Jesse's WLS Profile on Obesityhelp.com
It has been a couple of years since I have visited this site. I have been to a support group and am very ready to have the surgery. I have not attempted to get my insurance approved yet -- I don't trust that my PCP will give me a referral to see the surgeon. I am hoping that I can just keep changing PCP's until I find one that does. I need this surgery. I am over 300lbs overweight and I need this -- I know that more than anything. I use AVMed Heath Plan (HMO).
4/5 -- Avmed has turned me down and my PCP refused to follow up. I changed doctors three times now and none are understanding the reason why I want to do this.
4/19 -- Avmed recieved my letter on 4/12 as verified by one of their folks. I now have to wait at least a month for an answer. Wow -- hats off to everyone who hung in there -- I sure hope I can do the same.
5/2 -- AVMED turned me down due to a exclusion set forth by my company. I do have another alternative for insurance -- but will have to wait until December. I am very upset, depressed. But I see alot of people have to keep fighting and so will I.
7/3 -- A couple of friends of mine (mom and daughter) had surgery with doctor Michael Butler last week. They are doing great! I went with one to get her staples out and they offered to weigh me -- its been two years! I was not happy! I am now 527lbs! I need to have this surgery. I am going to try and see if my company will let me change carriers before open enrollment. hey -- its worth a shot!
7/23- I think I can work with Avmed and Dr. Butlers office to get past the exclusion that only mentions the surgery is excluded for treating Obesity -- not Morbid Obesity. And -- to be honest - its not only for obesity but for the other comorbidities too. So -- fingers crossed, prayers in the air, here I go.
7/26 - Went to see my doctor and asked for refferal to Dr. Butler. She also diagnosed Edema in the leg -- severe!
8/3 - Avmed told me that I need to see a GI doctor before I can see someone about WLS. I have called several time. MY PCP is reffering me to a GI.
8/9 - GI doctor says he will not see me about WLS. Told me he does not get involved witht he decision making. Called AVMED and after several minutes (about 1 hr) they said that my referral was denied because of the exclusion. I filed an appeal siting that there is not exclusion for Morbid Obesity Treatment. . . listed several co-morbidities. Now I need to wait 30 days to hear something back.
8/13 - Well -- it has been less than 30 days. Not even a week actually. AvMed called me today and has totally bypassed the second appeal and invited me to an appeal hearing on Thursday. She said that I have proved medical neccesity, but that the surgery is excluded. So -- I need to prove that the exclusion does not apply in my case . . .that the surgery is not just for weight loss . . that the weight loss is only the catalyst to making me healthy.
8/23 -- My appeal was denied. The fact is that Avmed Lied to me when they told me they did not need me to prove medical neccesity. I am going to appeal again . . .and write to the medical director about the injustice.
9/19 -- I have been meaning to update this. I can only say that I truly believe God wants me to have surgery. I am so upset that I can't talk to a surgeon because of the referral. However -- one Surgeon is seeing me and working things out after he talks to me. Dr. Hocking. I have heard only good things and he answers my emails . . .WOW! I have an initial conultation October 12.
10/4 -- another confirmation! I got a referral today for my Sleep study and for Dr. Hocking! Weeeeeeee! I can't hardly believe it! Now I will be legal when I see him!
10/9 -- I was refferd to the cardiologist. He said my heart is good -- and has released me for surgery! Yeah!
10/12 -- Saw Dr. Hocking for my consult. He's as great in person as he is in email. He explained everything and spent as much time as I needed answering my questions. He is confident everything is going to go well and hopes to have me in before the end of the year.
12/6 -- Had my sleep study last night. I did horrible! Getting perscribed a CPAP.
12/19 -- Got my new insurance information and Dr. Hocking's office put in the information. No surgery date yet -- but getting close.
1/2 -- Insurance is requesting additional information. The office is going to send it to him.
1/5 -- MY DATE IS SCHEDULED -- March 7. I was hoping it would be sooner after so long -- but I take what I can get.
1/30 -- My INSURANCE IS APPROVED! YEAH! I CAN"T WAIT TO BE POST-OP! THERE IS A LIGHT AT THE END OF THE TUNNELL.
3/7 -- My surgery is today!
3/29 -- Boy am I tired. No -- this is not easy! I have lost now 46lbs! Only 3 weeks. can't wait to see how it goes. Problem -- my incision was infected and had to be opened. I have to pack twice daily - -yuck!
4/30 -- 8 weeks out -- 70lbs down! Weeeee! I feel great. My wound is healing nicely. Food stays down and I am very happy.
Work has been great. Everyone is so happy to see me and can hardly believe the physical changes already. I am truly happy! I am down nearly 80lbs now. My mobility continues to increase. I can walk a mall now, play pool, go mini-golfing. What a change in such a short amount of time. My incision is still healing. Hopefully the draining will stop soon. Dr. Hocking is guessing another week or so. It doesn't hurt - just irritating. Other than that -- all I can say is "Carpe dium" . . . Seize the day!
The road to recovery isn't without a few bumps. I still have a problem with my incision. Today I went to the hospital and had it drained. I was also put o some nasty tasting antibiotics. But -- I have my health back! I have my life back! And I have 102lbs off . . .and they will never come back!
Can't believe its been this long since I have been here! Let's see -- I got married a month from tomrrow. I am now down 167lbs and have broken the 400lb mark - -385lbs. Life is good! I do have a hernia -- and I am looking at getting it fixed and a Panneculectomy (tummy tuck kind of). We'll see how that goes. . .
I am working in Tulsa, OK and went to see the local WLS doctor here about my hernia. He said I don't have one. Strange,it sure hurts like they say it does. I emailed Dr. Hocking who said I most likely do - cause through all my incision problems he had to break a suture. So, I don't know . . .maybe cause I wasn't his patient - I felt rather dismissed! So Dr. Hocking told me to hold on as much as I can - I have 160lbs to go and I now will have my Tummy Tuck . . thinking of removing some extra chest fat while I am at it . .at a local meeting the plastic surgeon said those could be combined. I feel awesome. Down 172LBS . .I weigh 380! About 160 lbs to go before my I near the end of my new beginning!
Today is 7 months and what a wild ride. I had a secret goal -- well two - -to accomplish by the end of the year. I didn't think it would be possible but I did it! I now weigh under 350lbs -- and I have lost over 200lbs! I can't begin to express how thankfull I am for a good surgeon, good family, good friends!!!
I had a consult for a hernia repair and Panniculectomy this past week. I should know this week when that is going to happen.
10/25/02 -- My Hernia Repair and Panniculectomy is today. How exciting.
12/02/2002 -- I feel great -- did feel great right after surgery. I was not intubated awake like with my WLS and I felt awesome from day one! My incision goes from right below to my belly button and then from side to side. It's healing nicely and I have just the slightest soreness still . . .but not too bad. I feel great! I just can't stop saying that. They took off about 17lbs of fat and skin. Just enough to make my hernia repair keep until I get some more work done when I loose the rest of my weight. Other than that -- I can't say enough -- I FEEL GREAT!!!
12/09 -- Still feeling good. Down 240lbs and I am so very happy. Added some pictures to my website . . I just love sharing my story. This Christmas is going to be great. Last year I remember thinking it would be my last . . .I look forward for spending time with many of my new friends!!!
1/07/2003 -- Well I am down under 300lbs now! YEAH! I am so excited. It's amazing! I haven't been this size since I was in middle school! I can't believe it. I was so happy this weekend as I went out - danced, hung out . .I just lived my life to it's fullest! It seems that I am genuinely happy . .and it is showing . .people are complimenting me left and right and I don't think its the size as much as my genuine acceptance of me -- and my pride in myself for what I have accomplished.
2/24/2003 -- OK -- it's beena wild and crazy ride. I am currently about half the size I was when I started my new life -- down 274 lbs! I feel great. I think I look good! And more important I am happy. I had a consult to remove my "chest fat" (man's equivalent of boobs . .he he). So I am waiting to hear about that. The extra skin is the worst thing -- I still have my arms to fix -- my legs -- and another tummy tuck! I'll be hapy when I am done. . .but I am happy now! I love my new life!
3/7/2003 -- A year! A year! Over 280lbs lost! In a year! What a difference a year makes. I wish I could sit here and tell you how it easy it is . . it isn't . . its work and its emotions . . .and its a change not only in your body, but your mind, your relationships. Every facet of your life. A year later and I am happy. I am finally enjoying life. Just remember -- the bad times in life help us to appreciate and enjoy the good ones!
Nothing in particular to update - but its been some time. I'm now down 304lbs! AMAZING! I feel great. I am so ready to have surgery though. I look thin enough that I am happy -- but I have so much work to be done on my chest, tummy, legs, and arms. I am not complainig though -- I'd do it all over again if I had to!
Well I am going to have an abdominoplasty! YEAH! Well, only post-ops can truly appreciate wanting to be cut open . .again! I have Aetna now, and they approved in like 3 days after getting all the paperwork. It will be nice to look a bit more normal! I am scheduled for a week from today. You never do get used to going in to be cut open, I'm nervous. But looking forward to the results.
Hospital Reviews(Gainesville, FL) - Shands
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Surgeon: Michael P. Hocking M.D.
I have been to a few of Dr. Butler's meetings and am very impressed by what I see and here. They even talked to me and weighed me when I was in with a friend who had surgery -- no charge! I am so very happy and hope that when I change insurance's they will allow me to go with Dr. Butler.
Well -- due to insurance reasons I am going to see Dr. Hocking. He too has been a credit to his profession. He answers my emails and is going to work with me to get the insurance thing taken care of. Thank you Dr. Hocking!
After my first visit on 10/12 I can see Dr. Hocking is just as wonderful in person as he is in email. His staff has been great. Not to much aftercare, but there is a great support group that is wonderful.
Another comment . . .I was dissapointed with my date --and Dr. Hocking Quickly responded and told me he was looking to getting more OR time to fit me in -- wow!
Day Before Surgery (March 7,
1 Year -- down 283 lbs.
Cigna Healthcare, PPO Privided by EDS
I had AVMED HEALTH PLAN -- HMO FIRST.
I don't have anything nice to say. It has taken me 3 1/2 weeks to find out why my initial referral was denied. Originally I was told to see a GI . . . However, the GI says he will not see me. It took quite sometime to explain to them that no surgeon in my network will do the procedure. After my last call -- 1hr -- I was told that I was denied because of a written exclusion. Right now I am fighting that decision because Morbid Obesity and obesity are two different things. 8/9/2001 I have a appeal hearing to attend on 8/16 -- I need to prove that the exclusion does not apply to me. I think I have a good chance.
8/23 - so they said I did not need to prove medical neccesity, but then say that with the info I provided they have ot uphold the exclusion. I have been taken for a ride. i will continue to appeal and this time have all my ducks in a row.
10/4 -- Somehow I got a refferal to Dr. Hocking and my sleep study? Not asking why -- just very happy things are moving along.
10/9 -- Reffered to my Cardiologist. He cleared me for surgery. See Dr. Hocking on the 12th.
10/12 -- Saw Dr. Hocking and he is going to put my paperwork into Avmed. -- They denied it again so I am waiting to switch to another provider.
CIGNA HEALTH PLAN
12/19 -- Happy Birthday! Got my new card. the paperwork is being resubmitted and its looking good.
1/9 -- waiting to get my approval. Only one piece missing from the Doctor's office but after this, all my ducks are in a row!
1/30 -- Approved! It took some time, but I finally got approved! I am amazed by the difference in insurance companies.