I know she loves me the way I am and doesn't want to see me go into surgery to try to fix my weight problems. BUT I also know she's scared of me possibly becoming diabetic like my grandfather was. So... it will be scary but we will see how it goes. One day soon i'll hopefully be brave enough to tell her. I also pray that she will be ok with it and God will give me the right words to say...

Today I went to the weight loss seminar with Dr Lo Menzo, and I really liked him! He was very knowledgeable about everything and gave us as much time as we wanted for questions. He even stayed after if we wanted to have some one on one time. But the most exciting part is that I learned an AMAZING fact about Maryland law from him. Maryland law requires treatment of Morbid Obesity to be covered if you are a company of over 35 people! When I asked him to clarify this more, he said that this is a new law that went into effect last May and that I may need to call them again to verify my policy.  I am hoping and praying to God that this is true (even though our headquarters is in TX which might affect the coverage). It would be so great to not have to go out and buy new insurance! So tomorrow I will be calling my insurance company once again... wish me luck!

For the past couple of years the idea of having WLS was just a thought in the back of my head. It was something that, yeah, sounded amazing, but could never actually happen. Well now after moving out of my parents house and living on my own, a devistating breakup and yoyo dieting more than ever, i'm 60 pounds heavier and now WLS is becoming more of a reality in my head. This really sucks, feeling like the 'fat friend' allll the time. My self confidence has always been an issue for me, but now that i'm at my heaviest it's really taken a hit. So, I have scheduled myself to go to the WLS Seminar in Greenbelt on Tuesday with Dr Kligman to see what this whole thing is about. I'm so nervous! This will probably never even become a reality because my sucky insurance has an exclusion on all surgery for weightloss. It is not covered, even if needed for a comorbity. I'm thinking about trying to get different insurance and just biting the bullet and paying more every month. I have no idea if it would even work... it seems too easy. Can you even have two health insurance policies at the same time? My roommate who used to deal with the insurance companies everyday for her job says yes, you can have primary and secondary insurances so everything the first doesn't cover you just send to the second. Unfortunately I'm stuck with paying my current insurance for now because I get it through work and open enrollment isn't until October, and even then i'd have to still pay it through the end of this year. I was looking at the ehealthinsurance website and there are a couple of possibilities for plans that look promising... if things go well at the seminar I will look more into it. I am trying so hard not to get my hopes up so I don't get let down when it may not work out. But if it does... I look forward to a life of no daily headaches (from the pseudotumor cerebri), being able to get up the stairs to my apt without feeling winded, and a calmer HEALTHIER life! Heck, I may even take up running, something i've never ever been able to do.