ObesityHelp

June 30th, 2003:
Hi there Everyone,
Today I am trying to write down my frustrations to try to get rid of the feeling of total despair that is hanging over me today, so here goes. First I'll do a recap of whats been going on...... I had Lap RNY done October 15,2002 and have done better than I expected with that(HURRAY!!) and faster than I expected as well. I have lost about 130 pounds and fit in a UNBELIEVABLE size 9!!! So whats the problem you must be asking... I am feeling terrible back pain from this hanging SKIN and the weight from it is killing me and making my life miserable. I mean I'm not regretting having the surgery but I still am feeling really depressed with all that is going on with the plastic surgery situation. I had my first initial consult with p.s on May 22nd who told me when I asked about something like a body lift, he said no such thing, rather he said I would have to do a tt and br in one operation an then legs an butt in another. He said I would have to quit smoking, which I did, with the help of Wellbutrin. Well still I was not happy with the having to do the separate procedures and was almost sure I could find someone to do it all. Sure enough I came here for info and found out such a procedure DOES exist and was debating what to do about it when I got a denial letter from BC/BS OF FLORIDA-HEALTH OPTIONS stating that cosmetic surgery is excluded and that I would not gain function from it, in there opinion.. I found this out when I called the office AGAIN to see if there was any info because I was in terrible pain! That was the FIRST thing I said to the plastic surgeon , that I was in terrible pain from the weight hanging from my front. Anyways, the lady in the office when she told me it was denied I asked her about a appeal and told her that I had to do an appeal for my gastric bypass too, she said yes that the doctor would help me with that and not to worry, that he would talk to the medical director, since he is the only one who can. I told her I would also do an appeal but felt it was important for the doctor to also have a say in the matter.she was very nice, this was on a thursday afternoon, on saturday afternoon in the mail was a letter from the p.s saying there was nothing more he could do and that I should go ahead and do an appeal on my own basically...He said if he were me, he would argue that " if they covered my gastric bypass surgery, they should be willing to cover the after-effects of having lost all the weight". Well this was not the thing I was expecting because from what we talked about a few days before I was under the impression that he did help with appeals. I spoke to the patient surgery coordinator on Monday and told her why couldn't he also help somewhat with a appeal? she told me quite snippily that he felt he spent enough time and that often they would not go thru on appeal either and it would be a waste of time. I told her that this a result of the first operation that they paid for, her answer explained it all for me...... I was told that in the future she was sure that the insurance companies would stop paying for the gastric bypass since "its so popular now and everyone is trying to get them". What does that have to do with anything????????? So I saw the attitude and decided no way, I'm fighting a losing battle here if they aren't even willing to help at all. I told her I was not happy and was going to look for a different doctor, and also one who would do a lower body lift instead of doing them all separately. She said she would send all the paperwork she had to me. When I recieved the paperwork,the letter he sent to the insurance was in there and my name was on the top and it said in the letter " Ms. FREEMAN has experience weight loss in excess of 100 pounds folling gastric bypass surgery. She now has massive amounts of excess skin causing her problems as noted in my dictated office consult note" WHO IS MS. FREEMAN?????? That is not even MY NAME!!!!!!!!!! It only gets worse unfortunately, In the dictated office note he referred to, he did not even mention that I was in PAIN!!! ALL THE TIME!!! AND THAT WAS THE FIRST THING OUT OF MY MOUTH TO HIM!!!! He says in the letter, "chief complaint: loose and sagging skin following massive weight loss." How ridiculous is that? In the proposal to the insurance company in which he referred to me as someone elses name, the codes he used were as follows:
ICD Code V51 aftercare requiring plastic surgery
ICD Code 701.8 cutis laxa, abdomen
ICD Code 278.1 panniculus adiposus, abdomen
ICD Code 611.8 breast ptosis

the proposed procedure was as follows"
these are called "CPT" codes
15831 dermolipectomy, abdomen FEE: $5850.00
15832-51 dermolipectomy, thighs FEE: $4860.00
19316-51 mastopexy, right FEE:$2925.00
19316-50-51 mastopexy,left FEE: $2925.00

Needless to say I was really upset about this, it was my biggest nightmare come true (other than not losing weight that is...) I got some names and info from the site here ( all us "posties" are an army of info..... HUGS) and got some names of doctors who did the lower body lift because I just feel that if it goes as one procedure it is better insurance wise too. Plus the real reason is because thats what needs to be done most of the time more or less after losing so much weight. If it goes in under one procedure it has to be better than doing them all separately, hard to find a medical necessity for a butt lift..... but with the lower body lift its all included. then the breast surgery would be separate of course, but still is only 2 surgery's instead of 4..sounds much better to me..... I called a different p.s in the area that my orthopedic doc mentioned and recommended and asked about the lower body lift, I was told to hold on while they asked the doctor. Then I was told that yes he can do it not a problem that he had alot of gastric bypass patients he worked with. I was happy with that and they took my insurance so I called my pcp and got a new referral for a second opinion to see the new p.s. I was able to get in within a few days with this one instead of having to wait over a month with the first doc, so this was a sign right?? I get there today and the office was empty except for me, I heard one patient in the back he was talking to, then he came out and was talking to the office lady and I heard him saying about the gastric bypass so I guess someone was back there who had one also, but I then heard him say he felt her surgery was COSMETIC!!! Then in talking to the office lady myself was told HE DON'T EVEN DO BODY LIFTS!! Sooooooo I left without even seeing him, I mean I didn't want to waste my referral on him since I don't know how many consults I can go on with my insurance. I came home and called some different docs that some posties told me about. One of them I called told me that the breast reduction would be covered under the insurance but that they would NOT EVEN FILE my insurance for a body lift, I would have to pay cash for it since they were not covered since they were "COSMETIC". I tried to explain to her that it WAS NOT COSMETIC, and that it was medically necessary since I lost all this weight and it was giving me alot of pain among other problems, she said nasty like.... "well in THIS office it is COSMETIC and is not covered under insurances. I told her I knew of some who had it paid for after the gastric bypass and also asked why some would be paid and some would not, she said again they would not even TRY an file for me... I am now waiting on a referral to a different p.s another postie gave me his name. He is far away from me though so before I go I am trying to make sure he can be the one to help me thru this ordeal here...They were nice on the phone, but was told they did not do any insurance at that office she was in but she would transfer me to there other office where they did it and I could talk to someone there about it, I got an answering machine and left a message about it, still haven't heard anything yet. I also called my PCP back and told her I did not use my authorization today because I found out before I saw him that he did not do the body lift so I came home..... She told me she will work on getting me to the one in Gainesville instead. More waiting....... = MORE PAIN AND SUFFERING. I am really down in the dumps about this, I don't have any happyness these past few days and just feel so depressed I don't know what to do, I can't imagine going thru the rest of my life this way, I feel fat still, unless I'm in jeans when my skin is 'TUCKED" IN. theres no way I can pay for it myself cash and can't get a loan ( I tried em all) have nothing to sell etc..... Is there anyone out there who had this similar problem? anyone with BC/BS of Florida who had there surgery paid for? Who did your surgery? Do they do the body lifts? SOMEONE help drag me out of the dumps PLEEEEEEEEEEZE!!!!! GIVE ME SOME GOOD NEWS?? Sorry this is sooooo long but hey, I'm making up for not keeping my profile up to date like I promised myself I would. Hugs to Y'all
Lori
Email me Please!!!

August 1st,2003
Today I went to see the new plastic surgeon in Gainesville, if you've been following along you'd know he was my 3rd one so far:) Well as they say 3rd times a charm?? well this doctor is definately the one for me!!! happy! happy! dance!!! Can you tell it was a great visit??? Well here's the gory details: First of course was the terrible part of having to stand naked while he pokes and pulls at your skin, but hey its going to be worth it in the end. He told me that he recommends the total body lift, he also said of course the breast reduction too but told me it would/should be separate because he feels it would be too much to do them both at once. I will have to stay in the hospital for a couple days for the body lift and when I go for the breast lift that is a outpatient thing. not sure if I like that idea but that is for another time.... I did do what the lady in his office told me to do about writing a letter to the insurance company just explaining how this effects me in my day to day life and I brought that with me today too. If anyone wants to see it just email me and I'll be glad to share it with you but I guess we should wait to see if it helped at all. Dr. Mast(thats his name) said he will send the letter and the pics out monday but meanwhile he scheduled me a surgery date! He said to just schedule it now since he is booked about 6 weeks away he said that would be plenty of time to hear from the insurance and in case I need to do an appeal then I can reschedule it, which of course we are hoping does not happen! I was told that I had absolutely NO FAT on me anywhere and that the trouble was purely skin so that was great news, doc assures me I will heal much better since I have no fat in my tissues so "from his lips to Gods ears" like my momma always said. I am at my goal weight so no problems there, just the waiting and the pain of having the skin thing going on here. Also one last comment, I have approximately 7-10 pounds of excess skin too. sounds great huh? but all in all I am on cloud nine after the visit today. At least he is enthusiastic about doing my surgery and so very skilled too and is most importantly willing to fight for me to get it done. He feels like we do that its bullshit what the insurance companies try to get away with. so that is a good sign. I'll keep y'all posted..til next time then:)

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Surgeon Info:
Surgeon: Muhammad A. Jawad, M.D.
I liked my surgeon, I have only been to see him twice now but I am happy to have him and I feel he is very competent.
Insurer Info:
BCBS, Health Options