tinkerbell64
Still Waiting To Hear
Apr 01, 2006
4/2/06 Well it has been 3 1/2 to 4 weeks since my appeal was sent into Humana and I still haven't heard anything. When I call Humana they tell me it is still in nurse review. I can't imagine why I would be denied now. I meet all of medicare's standards and Tampa General is a Bariatric Center of Excellance. The only reason I can think that they might deny me is if they are not up to date with the medicare changes and It won't be because I haven't tried to inform them. So I pray that I will hear something soon.
Eighth Month of Supervised Diet
Mar 14, 2006
3-15-06 I attended my 8th month of the supervised diet and exercise program at spectra healthcare. Perry Kaly, PhD. moderated the class tonight. I had been to one of his classes about 6 months ago. I also emailed Susan at Dr. Murr's office this morning to find out if Tampa General was a Bariatric Center of Excellence, she stated that as of March 3rd they were designated a Center of Excellence, but it wasn't showing up on the Surgical Review Corporation web site that it was. Well tonight when I got home I was surfing the web and there it was listed as a center of excellence. Hopefully now I will be approved and that won't stand in my way. I keep saying prayers hoping soon I will here those two words! I will post again when I hear something.
Denied
Feb 27, 2006
2/28/06 Received a call from AnnMarie from Humana DENIED, DENIED, DENIED. She said I didn't have the 6month diet history (which) I did through Spectra and gave to Susan @ Dr. Gallaghers office, and faxed to AnneMarie this morning. Second they said my BMI wasn't 40, it was 40 in July 05 documented by my gyn and it is 40.6 currently it did dip to 37.6 in October but since has gone back up from all the stress and the lack of being able to exercise as much because of the severe knee pain and swelling I have had these last two months. Lastly they said I didn't have proof of no abnormal thyroid or adrenal problems. I did all the required blood work and Dr. Gallaghers offiice had this information. AnneMarie said they had none of this information and Stacy at Dr. Gallaghers office said she was a liar. So now I am completely distraught and left in the middle to try and appeal. I refuse to give up because I have jumped through their hoops and still I am being denied. Once I get over this initial devastation I will pick up and go on and fight them. However I am so tired of having to fight for every single thing in this life. Nothing ever comes easy for me. Sorry I am so down today I will try harder tomorrow.
Humana has My File
Feb 22, 2006
2/23/06 Humana has my file. Now I wait not so patiently and hope and pray for good news. I just spoke to Jennifer and she said it was in nurse review and I should know something in the next 5 to 7 days. I pray that they approve it on the first go round. I have jumped through their hoops and will be devastated if I am denied, I won't give up but I will be severely disappointed. Will repost when I know something.
Consult with Dr. Gallagher
Feb 02, 2006
2-3-06 Had my consult with Dr. Gallagher today, he was super great. I was so impressed. He came in and asked my which surgery I was interested in and I told him lap rny. Then he went over my history and gave me a full description of what the surgery would entail (he even drew very detailed pictures). Then he did a physical and showed me where the 5 small incisions would be and how long they would be. He said they should have no problem doing the surgery laparoscopically. He then answered all my other questions. Then Susan came in with Dr. Gallaghers office coordinator Stacy. They looked through my paperwork and I gave them my 6 month supervised diet from Spectra. They said everything seemed to be in order. Susan said my file should be faxed to Humana by 2/10/06 then I should here something within 3 weeks. Susan also said Humana tends to be one of the easier companies to deal with so I will continue to say a prayer that I will be approved on the first try.
Sixth Visit of Six Month Supervised Diet
Jan 17, 2006
1-18-06 Went for my 6th visit for my 6 month supervised diet tonight at Spectra. I am going to continue going to these meetings monthly until I know I have the approval for the surgery. Tonights class was moderated by Martha Vidal and it was on the topic of Volumetrics and Vitamins. I had heard about the Volumetrics because that was the first class back in August. All of the classes from here on in will be repeats to some extent. My consult with Dr. Gallagher and Dr. Murr will be on Friday morning February 3rd. Hopefully shortly after that everything will be ready to submit to the insurance company. Also I switched my PCP to Dr. Bearison since Dr. Remmer left the office and I have seen him twice and he seems like he is going to help me get through this process. So hopefully things will start moving in the next few weeks. I will keep praying.
Fifth of Six Month Supervised Diet
Dec 20, 2005
12/21/05 Went to my 5th of 6 Supervised Weight Loss Classes. Tonight was the exercise person from Tampa General Hospital. It was informative and he stayed late to answer any individual exercise questions. Hopefully I will get to see Dr. Gallagher at the beginning of February as my 6th weight loss visit is January 18, 2006. I am seeing another PCP on January 9th and will see if he is going to be supportive like his partner was.
4th of 6 Month Supervised Diet
Nov 15, 2005
11/16/05 I went to my 4th weight loss class tonight at Spectra. Curtis was the moderator of the class tonight, it was very informative and there were several new people at the class tonight. I can't believe I have 4 months of this supervised weight loss done and two more to go. I can't wait until I am finished and can submit to the insurance company. I see Dr. Gallagher on December 2nd and then I have my 5th class on December 7th I believe. Just wish the time would pass faster.
Appointment with PCP
Oct 27, 2005
10/28/05 I had an appointment with my PCP today to change my blood pressure med to something that is not sustained release. One more requirement accomplished today. My PCP has been so supportive, he is the best primary care doctor I have had in years. He is understanding, he doesn't rush in and out. I have only been a patient of his for a little over a year but I think I found an angel in him.
Yeah Appointment to Meet Surgeon
Oct 20, 2005
10/21/05 Oh it has been a very exciting afternoon. I got home and was just about to get online when the phone rang and It was Susan from Tampa General Dr. Gallagher's office and she wanted to schedule an appointment for me to meet with Dr. Gallagher to discuss my surgery. The appointment is for December 2nd at 9:00am and I can't wait. By the 2nd of December I will have 4 of my preop physician supervised weight loss classes done. I am going through spectra for those. I was excited about the appointment and was logging on to obesity help to add this newest information when I found out that Carole had just finished sprucing up my web page and she did a great job. I just love tinkerbell. So things are moving forward one step at a time.
About Me
St. Petersburg, FL
Location
23.1
BMI
Surgery
08/02/2006
Surgery Date
May 13, 2005
Member Since
