More impediments -- need support

on 4/13/11 9:31 am - VA
I just saw another doc today to pursue self-pay, which I'm resorting to given how badly my insurance process has gone.  I still have a hail-mary appeal in to the Office of Personnel Management, who oversees BCBS Federal, but I'm not optimistic.  So far since last summer I've done a nut visit, pysch eval, surgery consult, PCP visit, pulmonologist visit, lung function test, and I'm about to have my second of two sleep tests, this time to calibrate the CPAP I'm supposed to get at yet another appointment next month.  I have also prepared two huge appeals that failed, and each took hours upon hours of my time.

I had this fantasy that if I went self-pay (about $18,000 around here) that all the obstructions to getting this surgery would fall away.  NOT.  New doc says I need an EKG, an endoscopy, and that I have to go ahead and get my CPAP before surgery.  Also need medical clearance from my PCP and a blood test, and have to see HIS dietician -- the previous nut visit doesn't count.  I have to go back for a pre-op consult as well.

I am terrified at the endoscopy since the last one I had 15 years ago gave me a severe traumatic adverse reaction to the sedatives.  I had what I think in retrospect was post traumatic stress disorder for 8 years after that.  I just can't face another endoscopy, but he says I need it since I have longstanding GERD.  He says they have lots of drugs to choose from, but that was what the last guy said when I said I'd had a bad reaction from sedatives during oral surgery.

Also, my husband is in a huge work crunch and will be out of town for a month in June.  He wants  me to wait until all his work demands are completed before having this done.

I am a competent organized person, and this is just taxing every last little bit of sanity.  I have an insanely busy job, and I am miserably unproductive dealing with all this.  How do I cope with all these stresses and impediments?  I am sure all these tests are in an abundance of caution, but I don't have any heart problems, high blood pressure, diabetes, or any other high risk condition.  Mild apnea is it.  

It's like everyone and everything is trying to prevent me from achieving my health goals. I know I will plow through, but why oh why do they make it SO HARD?????

5'7"  VSG on 6/6/2011  HW 224, SW 214, CW 144  
on 4/13/11 10:03 am - Littlerock, CA
VSG on 03/28/11 with
I had a VERY long wait getting approved for the problem if it had been the RNY or Lap upper endoscopy showed that I had numerous gastric polyps, which is why my surgeon felt the VSG was best for me, and I agreed.  I have read here that several people had some help writing their appeals from someone here. You might ask "sleevegenie" about it because she won her appeal with help from someone.  (My doctor appealed, then I appealed, both without any formal help, back in late 2009, and my insurance co stood firm on "NO" until the end of 2010, which is when they softened their position on the subject of the VSG). 

I know what it's like to feel like the whole world wants to hold you's an awful feeling, to say the least!  For me, getting here wasn't just a journey, it was an adventure of a lifetime!  At least it all worked out in the end...

Best wishes,  Viv 


on 4/13/11 1:43 pm - Minneapolis, MN
It is a long journey just to get to the starting gate, isn't it? There are a lot of hoops to jump, but they are there to protect you and to make sure that this surgery is really right for you. I promise you'll look back a few months after surgery and have a hard time remembering all that you had to do!

In the meantime, just remember to breathe :)
Highest Weight (2008): 360  Surgery Consult Weight: 340  Day of Surgery: 318
Height: 5'10"
on 4/13/11 1:56 pm - WA
I'm sorry you're having such trouble.  Regarding the endoscopy, it's a pain, but it is necessary because if you do have Barrett's esophagus from your GERD, then the Sleeve is contra-indicated - it could increase your risk of adenocarcinoma of the esophagus, so they need to know beforehand.  My doctor will do endoscopy without any sedation if that is what you need.  I asked for it, but couldn't tolerate it (I was gagging and dry heaving all over the place), but she does it all the time.  It may be an option.  Or you could just take a mild sedative that you know you are fine with and not get the full anesthesia.  It's worth considering.  Good luck.  It's harder for "lightweights" to get insurance approval, but it can be done.  
Weight: Highest 317, Consult 311, Surgery 292, Current 210.8
Weight lost by month: 22, 13, 11, 8, 6, 5, 5, 6, 3, 0, next update 12/5.    
on 4/13/11 9:28 pm - DES MOINES, IA
 I was in the very same I am doing mine in mexico for half the cost..don't let mexico surgeons and hospitals scare your research, some are better than the USA. I am getting too old to wait around to enjoy my life as a thinner, healthier person!! Good Luck!
B. Bap
on 4/14/11 11:53 am
You know I know part of what you are feeling. But I can not speak about Self Pay. I am not sure what you said to OPM, but the fact that you meet requirements of the "Insurance" company is enough to appeal to OPM. They should not be able to deny you, if you have met ever single requirement. If there are separate requirements for this procedure then they should list them separately in the guide.
Because they deem it experimental or investigative is not a medical reason to deny. FIGHT IT. And since Carefirst is MD contact the MD Insurance Admin. to see if they can help in someway.
Good luck to you... I am here for support in anyway that I can.
on 4/15/11 10:38 am - VA
Thanks everyone! I really appreciate your support!!!! I was pretty low and needed the boost.

I'm feeling a little better today and think that if I just plow through all the BS this might actually happen. Truly, though, I won't believe it until I have an actual date.
5'7"  VSG on 6/6/2011  HW 224, SW 214, CW 144