Many health problems all directed related to my weight. I've tried so many times and failed. I will turn 50 in 2003 and I want my life to begin at 50.
2/7/2003 - I am really beginning to get excited now about this entire experience. I was so happy with my visit with my surgeon yesterday and I am beginning to pull together all the information needed for my insurance company. There is a written exclusion in my policy, however, the program coordinator in the surgeon's office indicated that thus far, my carrier has been the easiest for her to work with. I certainly hope this holds true in my case.
2/10/2003 - I'm impressed with the quickness and efficiency of my surgeon's office...Just met with them last Thursday and I've already received telephone calls from a dietician and a gastroendocrinologist scheduling appointments. I am getting more and more excited about WLS and am beginning to be disappointed that my work schedule would prevent any surgery until June....I'm damned impatient......want to do it now!!
2/11/2003 - I have such a wonderful crew of co-workers. Called them all together today and told them about my quest for WLS and asked if they would rather me wait until June for the surgery, or if approved, if they would rather for me to go ahead and get it done....and they all said go for it! So, I talked to my surgeon's office and said let's go for a fast track if possible. I have nutritionist scheduled for this Friday and an endo on March 4. With prayerful help, I'll get through all the pre-testing, get insurance approval and be looking at an earlier date than June! WHoopeeeee! Just had to add this....ordered Chinese delivery tonite and my fortune in the cookie reads, "A new voyage will fill your life with untold memories." THIS HAS TO BE A SIGN!!!!!!
2/14/03 - Happy Valentine's Day - had my appointment with the nutritionist today. Very lovely lady - Dr. Barbara Ann Hughes. We spent almost 2 hours talking about the liquid diet that I will be on for 8 weeks following surgery. She gave me some material which reminded WLS people not to chew gum - if accidently swallowed it can close up the stoma - I would have never thought of that. Something that simple makes you realize just what a change this is going to be. Also received a voice message from the pyschologist's office telling me how much out-of-pocket they estimate I'll have to pay for the evaluation. They had talked to my insurance company and of course, the insurance is saying this isn't mental, it's medical and then they keep pushing it back to the other....well, if they're saying they will at least pay for part of the evaluation, then maybe that means I'm closer to full approval! Let's keep our fingers crossed.
2/20/2003 - Had psych evaluation today. Very pleased with Dr. Mary Ann Hartye! Very supportive. Talked with her about an hour and then spent about 45 minutes knocking out 2 computerized tests (MMPI and one other). One step closer to insurance submittal!
2/26/2003 - Had a meeting on Monday, 2/24 with the exercise physiologist recommended by Dr. Brader, Christin Sheppard. Very nice, very personable. In addition to being an exercise physiologist, she is a psychologist. We talked about what types of exercise I liked, didn't like etc. and she will develop a recommended program for me after surgery. Dr. Brader includes 12 one hour sessions with a personal trainer after the surgery and Ms. Sheppard's recommendations will be passed along to the trainer. She felt that I was a great candidate for the surgery. I'm really impressed with Dr. Brader's program - it seems very complete. TOday, I got a call from the psychologist, Dr. Hartye. I was originally supposed to visit her again tomorrow to go over the results of my evaluation, but she said today, that everything looked great, that she didn't see any reason for me to come tomorrow and that she was faxing the evaluation to the surgeon today! One step closer to being on the losing side! An AMOS member I met on this website, Pam Stephenson had her surgery on 2/24 and she is doing great - talked with her tonite and she sounds wonderful! Another person I met as a result of this website, Dotty B. is having her surgery with Dr. Brader on 3/3 and today another patient of Dr. Brader's emailed me - I'm sure we're all going to be a great support group for each other. Have recently found out there is a WLS support group in this area and plan to attend my first meeting on 3/8 - would you believe we're meeting at a Cracker Barrel???? And the best part is that it was at my suggestion! Still have to get all those comfort foods in before surgery! Hopefully paperwork will be submitted shortly for insurance approval. Also went to my oncologist this week for my "one year since breast cancer surgery" checkup. All my bloodwork was great and he said that I now have an 8% chance of getting cancer again. It was at 50% right after surgery before chemo, at 18% after I completed my chemo and now at 8%. The odds keep going down every year and I know if I have this surgery, it's going to reduce my odds even more. The only bad thing about the visit was that I had gained 2.5 pounds since my surgery consult - which I guess I should be happy that it wasn't more considering that I have constantly had food in my mouth for the past 3 weeks!!
2/28/2003 - A GREAT BIG THANK YOU TO MARCIA MCDANIEL FOR UPDATING MY PROFILE!!!! She did a great job - and in case anyone is wondering....the patriotic theme and the elephants come from my passion for the REPUBLICAN PARTY. I have been a Party activist for many years and two years ago I was offered the position of Chief of Staff of the North Carolina Republican Party and I am one of the few lucky people on this earth who has been able to merge their avocation with a vocation. Thanks again Marcia!
3/02/2003 - My insurance does not require a referral from my PCP to visit a surgeon. So I went ahead and had my surgical consult on 2/6/2003. On 2/18/2003 I took a packet of "all the information you would ever want on WLS" to my PCP's office, along with a letter to her explaining why I felt this surgery was for me, a sample letter from the PCP to the surgeon and a listing of websites where she could do additional research. Her reaction to me that day was, "Why are you brining this to me?" I posted on the message board that nite about my experience with her and I had several emails and posts saying, "Get rid of her". I decided to give her the benefit of the doubt and see if she would respond to me. Well, this week she did and I just opened the mail today. I am going to post her entire letter to me because I want everyone to know what an insensitive, ignorant and obvious "I know better than you do" physician (and I use the term lightly) this woman is. At the point that I compose my response letter to her (which will take me a couple of days to come up with one of my masterpieces) I will post that also. I just haven't had the opportunity to do a good job of gathering my thoughts to hand it back to her.
Dear Ms. Beatty:
I have reviewed the information from Carolina Bariatrics. More importantly, I have spent several days reviewing the letter that you wrote me on February 17, 2003. You are absolutely correct that many of your illnesses are secondary to your obesity. Your risk factos fro coronary artery disease are significant. Fortunately, you could have control over many of these factors.
In spite of the fact that you have gone through a very intense evaluation for hemoptpysis, you continue to smoke. You have obstructive sleep apnea, which is no doubt directly related to your weight issue. Nonetheless, in spite of dealing with the aggravation of using a CPAP mask, your weight has gone up. In fact, while I have been following you for this short period of time, your weight has increased. I note in your letter that you indicatae that you have lost weight in the past, but htat when you don't see results quickly, you stop your efforts and gain back all the weight you have lost plus more. These issues indicate to me not a patient who would benefit from a "quick fix" but someone who needs intense, routine and chronic psychotherapy to deal with an eating disorder. I doubt seriously if you have made any attempts to exercise routinely, and whether you have or you haven't, clearly it has not been effective for you. You need supervised activity.
I realize that you will look at your cardiac risks and think that these are reasons to proceed with gastric bypass surgery, but I do not veiw it this way. Anyone who does not have the drive to lose weight in the setting of diabetes, hypertension, reflux disease and obstructive sleep apnea will not have the drive to follow the directions necessary after the surgery has been completed including taking supplements for the remainder of your life. I realize that this will be disappointing to you, and I am fully aware that you may seek a referral elsewhere. That is certainly up to you, but my opinion is that this is not the right way for you to go.
My final comment is that insurance is not really meant to be used in this way. I think that over time we have become much too cavalier in our use of our insurance. I could never in good conscience recommend this surgery for that reason alone. I would much prefer to see you use your coverage to deal with your food addiction.
Certainly if you decide after receiving this letter that you would like receive your care elsewhere, that is fine, and you simply need to let us know that so we can get your records to the correct office. If you decide to continue to follow here, that would be fine as well, and I think that we could certainly work together to detail a plan which would allow you to lose weight. I sincerely hope that you will chosse the latter of these options.
Sincerely,
Lynn E. Keplinger, M.D.
I always knew that some doctors consider themselves God when they get that piece of paper that says M.D. However, this isn't heaven and they have no jurisdiction!!
3/4/2003 - Had my endoscopy this morning - nasty procedure, but frankly not as bad as I expected it to be. Was shot full of Demerol and came home and slept for 4 hours. Many thanks to my friend Dottie S. from Greensboro for coming and taking me to the hospital at an UNGODLY hour (had to be there at 5:45am) and getting me home and tucked in! Many folks asked for me to post my response to my PCP (term loosely used) and I have posted what I have written below. However, rather than writing to Dr. Keplinger and wasting my words, I decided to write to the President of the practice - especially after I found out there was another physician in that practice who is actively following one of our local support group members. Here is the letter (I deleted the paragrah that had all my contact info - love you guys, but you never know who is looking at this board).
Dear Dr. Miller:
I am writing to you as President of Wake Internal Medicine and to document my dissatisfaction with one of your associates, Dr. Lynn E. Keplinger. Dr. Keplinger has been my primary care physician since late summer, 2002. I will be finding a new primary care physician and I wanted you to know my reasons.
Through the times that I have seen Dr. Keplinger for medical assistance and advice, she never has been the most patient friendly individual, however, I did trust her medical advice. I have also found the staff at Wake Internal Medicine to be extremely patient friendly. In December, 2002 at my yearly physical examination I mentioned to Dr. Keplinger the possibility of looking at Weight Loss Surgery as a tool to help with my obesity. To fill you in, I have Type II Diabetes, GERD, Obstructive Sleep Apnea, Hypertension and Osteo-arthritis. Dr. Keplinger’s response was that she didn’t know much about it and that I could get her some information.
On February 6, 2003, I had a surgical consultation with Dr. Alan Brader of Raleigh and on February 18, 2003, I left a package of materials with Dr. Keplinger. That day, she was sitting at her desk and when I handed her the materials, she said, “What’s this” and when I explained what it was, her next question was, “Well why are you bringing this to me?” I was a bit taken back by her comment and her body language…I mean she is supposed to be concerned about the health issues that I’m concerned about isn’t she? I am enclosing copies of everything that I gave her for review, so that you can be fully aware of what she was given to review. In the meantime, I completed my nutrition, psychological and exercise physiology evaluations (the exercise physiologist is also a psychologist) and am pleased to say that I have been recommended whole-heartedly by these professionals for bariatric surgery.
I am enclosing a copy of a letter from Dr. Keplinger dated February 21, 2003 where she informs me that this surgery is a “quick fix”, that I need “intense, routine and chronic psychotherapy”, that I need “supervised activity” and that I would not have the “drive to follow directions”. It is obvious from this uninformed response, that she did not review any of the materials provided to her nor did she review any of my past medical history which had been forwarded to her last summer from my previous medical provider, Dr. Angela Waterman with Tannenbaum Medical Associates in Greensboro, NC. Actually, Dr. Waterman is who referred me to Wake Internal Medicine when she left her practice last summer. She had actually referred me to Dr. Wayne Harper, but when I contacted the office I was told he was not accepting any new patients.
Dr. Miller, I am not writing you to complain about Dr. Keplinger’s refusal to recommend me for surgery. I am writing to strongly complain about the manner and method she used in making her decision and in communicating it to me. This individual is obviously void of any sensitivity and communication skills. She did not do her homework and she displayed nothing but arrogance and self-righteousness in her letter. She obviously has the opinion that “if I wanted to, I could do better” and has a bigoted, biased attitude towards obesity. I pity any of her patients who have an addiction to alcohol and/or drugs or who may need medical counseling in their fight with other addictions such as gambling. I have no argument with her right to have her opinion and to express that opinion. I do have an argument with her using assumptions, not medical fact and her method of communication. It seems to me that any physician who honestly cares about his/her patients, without biases and bigotry would have at least picked up the phone and said, “Let’s discuss this”. And, if she had really bothered to look at her own records, she would have seen that Dr. Levin (he did my sleep study) wrote a prescription for a Stop Smoking Aid on February 17. My suggestion for Dr. Keplinger is that she goes into a research field, where she has as little personal contact with people as possible.
Additionally, she states, “My final comment is that insurance is not really meant to be used in this way. I think that over time we have become much too cavalier in our use of our insurance. I could never in good conscience recommend this surgery for that reason alone. I would much prefer to see you use your coverage to deal with your food addiction.” Dr. Miller, is she working for her patients or for the insurance companies? Quite frankly, any physician worth their salt knows that insurance companies, on the whole do not pay for nutritionists, exercise physiologists, or mental health care when it relates to obesity. Maybe if they did, the obesity rate wouldn’t be as high as it is in this country.
For your information, I posted her letter to me on my personal profile page at www.obesityhelp.com and asked other members to respond to her letter. I also posted this letter on two different weight loss surgery support groups I belong to on Yahoogroups.com (one of which is a Triangle Area Support Group). I am enclosing some copies of emails and message board posts that I have received in light of her letter. I do believe there are wonderful, sympathetic physicians who recognize the trials that an obese individual faces and who recognize the benefits of such drastic action. Obviously, Dr. Keplinger is not one of these and that is okay. What is appalling is her total lack of sensitivity and her total disregard of my opinion.
What Dr. Keplinger did not realize and obviously doesn’t care about since she was so very ready to refer my records to another physician, is that I actively participate in my health care decisions and I have made the decision to have this surgery. It is my decision and mine alone, even though I do have the wonderful support of my family and friends. Therefore, I’m not really looking for someone to refer me for the surgery as much as I am looking for a supportive and caring physician who will monitor me along with my surgeon when I am post-op. After reading Dr. Keplinger’s letter, I wasn’t sure if this was her opinion or the opinion of your entire practice. However, as recently as this morning I found out from one of my support group members that a physician in your group, Dr. C. Bradley Carlson, is supportive of bariatric surgery and is actively monitoring a member of the support group. I have not contacted Dr. Carlson, because I do not know if he is accepting any new patients and I also do not know if your group would consider it a conflict of interest to move to another physician within the same group. However, I would be very interested in hearing your comments about this situation and also responding to my question.
I appreciate you taking your valuable time in reading my letter and the information enclosed. I will look forward to hearing from you at your earliest convenience.
Sincerely,
Debra C. Beatty
3/8/2003 - Met with the Triangle Support group for the first time today. We had about 25 people there - 4 who were post-op. Pam S. came after only 12 days post-op. She looked great and says she feels wonderful. Great group of people and I know I'm going to enjoy all these new friends! Am still waiting to see where to go from here. I delivered the letter to Dr. Miller this week, however, he is on vacation until 3/17, so I'm not sure whether to just say the heck with it and find another PCP somewhere else, or wait and see if I can get an appointment with Dr. Carlson. Have emailed my surgeon's office to get their advice. Am leaving tomorrow morning for a regional RNC meeting in Jacksonville, FL - will be there until Tuesday afternoon and will get back home late Tuesday night. Hopefully, by then, I'll have heard from my surgeon's office and I can continue to move forward.
3/13/2003 - Haven't updated in a few days, but that is because nothing has happened. My surgeon's office is having some trouble with various insurance companies and they are taking the time to do it right, which I thoroughly understand and agree with, it's just that patience isn't my strong suit! Went to Amelia Island Florida on Sunday and returned on Tuesday for a regional RNC meeting. Beautiful place, just couldn't enjoy the facilities due to all the meetings I had to go to. Last night (3/12), my cousin Monica was on All American Girl on ABC and our whole family is rooting for her to win the big prize - but if she doesn't, that's okay too, we're just really proud of her. I wrenched my knee yesterday trying to pry this body out of a co-worker's convertible -- I'll never learn! HOpefully, this time next year, I will be able to get out of the vehicle like a normal person!
3/20/2003 - It's been a week since I've updated. I've had the "crud" all week, strep throat, bad ears, stuffy nose, rumbling cough and watery eyes. Dr. Miller's office called me on Tuesday morning to let me know that the doctor from hell had left the practice and encouraged me to talk with another doctor in the practice. I made an appointment with Dr. Sandra Thananart and went to meet her today. What a total opposite from Dr. Keplinger. Very personable and supportive of my decision to have the RNY. I am very pleased with her. Am very happy that this hurdle is behind me. Now, at least I know that when and if I'm approved, I have a PCP who will be supportive of my after-care. Still waiting to hear from my surgeon's office concerning the insurance approval. Since he has just opened his bariatric practice, my insurance company is having to "approve" him under the tax i.d. code that he uses for bariatric, even though they have worked with him for years under "general surgery". Go figure.
3/27/2003 - Finally got a picture posted on my profile. Thanks so much to Gwen and the AMOS staff and volunteers for helping. I am working on my letter to submit with my paperwork to the insurance company. I know I have a written exclusion in my policy so I'm trying to circumvent an automatic denial by addressing it up front with the company. Hopefully this will help. My surgeon's office is supposed to hear something by Friday (tomorrow) on their "new" contract with UHC, so hopefully that will be a positive response and my paperwork will be submitted next week. The waiting game is beginning to wear on me and especially with all the nice weather lately, I know I don't want to go through another summer looking like a beached whale.
4/04/2003 - Well, one more week of not knowing anything from UHC. They are really jerking my surgeon's office around. The office was supposed to hear something last Friday, then it was this Wednesday, now it's today....we'll see. Anyway, have met some really great people on the board this week and was honored to be picked as an Angel for both Connie Deneski (from Ohio) and Justin Glynn (from Alabama). Connie's surgery was on 4/3 and she came through just fine. Justin's surgery is a week from today (4/11) and I'm sure he'll do great also. Have really quit smoking this week. Thank God for Nicotrol Inhalers! And have been more diligent in watching my carb and sugar intake. My last A1c test was not good and my PCP added an additional medication - it's my own fault - was getting into "last supper" mode before I have even been approved!
4-8-2003 - Well, UHC just keeps jerking my surgeon's office around. I can't believe the run-around they are getting! It's been about three weeks now since they submitted their "new contract" using the tax id code for the bariatric practice and each week they have been told "call back on Friday". Well last Friday, it was "call back on Tuesday" and today it was, "another 10 business days from yesterday". Therefore, we have decided to go ahead and submit my paperwork and see what happens. I really think it's a case of the right hand not knowing what the left hand is doing. Hopefully, I'll be approved and then the surgeon's office can call the "business" side and say "hey - your case management side is approving the surgery". It's worth a shot.
4-9-2003 - My paperwork should be submitted today to UHC. Please God, let it be approved. On another note, my dear, sweet cousin Monica is appearing on ABC's All American Girl on Wednesday nights at 10:00pm (EDT). She made it through the initial auditions to the cut of 45, from 45 to 15, from 15 to 12 and from 12 to 10. Tonite, the public starts voting for the person who they think should be the All American Girl. All my AMOS friends, please vote for my wonderful cousin! She is a senior at East Carolina University and was Miss NC-USA in 2001 and was Miss Congeniality at the 2001 Miss USA pageant. We are all so proud of her!
4/25/2003 - Wow - long time since I've posted. I had been holding off posting because I really wanted the next post to say, I'VE BEEN APPROVED. However, sadly, I have to say I'VE BEEN DENIED. But the good news is that I was anticipating an initial denial just because there is a written exclusion and I was right, I was denied because of the written exclusion. Now, I have written my appeal letter and it is being faxed today from my surgeon's office. I'm so hopeful that I won't have to jump through any hoops after this one, but I'll jump as many hoops as they make me! On a happier note, my cousin Monica, referred to in the previous post, is doing great on AAG - she has made it to the final 6 contestants and we're waiting now to hear if she has made it to the top 4! We are all so proud of her! Our local support group meets tomorrow and it will be good to see everyone. We haven't met since March 8 and there have been quite a few who have been approved and had their surgery since the last meeting. I'm excited about seeing everyone. Well, I guess I'll hang it up until I have something else to say....hopefully, it will be an APPROVAL of my appeal.
5-11-2003 It's been a long time since I have posted. Still dealing with the insurance hassle. My original appeal was sent 4/28/2003 from my surgeon's office. I called the customer service number for my insurance on 5/5/2003 to check on the status. I was told there was no way to contact the appeals department, but that they would send out a letter within 10 days of receiving the appeal indicating that it had been received and a decision would be reached within 30 days. When I nor my surgeon's office had received a letter within 10 days, I called the Customer service # again and this time got a very helpful CSR named Edna. She put me on hold, called a CSR Supervisor and found out that no appeal had ever been logged in under my name. The Supervisor asked for the paperwork to be resubmitted to her attention (and a different fax #) and she promised to walk the paperwork to the appeals department herself. Now the 30 day wait begins again. Patience has never been my strong suit, but this process is certainly teaching me. My cousin Monica performed in the final voting show of All American Girl this past Thursday nite. The final show is being taped on Monday and we'll find out if she won. Thanks to all who supported her. My mother was admitted to the hospital on 4/30/2003 with pneumonia and was there a week. My sister and I made the determination that she could not go back to the assisted living facility where she had been living, so when she left the hospital this past Wednesday, she went to a rehab facility for a few months until I can get everything straightened out here to move her in with me. Hopefully, my surgery will be approved and I can have surgery prior to bringing her here. It would be so much better if I could be on the Losing Side before bringing her home! Our local support group meets again next Saturday, and we'll be missing 5 members for this meeting because they are all having surgery this week! Isn't that great - 5 locals in one week. I've told them all that I'm a little envious (okay, a lot envious), but I know my day will come. Happy Mothers Day to all!
5/19/2003 - Well still playing the insurance game. I had considered myself on the 30 day countdown from the day the paperwork was resubmitted which was 5/9/2003. On 5/13, I started calling them again to make sure they had it....my surgeon received a phone call on 5/14 saying that they had it....so the actual 30 day countdown began on the 14th. I know, I know, it's only 5 days, but this waiting is driving me nuts. Just had to vent a little. My morning horoscope said that I would receive "good news about my health today". Sure wish I believed in those things.
5/23/2003 - Well, I have been denied again. They had the audacity to quote the exclusion back to me in the letter when my appeal letter acknowledged the exclusion was there, but gave all the reasons why there should be an exception. ESPECIALLY THE FACT THAT THEY HAVE RECEIVED OVER $80,000 IN CLAIMS ON ME IN THE PAST TWO YEARS!!!! Guess they don't really care about their bottom line being in the black. The really great sentence was, "If you are not satisfied with this decision you or an authorized representative may request an enrollee hearing. NOT SATISFIED!?!?!? NO SHIT SHERLOCK!! At least in this letter, they did give me a name and a phone number where I could call and talk to them about it (A MAN, NATURALLY). And here it is a holiday weekend and I can't even call until Tuesday. Oh well, I know God is trying to teach me patience, but I think I'm about "patienced" out.
6/04/2003 - Well it's been quite a while since I've updated. I have been very busy over the past two weeks and haven't really had any time to deal with my appeal of the second denial. However, I got back on track today. Our annual state convention was this past weekend and I have been living and breathing NC Republican Party for the past two weeks. Additionally, my mother fell last week and ended up in the hospital with a severe concussion and additional problems that accompany a traumatic injury to someone who is 84 and also suffers from Parkinson's Disease, arthritis and fibromyalgia. I have contacted Walter Lindstrom and he has responded that the exclusion that is in my policy is unlike any exclusion he has ever encountered with UHC. I have until 6/19 to post an appeal with UHC and am working on everything that needs to be submitted now.
6/23/2003 - Can't believe it's been almost three weeks since I've posted - but it has been a busy three weeks. I decided to take an "unorthodox" method of appealing to UHC and go through the NC local office for UHC of North Carolina. All my denials have been through the San Antonio and Dayton offices. Thought maybe a local businessman would look at his own bottom line differently than someone in Texas or Ohio. I asked a mutual friend to send my information to the CEO of UHC of NC, which they did on 6/9. Thanks to the wonderful US Postal Service, the package was not delivered and was returned to the person who sent it today. So, another two weeks have gone down the drain. However, last week I was concerned about going this track, so I also did a formal appeal asking for an enrollee hearing through the normal channels. And, since the USPS screwed up, my appeal was Fed Ex'd to the CEO of UHC today and he knows it's coming. So, hopefully I'll find out something, good or bad this week. And as Jimmy V said, "Never, Never, NEver give up!"
6/30/2003 - Well, it's been one week since my appeal information was sent to the CEO of UHC of NC. Still no word. However, I also sent a letter to UHC requesting an enrollee hearing. I received a letter from them saying "we are reviewing the appeal". Well, finally got someone from UHC on the phone today and it turns out that they haven't received my request for an enrollee hearing, they were responding to the first appeal which this customer service rep didn't know had already been responded to! These insurance companies don't seem to know which end is up! However, my call today was handled by a very friendly and cooperative appeals representative and he spent all the time I needed. He also allowed me to email my request for enrollee hearing and said I should hear from that within 7-10 business days. So, maybe I'm a little closer to approval. He said that I would be allowed to have anyone I wanted on the call, including my surgeon, PCP (the good one who is very supportive)and anyone else who could help my cause. I just ask for everyone's continued prayers that I will be approved and save my life!
7/13/2003 - Well I had more bad news this week. My end run on the insurance company didn't work either. Got another denial letter from the Chief Medical Officer. Still stuck on the written exclusion. However, the good news is that my enrollee hearing is set for Wednesday, July 23 at 9:45 am. I am going to be in New York City that morning for a meeting, so I'm just going to have to sit that part out and participate via telephone. I'm trying to "get my ducks together" and I think I'm going to call Walter Lindstrom in the morning and see if he will help me. Might as well go for broke.
7/27/2003 - My appeal hearing with United Healthcare was Wednesday, July 23. Walter Lindstrom represented me and then I was able to make a few comments. Fifteen minutes really flies by....fifteen minutes to decide on life or death. Doesn't really seem fair does it?!?!? Anyway, Walter was wonderful and I do hope that it was the best investment of $1100 I've ever made. They said they would deliberate and make a decision that day, but they have 5 business days to render a written decision. Walter said I would probably hear on Monday or Tuesday....this is much worse than waiting for the pathology report from my breast cancer last year. Anyway, I continue to wait and to pray.....
7/29/2003 - Well, it's official. I'VE BEEN DENIED THE RIGHT TO LIVE BY UNITED HEALTHCARE OF NORTH CAROLINA!! They just couldn't see the difference between "surgery for weight loss" and treatment of the disease of morbid obesity. It really feels strange that 3 people who don't know me or give a crap about me can make a decision on whether I live or die. So, now it's called cash in whatever I can cash and go to Mexico. I have emailed Dr. Aguirre and will follow that route, or possibly look at Brazil for the DS.
8/03/2003 - I have a date! I emailed Dr. Aguirre in Ensenada and I have a date for November 21, 2003!!! Thanksgiving in Mexico!
8/6/2003 - Made my flight reservations and hotel reservations today for Ensenada. Two of my best friends, Dottie and Jane are going with me and I couldn't be more excited and please. We fly out on November 19 and will return on November 29. Turns out that November 20 is a holiday in Mexico and therefore a holiday weekend, so I couldn't get reservations at the Hotel Coral and Marina until the 23rd. So we are staying at the El Cid from Wednesday until Sunday and then will move to the Hotel Coral on Sunday afternoon. My surgery is on Friday, November 21 and I hope to be out of the hospital by Monday, November 24. Then I will have a few days to "enjoy" Ensenada (even if it is just sitting on the balcony and looking at the ocean). Dr. A will take out my staples on the morning of the 29th and then we're off to San Diego and back to North Carolina. Only 104 more days before we leave!!
9/13/2003 - Can't believe it's been so long since I've updated. There's been some changes since my last posting. Surgery is still scheduled for November 21, however, I have changed my initial reservations from the El Cid to the Posada del Ray - there were just too many negative comments about the El Cid for my comfort level. I have called the Hotel Coral and Marina several times to see if there have been any cancellations, but to no avail. Additionally, some good news is that I smoked my last cigarette on August 21 - exactly three months before surgery. Today is day 23 and I am smoke-free and did it cold turkey!! No inhalers, no patches, no lozenges!! I knew it was all a mind game and I had to have the surgery date in my brain. Once I hit the three month mark before surgery - it was no problem. Not to say that it hasn't been hard and yes, I have felt withdrawal....but the knowledge that the surgery date is looming ahead has prevented me from buying another pack of cigarettes or to bump one off of someone! I do have to say that since I quit smoking, I feel like I am absolutely falling apart. I have had bronchitis, a bout with pleurisy, have fallen twice and am now having horrible back spasms and leg pain. Was in the emergency room a good part of last night with a possible blood clot in my leg. I am now home with instructions for aspirin, leg elevation, ice packs and some great pain medication. I am ready for this stage of my life to pass!! Only 67 days until I leave for Ensenada and 69 days until surgery!!
10/10/2003 - Today is exactly six weeks unti my surgery and day 50 smokefree! Can't believe it is actually getting this close. The no smoking is going okay, even though I should have bought stock in the Sugar-Free Popsicle Company. I have found sf popsicles to be my salvation. Costs less that a pack of cigarettes (and you get 24, not 20), you can suck on them and crunch on them and an entire box is only 360 calories!! I am really getting excited about my trip to Ensenada. Just one more big hurdle at work and I can devote myself to my trip. I've started doing things at home, bit by bit, cleaning out chest of drawers, closets, etc., and even straightened up my pantry so that I could really see what was in there and eat some of the stuff before I leave and get rid of it. I've also started my "where I want to go for last suppers" list. I'm hoping to start a "modified" Atkins diet on October 21 - just one month from surgery to try to reduce my "fatty liver" some. At the same time, I'm not going to deprive myself of something I want....just want to ask myself if I really want it first. Forty-two days.....HALLELUJAH!!!
10/17/2003 - What a see-saw, dumbfounding, mind-boggling process this all is!! Five weeks from today, I am scheduled for open RNY with Dr. Aguirre in Ensenada, Mexico. I had been denied 3 times by the insurance company from hell, United Healthcare of North Carolina. Today, our broker presented a renewal proposal from UHC which was a 25% increase in cost (industry standard this year in this area is 18%). The second proposal was for a new contract with BCBSNC which was still an increase in cost, but less expensive than UHC. And here is the kicker, under Exclusions in the SPD, this statement "For treatment of obesity, EXCEPT FOR SURGICAL TREATMENT OF MORBID OBESITY." Looks like this policy COVERS WLS, which means if I wait just a few weeks longer, I can have the surgery here, with the surgeon I originally chose, be at home rather than 3000 miles away AND not have to self pay. I can't believe it!! Right now I'm scared that it's too good to be true. I am perfectly settled and happy with my decision to use Dr. Aguirre and go to Mexico, but if it means saving $10,000, it would really be stupid for me to expend the money. I'm just scared that I'm going to give up a sure thing with Dr. Aguirre and have to wait until December 1 to even submit for an approval to BCBSNC and then who knows how long that might take. I'm really in a quandry right now, but I guess it's a good quandry to be in - hope everyone has a great, beautiful fall weekend!
10/28/2003 - Well, it's official. We are completing the paperwork to go with BCBSNC as of 12/1/2003. We still have to go through underwriting and we'll see what happens. However, I'm going to switch dates with a member of my local support group who has a date with Dr. A in February. That way, if I get turned down by the insurance, I'll still have the option of going to Mexico within a couple of months. It's hard giving up a sure thing that's only 3 weeks away to go back to the land of the unsure, but this is the only thing that really makes sense at the moment. I talked with my local surgeon's P.A. today and she said that they would be willing to work with me at any time to have the surgery. So, hopefully, I'll still get this done before my 50th birthday on 12/11.
11/21/2003 - It's been a long time since I have updated. Today, I was supposed to be in Mexico having open RNY with Dr. Aguirre, however, as previously noted, my insurance is changing and I should be able to have the surgery done here. BUT OF COURSE THERE IS ANOTHER ROADBLOCK. The new CEO at the hospital where my surgeon does surgeries has decided that gastric bypass is not the "direction he wants 'his' hospital" to go in and has placed an immediate moratorium on all WLS. This happened two weeks ago. So we are trying desperately to overturn this decision. How can you help? By contacting the Members of the Board of Directors at WakeMed. You don't have to write individual letters, but if you would write a letter addressed to: Board of Directors, WakeMed, 3000 New Bern Avenue, Raleigh, NC, 27610 it might help. Not anything vicious, just matter of fact and to the point. How WLS has improved your life, etc., etc. Please help us. Thanks!!
1/8/2004 - Can't believe it's been so long since I've updated, but bottom line is that I have switched surgeons and as of today, I am approved by insurance and will have Lap RNY on Monday, January 12!! It's finally going to happen!!!!
2/9/2004 - Well, I'm back, but not with the news that I had hoped. To make a very long story short, my surgery was cancelled on 1/12/2004 because my blood work indicated that my cancer may have recurred. Surgery was cancelled the morning of surgery and the following week I had a P.E.T. scan to check it out and sure 'nuff, my cancer has recurred and has metastasized to the bone. I have been undergoing hormonal treatment for the past two weeks and we'll determine in a few weeks if chemo will be added to the regimen. Please keep me in your prayers.
Surgeon Info: Surgeon:Paul Enochs, M.D.
I just had my first visit and consultation with Dr. Brader and his staff at Carolina Bariatrics. I was very pleased with their explanation of the process. Dr. Brader is very personable and very capable. He does one-on-one interviews with potential patients because he feels this is a very personal decision and doesn't feel a classroom/seminar situation is the best for a physician/patient relationship. He has quite an extension background in general surgery, along with laproscopic surgery. His program is a total program, with ongoing consultations with exercise physiologists, trainers, pyschologists, nutrionists, etc. The program coordinator in his office is a surgical P.A., and was very helpful in discussing the insurance approval process and will handle most of the insurance approval process herself. Having attended a couple of physician sponsored seminars where I felt the physician boasted too much about their capabilities, I feel I have found a physician in Dr. Brader who is quite capable, knowledgeable and who doesn't have an ego the size of Australia. UPDATE 8/02/2003 - United Healthcare of NC denied me three times for surgery. Therefore, I am going to Ensenada, Mexico and having surgery with Dr. Aguirre on November 21, 2003. 10/28/2003 - Yet another change of plans. My company is changing insurance as of 12/1 and this insurance will cover the surgery, so I'm "postponing" Mexico (actually swapping dates with someone else) and trying to get approved for here - Dr. Brader, I'M BACKKKKKKKKK!!! Well, WakeMed put a moratorium on all gastric bypass surgeries and that is the only hospital where Dr. Brader does his surgeries. So I switched to Dr. Enochs and I now have a surgery date of 1/12. Insurer Info:
United Healthcare of North Carolina, Choice
Filed initial appeal letter on 4/28. Called on 5/5 to see if it had been received and the CSR said there was no way to contact the appeals department, but they would send out a letter within 10 days indicating they had received the appeal. When still had not received that letter after 10 days, I called back and got a very helpful CSR who put me on hold and called a Customer Service Supervisor. This supervisor indicated that nothing had been logged onto my file and to resubmit the paperwork. She asked for it to be faxed directly to her and she would personally walk it down to the appeals department. I now consider myself in the 30 day period that UHC has to respond to the appeal. 5/14/2003 - I was wrong, 30 day period actually starts today, cuz they say they didn't "officially" receive it until today....of course, that was after I called for two days to make sure was was submitted on 5/9 had been received...this is driving me nuts! I wish there was just some # that you could call to get a "status" report.
5/23/2003 - well, now I have that number to call....I received my second denial letter today. Still hung up on the written exclusion. It makes no difference to them that they are royally losing money on me and this surgery would pay for itself very quickly. I have contacted Walter Lindstrom and will go for a second appeal. 7-28-2003 - Walter Lindstrom presented my case to a 3-member review panel with UHC on 7-23-2003. We were given a total of 15 minutes for 3 people who do not know me to determine my life. I was given the opportunity to make a statement. The facilitor stated up front that this was not about medical necessity, it was about whether UHC had performed its contract. I was notified by the LIndstrom's on 7-28, that UHC had upheld the denial based upon the written exclusion language of "surgery for weight loss". They just didn't buy the argument that weight loss and treatment of the disease of morbid obesity were two different things. I am now looking into going to Mexico and being a self pay.UPDATE 8/3/2003 - Dr. Aguirre in Ensenada, Mexico has given me a date of November 21, 2003. Three people at UHC will not determine if I live or die.....I am a self-pay heading to Mexico!
