- HEALTH TRACKER
Hawley, PA, USA
Post Op - BMI: 46.0
Surgery Type: RNY
Member ID: L1087100366
Surgeon: Neil S. Marymor, M.D., F.A.C.S.
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April 8, 2004 - Well everything is into BTC. My husband faxed the last of it last night. Since it's a Friday I will leave the ladies at the office alone and start calling on Monday. When I went for the initial consult they said that normally it takes about 90 days from initial consult to surgery date. I am so hoping that is the case and it means that I'll be having surgery next month. I plan on beg, borrowing and stealing if need be to get the earliest date possible. I am so ready for my new life.
All of the testing I had to have done before it was sent to my insurance was to terrible. The Sleep Apnea was the worst, but luckily I don't have it. I do however have restless leg syndrome but now take meds for that. I also had to meet with an endocrinologist, dietician and psych eval. They all were quick and painless and everyone was behind my decision. It was such a validating experience. I do also have my families support, but to have professionals that don't know me personally give it was a good feeling. I'll update more as I know more.
Well I contacted the Insurance company and they said they requested some clarification of information from the dr's office. I can only assume this is from the psych eval because it was utter chicken scratch. So I called the surgeon's office and they didn't seem to have any request. I politely asked them to call the insurance company and see what the deal was. I also asked them to call me back but since it was 4pm est they didn't think it would be today.
Got a called the the Barix Clinic today, they did receive a fax from the Insurance company and refaxed info with certain things underlines and highlighted and the INs also needed them to fill out some kind of form. The did all that yesterday so around 4:30 I called the insurance co to see if it was received. The case manager who is also a nurse was gone for the day but I was given her name and direct line. So I'll be calling around noon on tuesday to see if they have everything. The secretary at the psych eval said they can call her and she will interpret his writing or type something if she has to. Since I won't be going back to see the psych most likely, they don't type the report. Why waste time on it. I can understand this.
OK things are slowing.......... I just talked to the insurance and they are denying it at this time they said i can appeal but they are looking for "Physcian directed weight loss program with low caloric diet" I called the surgeon and they are waiting for the written denial then we can appeal. I've also called my PCP for a detailed letter on her treatment of me and that my trying of xenical and going to curves was physcian directed and I was weighed in at the curves center. So we'll see what happens
May 6 - Got a letter today from the Insurance Company that they received my appeal and should have an answer in 30 days. If they don't respond in 30 days I am to assume it is covered. I find that odd! Anyway, the paperwork said my date is June 19 thru 21. So for now to calm my nerves I'm going to assume my date is June 20 because the 19th is a Sunday.......
Lucky Friday the 13Th!!! Got the Call!!! I am APPROVED FOR SURGERY!!! The funny thing is I haven't told anyone yet except my PCP and my mother in law. It's like I have this little secret that brings a smile to my face every time I think about it and I'm not sharing it yet!!! I'm trying to wait until I get a firm date from the clinic before I tell.
May 27 Well, here I am. May 13, Friday the 13th I receive the call that my insurance has approved my surgery after my first appeal. This makes me very very happy. I think I'm on my way!!!
I call the Barix clinic and my file will be closed on the insurance level and returned to the doctor. On Wednesday May 18 I am told that the requirements by the surgeon are not in my file. My sleep study and psych eval. Well the psych eval had to be there for the insurance approval. Well I call every dr that has a copy of these papers and get them faxed to the clinic. I am then told it will be about a week before the dr will be able to sign off and then on Thursday May 26 I should hear from someone to schedule.
Well on Thursday May 26 I call and am told that my file is going back to corporate for INSURANCE VERIFICATION. No no one has mentioned this before and I'm thinking dear god now it's going back to the corporate office in Michican??? Am I being pushed around and basically being told to leave people alone!!!???
So I make some more phone calls. Maybe the person I'm talking to is having a personality problem with me or maybe I am with her!?
So this is what I find out. There is this little step called Insurance verification where even though the insurance company has approved your surgery, they may not approve of all the costs associated with it. So one ladies job is to make sure they will pay for everything the clinic is doing. OK now I calm down and start to feel somewhat better.
Today, Friday May 27 I find out that the insurance company is saying Pre-existing condition and want/need confirmation that I had insurance before them!!!!!!!!!!!!!
So now I have found that certificate (the company changed insurance we did not) and am mailing and faxing it to the company. Ofcourse with the 3 day weekend things will slow down a bit.
It's just all so confusing!!!!!!! Anyone else have anything similar or can shed some light on this BENEFIT VERIFICATION and how you can be approved, but not really approved??
June 4, 2005
Well I called the Insurance Company to complain that my dr's office had been waiting for 3 days to get confirmation of benefits. I had the name of the supervisor that we were waiting to hear from so I basically in a very very nice way stayed on the phone until I got to speak to her! I did and it went well and she called the dr. To make a long story short, the hospital is covered 100%, but I have a $5,000 deductible for the dr. They will work with me on this so I'm not worried. So I am SUPPOSED to talk to a scheduler on Monday afternoon tuesday at the latest. CAN'T WAIT!! I feel like I could choke someone sometimes. The only way I can explain it is like a constant state of PMS!!!! NOT FUNNNNNNNNNN
June 11 - Well I didn't get to talked to a scheduler until Wednesday, BUT I HAVE A DATE!!!!!. I found out it wasn't just the fact that I have a $5000 deductible and they were deciding whether or not to except my offer of $1000 down payment. The issue was also that the insurance company will not send the payment directly to the dr. They will to the hospital, but not the dr. At Barix it is against their policy to do this, but they have put that aside and took my word that I would send them the checks AS SOON AS I GOT THEM. I was so excited to hear this. I actually got a call from the administrator of the clinic about it. It just shows my theory that you get more bees with honey than vinegar. I have tried to be the most patient and kind thru all this because it was not really any one persons fault that this was crazy.
So my date is June 22. They call the day before with the time. I go this Monday for my PATS. Can't wait to get the really really hard stuff of recovery from the surgery over with and get on with learning my new way of life.
June 15 - On Monday I went for my PATS. They run things so smoothly there. I was late and no one seemed concerned about that or put out. I filled out papers then went right back to have blood taken. Reva was great. She was calm and very good at what she does. Then it was off to a room to put on a gown. Not a paper one either!!! And it fit!!! Then it was off to have 2 chest x-rays then ultrasound. That woman wasn't very personable and made me hold my breath til I thought I would pass out, but I survived.
Then I met with respiratory and learned breathing exercises and she needed blood, but from an artery. This didn't go so well. They take it from the wrist area and need to be careful not to hit a nerve. She came close. Tried twice didn't get it and quit. They sent someone else in later to try the other wrist and although he still had a little trouble he finally got it.
I also met with the nutritionist. Alot of good information. The medical dr came in and his only concern was my iron is low. If it goes any lower surgery will be rescheduled. The nurse told me to load up on iron until my next blood draw on monday. So that is where I am at right now.
June 19 - Up until now people have been asking me if I'm nervous, scared, excited and I have had to tell them that I don't feel like I feel anything. That I think I shouldbe feeling something about my upcoming surgery on Wednesday, but I don't.
Well tonight hubby and I were sitting on the swing outside by the river where we live and I was able to just clear my mind and think and I believe I have an answer.
I'm Scared! Of What? not the surgery, but the pain, recovery, thinking about the food that I won't be able to have for awhile(will I miss the food), pain, pain and that I am really doing this to and for myself. I'm not used to doing anything for myself. I take care of everyone else.
I'm not used to attention being on myself and I have never been a "normal" weight girl or woman. I don't even have a picture in my head of what I might look like. I won't know this person. I was even over weight in school. How do you deal with that. Some people were "thin" or "normal" sized before and know what they are going back to or striving for. I don't!
Anyway, that is how I feel. Oh, yes and I do worry about any strain I will be putting on my husband and kids by doing this (what I consider) somewhat selfish thing.
That's how I feel. That's my story and I'm sticking to it!!
OH MY GOODNESS---- Have I been a bad girl!! Things happened so fast and slow all at the same time after surgery and I can't believe I haven't posted.
Surgery at Barix Clinic was as expected and the facility was awesome. Ofcourse I'm hardest on myself and think I should be doing better than I usually am, should be feeling better, etc. I came home on June 25 and we had a church picnic at my house on June 26. The great thing was seeing friends and they knew ahead of time that I would not be able to help with a thing and don't be worried if I disappeared into the house.
It was so blessed hot that I tried to stay out of the sun and did go in a few times to sit in front of a fan. This picnic was also a way that people had to come visit me if they came to the picnic.
Recovery was as expected, but not planned on in my head. It really takes a good 6 weeks to be back up to snuff and even then you are taking things slower.
Hardest part was what I couldn't do physically, but thought I should be able to. 4th of July was another hard day because I was still on liquids and this holiday is a big reunion for my family with usual cookout, smores and food food food.
I started back driving July 6th right before I had my 6 week check up and that wasn't to bad. At my 6 week the dr said everything was on track and I had lost 25 pounds I think. Maybe 30.
First 2 weeks of August I went to YMCA Camp with a 6 year old autistic child and my 13 year old went to help. Being outside and getting the exercise was great and it was new and different to not be huffing and puffing up and down stairs and hills.
AUgust 14 my sister was married and I had NOTHING to wear! The mother of the 6 year old opened her closet to me and I went to town. I borred a great Navy blue pant suit that I think was a 26. one size down!! I know it was my sister's wedding, but how great was it to see people and their reactions to me. Not a big change yet, but it was coming!
August 29 I started a new job with the 6 year old autistic child as his aide in public school. This was so tiring for me at first!!! But I was really started to feel the weight being gone and so thankful for it. I was going up and down stairs to the bathroom with him and up and down from the floor. Before this surgery and weight loss the floor was an impossiblity for me. We also moved because of my job and distance I would have to drive. I didn't realize it, but my husband said I kept up really well with the moving of boxes and he noticed I wasn't getting tired to quickly. !!! YEAH!!!
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Surgeon: Neil S. Marymor, M.D., F.A.C.S.
Very relaxed and didn't rush our consultation. Answered most if not all questions before we even had a chance to ask. The staff was very friendly and accomadating. After care was emphasized by the patient counselor. Someone who has had the surgery at the Batrix clinic 2 years ago. They do have a program, but I live 31/2 hours away so I'll be looking for local care and possibly starting my own support group. I want to say that Mary H. in the Insurance Dept., has been WONDERFUL to me and patient and very kind with my NUMEROUS phone calls. Thank you so much Mary
I'm just getting started, but all they have said is that it needs to me medically necessary and needs pre-cert. My BMI is over 50 and my cholesterol is creeping and legs are starting to ache, etc. I have my initial appointment with the Batrix Clinic on Feb 17, 2005. I wasn't denied, but I wasn't approved. They want to see a "physician directed weight loss attempt" My dr feels this was my attempt at curves so we wrote another letter to the insurance and are hoping for quick approval. Well today is my LUCKY Friday the 13th!!! I got THE CALL. I have been approved. I screamed in the ladies ear then apologized, cried and thanked her and complimented her and her office about how patient they had all been with me and my many calls.