Melissa Mermaid
6/10/04: Mourning Momma Angel
Jun 10, 2004
Momma eventually had the opportunity to have weight loss surgery but although it initially had been her desire and what first made her come to OH, she decided not to. Nonetheless, she stayed amongst the fellowship and continued to give tirelessly to members. She scanned surgery dates of members and when she saw the support was lacking, she posted their names and sites so that other members could help her in making sure the imminent-WLSer felt loved and supported.
This is what I posted to a memorial posting for Momma Angel upon hearing about her passing:
"As a member of the AMOS/OH fellowship, Momma Angel was a model to us all - of love and acceptance, of hope and support - a mother with an unconditional love beyond that which many of us ever received from our own mothers. As a person, Paula was a friend and kind woman who asked for little but deserved so much.
Now we are filled with sadness beyond measure, inconsolable and grieving ... The tears are unstoppable. How could we feel so close and so sad upon losing someone with whom most of us never came face-to-face? Because all she gave us was so genuine, so warm, so pervasive, and something that all of us who were so gifted to have experienced at her hand will never, ever forget.
God bless Momma Angel's soul and may her spirit live on in all of us. Prayers and blessings to all who love her - her children and family, and all of us at AMOS who hurt right now to our very core. We will miss her more than words can say."
To so many of us, Paula was the embodiment of love and support and we honor her.
May 28, 2004
May 28, 2004
Nurse/reviewer said the DS is definitely an issue because it's a non-approved procedure and investigational. About as much as one would expect. I went to our golden Yahoo Groups files and copied the Drs. Hess, Rabkin, Gagner, Baltasar & Anthone presentations to my hard drive and uploaded them in an email to her. I said I was trying to spare her pages and pages of faxes but if she wanted pages and pages of docs, that could be done as well.
Then I called my surgeon's office and asked his Practice Manager: "What do you send to the insurance company to justify the DS and prove it's not investigational?" The response (I swear to my life, verbatim): "It's not up to us to prove that. The insurance companies set their parameters and we follow them. They'll approve you for the RNY and then you and I will decide on a date for the surgery, ok Hon?"
How can all these supposed medical professionals act like the RNY & the DS are interchangeable and one is as good as the other? There are hard and fast differences between the surgeries and very credible reasons why each person might prefer one over the other. I feel all these bozos are out there, making money on us fat people but they really don't give a g-damn about our quality of life or what we want!!
Why isn’t it the surgeon's responsibility to qualify the procedure? Have you ever heard of a heart bypass patient having to do his/her own research to make sure all the qualifying data for the procedure is available? For me, remember, this is not an elective procedure.
Medical necessity for WLS has been proven; it's all about which procedure now.I tell you we're getting jerked around and treated like second-class citizens because we're fat and we're used to settling and we don't matter. Nobody understands what it's like to be us unless they are - or have been - one of us.
We're disposable in their minds. Why else would the billion dollar diet industry continue to take our money and our dreams and run away with both, leaving us fat, broke, and sadder than we were at the get-go?
I know I sound bitter; I'm really not. It's not being fat I hate as much as I hate being sick. If I weren't sick, I would be thin(ner) and not so eager to be sliced open.
Just burns my butt 'sall. I cannot and WILL NOT have the RNY. It is not the surgery for me because of medical reasons and personal preferences. None of us should have a surgery we don't want when one that we do want is within our grasp!!
*OFF SOAPBOX*
May 3, 2004
May 03, 2004
She asked me several questions about why DS over RNY and she responded to my counterpoints with a few “you’re rights” and even one “yknow you have a point.” Of course she was, in part, so warm and forthcoming because she was about to leave on a two-week vacation and gave me the contact information to send my files, etc to her “senior,” who would have been playing a part in the approval process anyway.
Unless I’m thinking too naively like a “glass is half-full” person, it was a very positive interaction. Certainly worlds better than any of my Cigna PPO/Intracorp experiences. So I emailed my now-11-page letter/case history to “the senior” and emailed my surgeon’s office a couple of days later with all the particulars so they could fax her my file, from which clinical data could be used to verify my personal synopsis.
Incredibly patient, I waited a week. I wanted to call “the senior” to see if she had all my stuff but figured I’d make sure the surgeon’s office faxed over my file first – and they hadn’t! So waiting on pins and needles for a week, imagining “the senior” going over all my information, and contemplating my next move - whether I’m approved or denied - only to find out she didn’t even have all the information necessary with which to move forward!! It’s very disheartening.
My whole life is on hold pending this operation. Now it’s going on three months since my original surgery date. I’m getting weaker by the second; my niece graduates from GWU in DC in two weeks and I’m the only family member unable to go because I’m absolutely not up to it! I fight depression daily.
March 29, 2004
Mar 29, 2004
When I spoke to the Intracorp rep on Wednesday (Intracorp is a Cigna company that clears patients for inpatient surgery precertification), I was told that they needed a peer-to-peer review with my surgeon and had left a message on his voice mail the previous day at 5pm. (Hmmm ... already sensing a problem when they're trying to do business at 5pm but somehow I thought it was a good sign that they were going in this direction.)
On Thursday I called my surgeon's office to facilitate this peer-to-peer review but they never called me back. On Friday I called and "caught" the surgeon's assistant in the office. She said the surgeon had called Intracorp back for the peer-to-peer review but it did not happen.
So ... Instead of bothering to conduct the peer-to-peer, Intracorp just denied me, saying they had no proof the surgery was medically necessary. Of course not, they never spoke with the surgeon! (Although it mystifies me that inability to work for nearly a year and being as-close-to-bedridden-as-it-gets aren't justification enough for "medically necessary.")
So now I have no choice but to wait until Empire BC/BS takes over this week, complete with the same exclusion. The fun part is that I believe Intracorp works with this insurer as well.
Sometimes when you're in limbo, it sure feels like hell!
All this taken into consideration, the good news is that my daughter does not have diabetes (thank God!) but she is lactose intolerant.
Like Roseanne Roseanna-danna used to say: "If it's not one thing, it's another!"
March 24, 2004
Mar 24, 2004
Although I admittedly have a flair for the dramatic, I'm being very honest and matter-of-fact as I say that it's becoming very difficult to fight back tears right now. The Hashi's seemed to show some improvement in the last couple of weeks as I upped some of my vitamins; at least the mental fogginess had been clearing. But this week I'm so drained, teary, constant headaches. It's the Hashi's and depression and PMS all rolled into one.
I've started becoming more proactive with the insurance company. After all, time is running out and I have yet to get an approval. If I were to have approval and surgery date set prior to 4/1, Empire BC/BS supposedly would honor that date and I'd be good to go.
But the reps I spoke with today were very vague (which is common for Cigna PPO) and threw all kinds of dates at me that didn't make any sense about when information had been received - some as recent as 3/22. I was first denied on 2/11 and we started the appeal the next day! Yet one rep said that I'm not officially in the appeal process yet. Excuse me, I have received a denial and was told to fax in additional information. That means I'm in the appeal process!
Each person I speak with is less knowledgeable and less committal than the other. What's really amusing is how they seem to want to be helpful but in effect, do nothing. Having a native NYer's manner of speech, I cannot tell you how much I just want to say: "Stop dicking me around!" But I hold my tongue - which, I believe, is one of the reasons my head is throbbing as I write this.
Supposedly "just yesterday" Cigna tried reaching my surgeon for a peer-to-peer review but was unable to reach him. I am in the middle of trying to facilitate that.
The one thing that is abundantly clear is that having the DS is going to be a major fight. Phrases like "RNY is an approved procedure but DS is not," stopping short of using the word "investigational" to describe the DS. Why? Because in my 9-page appeal letter I immediately called that bluff before it was even posed by stating that the ASBS had removed the DS from the investigational surgery list in June 2003.
I try to remain strong in my resolve. I knew this would be an uphill battle at best. I feel foolish when I read of years-long battles others have waged to get their WLS and my battle has barely begun. But my condition worsens daily and is essentially untreatable; it's the weakest I've ever been yet the hardest I've ever had to fight.
I eat less and less everyday, completely fighting the old compulsive overeater mentality of overeating due to depression or frustration. I can be such a winner in my weight loss journey with the tool of this surgery but my pleas and prayers seem to fall on deaf ears.
My family gets progressively more worried about me as I sink lower and lower into the pity party. My daughter believes she has diabetes now (in addition to her PCOS) and is getting blood tests taken Friday. I cannot even be at her side! I can barely lift my head from the pillow each day!!
I wish it was just the fat and all I needed to do is lose weight but it is no longer that simple. I cannot be the mother I want and need to be and I pray my husband stays well as I fight this good fight. If he needed me to be his support system (other than emotionally) right now, I don't have the stamina to do it.
March 16, 2004
Mar 16, 2004
As the seconds tick away until receiving the response to my appeal (already overdue), it's hard to be optimistic but I keep trying. Every day a response doesn't come, it feels as though I'm sacrificing another month of my life. I've lost so much quality time out in the world already.
Nonetheless, there's a resolve inside me that won't be defeated. God help these villainous insurance companies once I'm strong enough ... They don't stand a chance! With the help of my peers, it'll be an all-out media campaign so that no one else ever again has to suffer the ridiculous injustice of being denied WLS when it's necessary to save their lives!
March 1, 2004
Mar 01, 2004
Time running out for approval thru Cigna as company switches to Empire BC/BS on 4/1/04 with same exclusion included ... Hence this term in limbo may be extended.
February 12, 2004
Feb 12, 2004
It's 5 days from my surgery date and we discovered that company has a specific exclusion for the treatment of obesity on their Cigna PPO contract: Worded "No medical or surgical intervention for treatment of obesity/morbid obesity."
For whatever reason, this was not revealed during the insurance pre-determination process by the surgeon's office. We are in the appeal process with the help of company's HR Department, who is ready to okay the surgery as long as medical necessity is proven.
CHECK CHECK CHECK IMMEDIATELY with your insurer when first considering WLS and get specific re your employer's contract with them. Do not get blindsided like we did. It's devastating!
February 2004
Feb 01, 2004
I am a 48-year-old broadcast news journalist who quit my job due to my disability with a thyroid-related autoimmune disease that seriously affects my weight and my ability to lose weight. (Nobody likes a gal "bleeding the corporate coffers dry" by being on disability; I'm too old to have that black mark on my spotless record in such a youthful industry.)
I am married to a divine man (my third marriage); we have been together for thirteen years and married for almost eight. I have a talented and beautiful 24-year-old daughter who is engaged to a terrific guy. She suffers from PCOS and battles her weight constantly. We both blame my father for the inheritance of these horrendous fat genes; too bad he disappeared when I was five years old and we can't kick him in the butt for this dubious legacy.
Since deciding upon having surgery in November of 2003, I've been praying nonstop that I will be able to leave the hospital without complications - and stay that way! Then everything after that will be a "piece of cake"(?!) - or, I should say, "a walk in the park!"
My very nervous yet loving family started out very worried about me having WLS. As time passed, my commitment and knowledge about the subject increased. Although they accept the necessity for me to regain my health, they remain concerned about the "What ifs?." But they know how much I detest doctors and hospitals, so they finally realized how desperate I am to be pursuing this last resort.
I would especially appreciate hearing from those who have gone into surgery with an autoimmune disease and what has happened post-op. (I have been diagnosed as non-hypothyroid Hashimoto's Thyroiditis, which is untreatable with medication - yes there IS such a thing - and it knocks me on my ass big time!)
Some say "Oh, you're just fat, that's why you're so weak." Well I've been fat enough at different points in my life to know the difference:
o Being too fat doesn't make loading a dishwasher a two-or-three-shift procedure because you're too weak to do it in one.
o Being too fat doesn't make you too weak to get out of bed. I cannot stand for anything past a few minutes because I get lightheaded and need to rest or lie down.
o Being too fat doesn't cloud your mind to the point that you have to concentrate to remember your own phone number.
At this point, just being fat would be a gift. The combination of this disease and being fat is almost indescribably difficult.
Like I said in my appeal letter: "You have just enough energy to move 150 pounds and you have a 300 pound load. You can't remove that extra load on your own ... What do you do?"
Your support is incredibly welcome. In the meantime, see my life in pictures by logging on to my website: The Ups & Downs of Being Me.
