Melissa Mermaid
November 3, 2004
Nov 02, 2004
It's official: I have now been waiting FOREVER ... or so it seems.
To make the long infuriating story short, I will not have my surgery date for at least another week -- making it three weeks since I got my approval after an 8+ month insurance fight. After persistent calling and emailing without a response, I bitched to someone who helped me "break through the cone of silence" (my birthday sis, Margie R -- a true friend indeed ... thanks, Puss!).
So I see him on 11/10. Although I'm incredibly frustrated that it wasn't a surgery date, it stands to reason he'd want to take another look at me since it's been nearly a year since our one and only appointment. (Thank God I haven't gained any weight!)
Once we are done, I should finally have my DOS. If not, I do believe my head will explode ... and if you think I'm exaggerating, ask Margie!
To make the long infuriating story short, I will not have my surgery date for at least another week -- making it three weeks since I got my approval after an 8+ month insurance fight. After persistent calling and emailing without a response, I bitched to someone who helped me "break through the cone of silence" (my birthday sis, Margie R -- a true friend indeed ... thanks, Puss!).
So I see him on 11/10. Although I'm incredibly frustrated that it wasn't a surgery date, it stands to reason he'd want to take another look at me since it's been nearly a year since our one and only appointment. (Thank God I haven't gained any weight!)
Once we are done, I should finally have my DOS. If not, I do believe my head will explode ... and if you think I'm exaggerating, ask Margie!
October 21, 2004
Oct 20, 2004
Hey All! Today is my birthday. My last couple of birthdays have been really lousy – through no fault of anyone (especially not DH). My energy/stamina levels are so low at this point and I have felt so damned defeated that this birthday was not looking any better. I couldn’t figure out if “third time is the charm” or “three strikes you’re out.”
BUT THEN … I got a call from my lawyer Gary Viscio!
SO …
After more than EIGHT months of fighting tooth and nail for what I knew was the right surgery for me ... In spite of being disabled, feeling mentally and emotionally defeated, and physically unable to fight ... I HAVE BEEN APPROVED FOR MY DS.
Thank you ALL for your love and support ... Your wisdom and kind words ... You have been continual sources of inspiration for me. I absolutely could not have made it this far without each and every one of you. It is the only glimmer of sunlight in such a dreary experience. If I had had my surgery when I first expected to (2/17/04), I probably never would have learned so much and met so many incredibly wonderful and gifted people. It is because of you that I know the direction in which to point my future!
Especially Diana Cox, Stalker Val (Snookums), my angel, Izdawnie 2 (Val), Dina McBride, Tooter, Kari, Sharon Neva, Sarah 914, my "Little Sis" Margie R & my "Hula Sis" Mokihana, the entire DS Forum, Judith Weaver, Alice W & Christine Garcia* ... AND, OF COURSE … my lawyer Gary Viscio.
Never, EVER stop fighting the good fight when it is your life at stake and you know WLS is your last chance for health. Be as proactive as possible and don’t hesitate to “bury ‘em in paper”!!
Love & Kisses & Never-ending Hugs,
Melissa Mermaid
*Please don't be offended if I haven't mentioned you because each of you – especially the Dsers – have touched me more than words can ever say and I truly LOVE you all ... But for now, my mind is racing a thousand miles a minute and it's all I can do to focus long enough to type!! LOL
BUT THEN … I got a call from my lawyer Gary Viscio!
SO …
After more than EIGHT months of fighting tooth and nail for what I knew was the right surgery for me ... In spite of being disabled, feeling mentally and emotionally defeated, and physically unable to fight ... I HAVE BEEN APPROVED FOR MY DS.
Thank you ALL for your love and support ... Your wisdom and kind words ... You have been continual sources of inspiration for me. I absolutely could not have made it this far without each and every one of you. It is the only glimmer of sunlight in such a dreary experience. If I had had my surgery when I first expected to (2/17/04), I probably never would have learned so much and met so many incredibly wonderful and gifted people. It is because of you that I know the direction in which to point my future!
Especially Diana Cox, Stalker Val (Snookums), my angel, Izdawnie 2 (Val), Dina McBride, Tooter, Kari, Sharon Neva, Sarah 914, my "Little Sis" Margie R & my "Hula Sis" Mokihana, the entire DS Forum, Judith Weaver, Alice W & Christine Garcia* ... AND, OF COURSE … my lawyer Gary Viscio.
Never, EVER stop fighting the good fight when it is your life at stake and you know WLS is your last chance for health. Be as proactive as possible and don’t hesitate to “bury ‘em in paper”!!
Love & Kisses & Never-ending Hugs,
Melissa Mermaid
*Please don't be offended if I haven't mentioned you because each of you – especially the Dsers – have touched me more than words can ever say and I truly LOVE you all ... But for now, my mind is racing a thousand miles a minute and it's all I can do to focus long enough to type!! LOL
September 16, 2004
Sep 15, 2004
Yes ... It's true ... Screwed again. I have not been "denied," per se, but it turns out (can you believe we're just finding this out NOW???) that DH's insurance is self-funded by his company and therefore, is not eligible for a state review.
So ... We still have one more appeal coming to us through Empire and we'll have to take our chances. I'm taking matters more into my own hands by doing additional research to accumulate peer review literature proving that the DS is no longer investigational. If you have any such info available, it would be terrific if you'd let me know via e-mail or IM.
However, I'm going to be scarce on the boards while I pull this stuff together ... I'll drop in to post the Birthday Patrol but ... a major side effect of my autoimmune disease is that any emotion completely wipes me out ... So, suffice to say ... I'm ready to sleep for about the next fifty years.
As always, much
and 
and 
to all those who care and if you don't ... What the hell are you reading this for??? 
So ... We still have one more appeal coming to us through Empire and we'll have to take our chances. I'm taking matters more into my own hands by doing additional research to accumulate peer review literature proving that the DS is no longer investigational. If you have any such info available, it would be terrific if you'd let me know via e-mail or IM.
However, I'm going to be scarce on the boards while I pull this stuff together ... I'll drop in to post the Birthday Patrol but ... a major side effect of my autoimmune disease is that any emotion completely wipes me out ... So, suffice to say ... I'm ready to sleep for about the next fifty years.
As always, much
and and September 8, 2004
Sep 07, 2004
For all of my dear friends who have been on approval watch with me ... I have AGAIN been denied for the DS by Empire BC/BS (still claiming "investigational" despite VOLUMES of materials submitted stating quite the contrary ... Look in the encyclopedia under "injustice" and just such a denial will appear).
My lawyer is undaunted by this however, saying we can now go to the state level and that is where most of these bogus denials get overturned. From his lips to God's ears!! ... So keep praying for me if you're so inclined but don't worry ... It ain't over 'til I start singing!!
My lawyer is undaunted by this however, saying we can now go to the state level and that is where most of these bogus denials get overturned. From his lips to God's ears!! ... So keep praying for me if you're so inclined but don't worry ... It ain't over 'til I start singing!!
August 26, 2004
Aug 25, 2004
It’s so funny (not!) to once again be at this point. The question (for like the 172nd time): “Is this the darkness before the dawn?” The response from Empire was delayed due to a misfiling of the appeal (don’t ask) and now I’m hoping for an answer by Labor Day (do you realize if things had gone according to my earliest plans, I would be SIX MONTHS OUT already?) … Sometimes I wonder if I’m in an alternate universe … or are they (Empire) in an alternate universe?”
It must be a PMS thing (the red tide starts wiping me out about a week in advance) … and I’m so damned blue but I refuse to pig out. As a matter of fact, if you can believe it, I am literally blue! …
I got these beautiful jersey sheets in a dark blue and green ocean stripe (hard to explain, so I’ll spare ya … but what else would you expect a Mermaid to have as her bedding?) and yeah, sure, I know you’re supposed to wash sheets before you use them but I don’t have a washer/dryer and we send our laundry out like twice a month, so I just put them on the bed out of the package …
And I’ve been washing blue off of every part of my body ever since (yes, if you had jersey sheets you too would sleep in the nude because everything else gets “caught” on the material ... not quite like a tee-shirt like I thought they’d be … maybe if I wash them first … hmmm) … So it’s sleep in the nude or buy myself a silk mumu. Anyway, I digress …
To recap … I’ve got the blues (boy am I blue!!) and I’m still wondering when my day is gonna come. I refuse to say “if” and keep the jargon to “when.” I remain optimistic … But let me tell ya, it’s not always easy. I’ve checked the bank and I’m clean out of dues … I think I’ve paid them all already.
So … If you’re bored enough to still be reading the ramblings of this tortured mind … Throw the Mermaid a good thought and/or a prayer and wish me luck … It’s about time I got back into the “swim of things!”
It must be a PMS thing (the red tide starts wiping me out about a week in advance) … and I’m so damned blue but I refuse to pig out. As a matter of fact, if you can believe it, I am literally blue! …
I got these beautiful jersey sheets in a dark blue and green ocean stripe (hard to explain, so I’ll spare ya … but what else would you expect a Mermaid to have as her bedding?) and yeah, sure, I know you’re supposed to wash sheets before you use them but I don’t have a washer/dryer and we send our laundry out like twice a month, so I just put them on the bed out of the package …
And I’ve been washing blue off of every part of my body ever since (yes, if you had jersey sheets you too would sleep in the nude because everything else gets “caught” on the material ... not quite like a tee-shirt like I thought they’d be … maybe if I wash them first … hmmm) … So it’s sleep in the nude or buy myself a silk mumu. Anyway, I digress …
To recap … I’ve got the blues (boy am I blue!!) and I’m still wondering when my day is gonna come. I refuse to say “if” and keep the jargon to “when.” I remain optimistic … But let me tell ya, it’s not always easy. I’ve checked the bank and I’m clean out of dues … I think I’ve paid them all already.
So … If you’re bored enough to still be reading the ramblings of this tortured mind … Throw the Mermaid a good thought and/or a prayer and wish me luck … It’s about time I got back into the “swim of things!”
August 12, 2004
Aug 11, 2004
So the fifteen calendar days for an answer to my appeal have come and gone ... add another week, and here we are ... Still, no news. My lawyer called Empire and was told that a decision has not yet been rendered.
I am beyond antsy and now I'm really beginning to get angry. If the shoe were on the other foot and I was given a timeline by Empire (or any insurance company) and I didn't meet it, I would be SOL. But here we all sit, our thumbs up our butts while they figure out if I get the right to live the rest of my life as a healthy woman or continue laying back in a recliner thinking about that life without ever being given the chance to live it.
I am beyond antsy and now I'm really beginning to get angry. If the shoe were on the other foot and I was given a timeline by Empire (or any insurance company) and I didn't meet it, I would be SOL. But here we all sit, our thumbs up our butts while they figure out if I get the right to live the rest of my life as a healthy woman or continue laying back in a recliner thinking about that life without ever being given the chance to live it.
July 23, 2004
Jul 22, 2004
I’ve been mentally designing my improved life for so many months now that sometimes it seems as though I’m already there. I think like a post-op, practically eat like a post-op (okay the portions aren’t tiny but my stomach is still huge, I’m doing the best I can!), and I haven’t been full in I can’t tell you how long. (Although I must admit the smallest amount of couscous expands in my belly like a mother – but it’s not so much a full feeling as a really uncomfortable “enlarged” feeling.) The only thing that makes it brutally clear I’m not post-op is that I’m still weak, still fatigued, still essentially housebound, and still incredibly huge!!
Well, for those of you following my saga, the appeal has gone out and I believe my lawyer has done a good job. Decent guy … very honest, really dedicated to WLS. He’s seen the miracle in his own life and believes it is a miracle we should all experience if and when we’re ready. He’s a good lawyer to have on your side when you feel the system is out to get you (and just because you're paranoid doesn't mean that it's not!).
Empire BC/BS PPO has fifteen days to give us the nod or the gloves come off and we’re really gonna have to get tough ... LOL ... Tick-tock!
Well, for those of you following my saga, the appeal has gone out and I believe my lawyer has done a good job. Decent guy … very honest, really dedicated to WLS. He’s seen the miracle in his own life and believes it is a miracle we should all experience if and when we’re ready. He’s a good lawyer to have on your side when you feel the system is out to get you (and just because you're paranoid doesn't mean that it's not!).
Empire BC/BS PPO has fifteen days to give us the nod or the gloves come off and we’re really gonna have to get tough ... LOL ... Tick-tock!
July 7, 2004
Jul 06, 2004
Just a little P.S. to Monday's post ... I think the weather (humidity) and a little bug were taking me over because I feel much better today. Still weak and fatigued (which is the norm ... sort of like being in the third trimester of pregnancy for about two years) but not quite near-death ... Always worth waiting 24-or-so hours before giving up - on anything!!
June 5, 2004
Jul 04, 2004
They say it’s always darkest before the dawn and I truly pray I’m at the dawn of a new and improved dimension of my life, which will start with insurance approval.
The past couple of days have been very difficult for me. I feel like it’s a race between my bed/officially being bedridden and the operating room. I have less energy than ever, and I really didn’t think that was possible. Getting up and peeing is an effort like I once felt walking up steep hills. It sucks so badly!
Nonetheless I hold on to the hope that the efforts of my lawyer will prove swift and fruitful and my appeal will be approved shortly.
I can’t believe that someone can feel the way I feel and there not be a medication or reasonable treatment available. I keep asking myself if cancer is any worse and shudder at the thought that it might be.
I even find myself looking at the world through fatigued eyes. Doesn’t that sound silly? But I’ve recently realized I’ve been doing it for a couple of years now. When someone tells me they’re wiped or exhausted, I automatically think they mean it to the degree that I feel. I look at someone performing an exhaustive feat and I say to myself: “Hmm, how his/her life would change if they had an autoimmune disease.”
Then I look at someone significantly older than I who has incredible energy – like Carol Channing at the Tony Awards last month – and it gives me hope that I’m not getting too old to have energy and life in me again. But it all begins with having this surgery. Have you ever in your life seen someone so desperate to be sliced open?
The saddest thing is that (according to my peers in the news business) the public-at-large doesn’t want to hear about it. All my media contacts have proven useless. The judgmental nature of many is that I’m a fat chick and I’ve dug my own grave. It doesn’t matter that I’m so fat now because of an autoimmune disease that has disrupted my thyroid and metabolism; it doesn’t matter that I go to bed hungry every night and wake up with a headache because I’m dehydrated and starving. I’m just not “sympathetic” because I’m too pathetic!!
Why will it take me getting thin and being a survivor for anyone to care how desperate I am now? It’s sad and isolating and unbelievable to many. You can’t possibly imagine this experience unless you have lived it. It falls on my shoulders to someday be able to express to a very unsympathetic world that things aren’t always as they seem … That being fat is not always about stuffing our faces and that what has happened to me can actually happen to anybody.
The past couple of days have been very difficult for me. I feel like it’s a race between my bed/officially being bedridden and the operating room. I have less energy than ever, and I really didn’t think that was possible. Getting up and peeing is an effort like I once felt walking up steep hills. It sucks so badly!
Nonetheless I hold on to the hope that the efforts of my lawyer will prove swift and fruitful and my appeal will be approved shortly.
I can’t believe that someone can feel the way I feel and there not be a medication or reasonable treatment available. I keep asking myself if cancer is any worse and shudder at the thought that it might be.
I even find myself looking at the world through fatigued eyes. Doesn’t that sound silly? But I’ve recently realized I’ve been doing it for a couple of years now. When someone tells me they’re wiped or exhausted, I automatically think they mean it to the degree that I feel. I look at someone performing an exhaustive feat and I say to myself: “Hmm, how his/her life would change if they had an autoimmune disease.”
Then I look at someone significantly older than I who has incredible energy – like Carol Channing at the Tony Awards last month – and it gives me hope that I’m not getting too old to have energy and life in me again. But it all begins with having this surgery. Have you ever in your life seen someone so desperate to be sliced open?
The saddest thing is that (according to my peers in the news business) the public-at-large doesn’t want to hear about it. All my media contacts have proven useless. The judgmental nature of many is that I’m a fat chick and I’ve dug my own grave. It doesn’t matter that I’m so fat now because of an autoimmune disease that has disrupted my thyroid and metabolism; it doesn’t matter that I go to bed hungry every night and wake up with a headache because I’m dehydrated and starving. I’m just not “sympathetic” because I’m too pathetic!!
Why will it take me getting thin and being a survivor for anyone to care how desperate I am now? It’s sad and isolating and unbelievable to many. You can’t possibly imagine this experience unless you have lived it. It falls on my shoulders to someday be able to express to a very unsympathetic world that things aren’t always as they seem … That being fat is not always about stuffing our faces and that what has happened to me can actually happen to anybody.
6/15/04: Denied but IMproved
Jun 15, 2004
Well I knew things were going to move fast once the surgeon’s office’s procrastination of six weeks was conquered. (Surgeon's office had not complied with repeated attempts by the insurance company to supply them with my files.)
Too bad the decision was NOT in my favor. But it was my first submission under this new insurer (Empire BC/BS) and I’m asking for approval for the Duodenal Switch after all, so I’m not happy but remain optimistic. (Reason: Still trying to get away with declaring the DS as investigational, regardless of volumes of submitted data and clinical trials proving otherwise … a delaying ploy hoping we’ll walk away with our tail between our legs.
This was my horoscope today: “Don't avoid the issue. Face it and get it over with. The good news is that it's going to turn out much better than you'd imagined. Amazingly better.”
What exactly IS the issue here? That as long as those of us who truly want the DS and know – as I do – that it is the optimal weight loss surgery for many of us MUST continue to fight and never settle. Onward and upward, only this time I’m using a lawyer –and- we’re gonna take care of Cigna PPO’s egregiously inethical behavior while we’re at it.
Thanks for your support and I’d appreciate it if you keep the prayers coming. As far as I’m concerned, you’re not just supporting me but all of us – especially DS wannabes. It’s about time that the doctors, medical community and insurance companies in whom we’ve placed our lives and our trust stopped treating us like blithering idiots who don’t know what we need.
How sad a state of affairs it is when the data and research we manage to find and exchange is better than what our doctors have at their command.
I have each and every one of you to thank because of what you’ve taught me. When I was first denied with Cigna in February, my DH had a bawling, devastated, completely defeated WLS-wannabe on his hands. Today, when I received the call that I had been denied by Empire, he was ready to pick up the broken pieces.
But no broken pieces this time. Why? Because of all of you … because we are fighters … because we work together, supporting each other, and sharing experience. It makes us stronger. It makes us want to fight when we thought there was no fight left.
Too bad the decision was NOT in my favor. But it was my first submission under this new insurer (Empire BC/BS) and I’m asking for approval for the Duodenal Switch after all, so I’m not happy but remain optimistic. (Reason: Still trying to get away with declaring the DS as investigational, regardless of volumes of submitted data and clinical trials proving otherwise … a delaying ploy hoping we’ll walk away with our tail between our legs.
This was my horoscope today: “Don't avoid the issue. Face it and get it over with. The good news is that it's going to turn out much better than you'd imagined. Amazingly better.”
What exactly IS the issue here? That as long as those of us who truly want the DS and know – as I do – that it is the optimal weight loss surgery for many of us MUST continue to fight and never settle. Onward and upward, only this time I’m using a lawyer –and- we’re gonna take care of Cigna PPO’s egregiously inethical behavior while we’re at it.
Thanks for your support and I’d appreciate it if you keep the prayers coming. As far as I’m concerned, you’re not just supporting me but all of us – especially DS wannabes. It’s about time that the doctors, medical community and insurance companies in whom we’ve placed our lives and our trust stopped treating us like blithering idiots who don’t know what we need.
How sad a state of affairs it is when the data and research we manage to find and exchange is better than what our doctors have at their command.
I have each and every one of you to thank because of what you’ve taught me. When I was first denied with Cigna in February, my DH had a bawling, devastated, completely defeated WLS-wannabe on his hands. Today, when I received the call that I had been denied by Empire, he was ready to pick up the broken pieces.
But no broken pieces this time. Why? Because of all of you … because we are fighters … because we work together, supporting each other, and sharing experience. It makes us stronger. It makes us want to fight when we thought there was no fight left.
About Me
Westbury, NY
Location
20.7
BMI
Surgery
11/19/2004
Surgery Date
Feb 01, 2004
Member Since
