TraceyB-LV
A little further along
May 30, 2006
Well, I'm two-steps closer to actually having the surgery. I went to my PCP last Friday, who stated, "I think you'd be a good candidate for the surgery." (DUH).. I went through the Diet & Nutrition class, and then three visits with a registered dietician, and now, she wants me to see my Pulmonologist to get a clearance, I will be doing some blood/urine lab tests and a chest x-ray this Friday, and will have follow-up appointment & possibly the EKG test on June 30.
From there, I'll need another Psychological approval, then, ... the edge of cliff is coming closer! Probably after that, the referral to the surgeon's office, a consult with them, and see where my insurance will be at that point. I am going to change my primary insurance carrier to the same one that my husband has, and maybe they will pay $10,000, and all I will have to come up with is a $6000 ... for the surgery ... if not, I'll have to pay $11000.. eek. I might have to solicit funds from friends -- 1000 friends at $100 a person... ...
I have a pay-pal fund people could donate online!
Lean on Me Classes
Jan 05, 2006
I have started a 4-week Diet & Nutrition class (this past Tuesday), required for WLS, through Health Plan of Nevada. I'm not sure if there is any further requirements once I complete this class. I have heard there is a 3-month 'try and diet' phase before putting in for surgery. HPN will only pay $5000, but with all the medical necessities, piling up, I'm hoping/praying they will pick up more of the cost.
I also asked my PCP to put this request into my Primary insurance carrier, through my work, so that I can get a formal denial letter, so that if I choose to appeal, I can have everything in writing.
Husband is scared for me
Dec 13, 2005
I'm finally on the move now with my husband's insurance HPN. I have to do four sessions with their "Lean on Me" Health and Wellness classes, which will be the four Tuesdays in January. When I talked to my Case Nurse, Virginia, I thought it was 3-months, she explained, "No, three sessions!" I was extremely excited. I am extremely happy about this.
I have been having some problems with UTI's and other female problems, which I know are related to my weight.
I'm also dealing with my husband, who is very scared about me going through surgery, mostly because, I am on oxygen, and have a problem of 'de-saturating', when I am asleep. My one doctor (A GYN Oncologist, who wants me to have a hysterectomy, once I have my WLS), told me that if she
was going to do the hysterectomy now, she was afraid
that I would be put on a respirator/ventilator, and not
come off. This freaked my husband totally out.
Both my sister and niece (Shannon & Mandee B) have explained to him that Dr. Atkinson, Dr. Fisher and Dr. Cottam, all have experience in dealing with LARGE folk, and their team all have the experience to handle persons who are on oxygen, and have sleep apnea, and know what to do when I will be on the operating table, as well as the North Vista Hospital's staff.
I also have assured him that my pulmonologist would have to okay my 'lungs' prior to having anesthesia, and give me the necessary testing before the surgery was to be scheduled.
I really think that once it comes down to getting the testing and scheduling done for actual surgery, then he will probably be fine and calm down a lot and put his trust in the capable hands of these fine doctors.
This process has be so long in the making -- since April of this year. I am excited to be coming up on having everything taken care of soon.
With my insurance, however, I asked my PCP doctor to 'formally' request the surgery through my insurance plan. I know they will deny the claim, and then I can go in for an appeal.
I am already gathering the necessary "ammunition" to write to the board of trustees, regarding what they have paid for in the past on all my medical problems, and comparing that to what the remainder would be on the surgery, doctor & hospital fees, of the WLS (after HPN will pay $5000).
If anyone has any "appeal" letters that have worked for them with their insurance company, can you send me a copy? I have found a few on other people's websites, and will see if I can modify it to my situation.
I keep wanting to post more, and will once my surgery is complete. I have really learned a lot and will continue to do so in the future, with everyone's help.
New Primary Doctor
Sep 20, 2005
I have finally gotten an appointment with the new primary care physician, Dr. Karen Kim (recommended by the Surgical Weight Control Center), on October 21, 2005. I will see what happens from here.
I went to see my GYN, who sent me to a specialist - a Gynecological Oncologist on Aug 18, 2005. She feels I may have a malignant tumor in my uterus, but due to my morbid obesity, I can not have any Open MRI or Ultrasound, nor
can I have any surgery for a biopsy, due to my respiratory oxygen dependency problems, until I have the surgery and lose some of the weight. She wrote a letter instructing me
to have the Gastric Bypass surgery first, before any other treatment can begin.
I'm expecting a favorable outcome soon... hopefully to have surgery scheduled soon? I don't really know what the future will hold on all this yet. We'll see.
I have all kinds of letters and medical records already at SWCC's office (along with their Psychological Exam), and I went to a seminar with Dr. Cottam in April of 2005.
My niece, Mandee, who had the surgery in 2003, suggested that I request a Case Manager through Sierra Health/Health Plan, to see if I can move the situation along faster. She also said that HPN will only pay $5000 of the surgery. (humm ... bad news?)
Has anyone else dealt with HPN/Sierra Health? Was there any struggles or other hurdles you had to deal with before having your surgery?
I appreciate everyone's support and help and ideas for this big step I want to take in my life.
Moving along slowly.
Change of Husband's Insurance
Jul 28, 2005
Everything is on hold for now. Probably will have surgery first of next year. My husband changed his insurance carrier to Sierra Health/HPN, which will probably go into effect September 1st. They will approve surgery, with 3 months of diet/exercise failure to lose weight. I have heard that they have a program through Sierra Health that would be 'mandatory' to attend, but I'm willing to jump through these hoops, to ultimately get the wls.
I'm currently having other health issues (which are weight related), which also is causing me to jump through hoops with my insurance carrier. (what a drag).
To catch up .. my surgery date is on hold, due to change of
insurance carriers. We changed my husband's from
NV(we don't)Care, to Sierra Health (or Health Plan of NV). With Nevada Care, I would have had to show 2 years of diet/exercise plan which failed, but due to health problems, I have been unable to exercise. However, Sierra Health has the following Indications:
Gastric restrictive surgery for extreme obesity is covered
under the following circumstances:
• Have a body mass index (BMI) of greater than 40 kg/m2 or
• Have a BMI greater than 35kg/m2 with significant co-morbidities and
• Can show that dietary attempts at weight control have been ineffective
• Patient must be at least 18 years old
Patient History
• Compliant attendance at a medically supervised weight loss program within the last 24 months) for a least 3 months, with documented failure of weight loss
So hopefully, Doc's office has all my records, and letters
from my other health care providers, and I was told that
I fit the BMI, and SIGNIFICANT co-morbidities. So,
possibly, I can do the three or four month program
through their system, and have the surgery at a later date
(if I can make it that long!).
SO, in the mean time, another problem has come about, with my female organs.... for lack of less gross wording ... my GYN, Dr. Nancy Long, has been, for the most part, understanding about my plight (and hopefully wls), but we have run into a snag. She has asked for me to have a MRI. I went to Desert Radiology on Eastern and Flamingo, to use their open-sided MRI, but due to my COPD, in which I can hardly lay flat, and I don't fit in their machine, with their magnetic band around me.
So, she wants me to consult with another GYN, for other options to see inside my pelvic regions. Does anyone know of another machine to do this, for a large woman (nearly 400#)... I've had an internal ultrasound, which she stated did not show everything clearly enough.
Red Tape & B. S. Paperwork
Jun 13, 2005
Just a quick note to update. I haven't got approved for my surgery yet. I'm feeling a little frustrated at the slowness of red-tape, paperwork and also feeling helpless (not being able to speed it along).
I am going to change my primary insurance to HPN (in the next week or two, through my employer)- who I know will approve the surgery. I've already talked to the surgery office, and who advised me that I would have to go through their 3-month weight loss program ... to see that I was not losing any weight. (3 months, is better than 2
years - with Nevada Care)...as it has already been 3 months since I went to the seminar in April.
My main problem of not losing weight, is having so much pain in my hips, legs, butt and feet, that it is nearly impossible to walk, or even sit with my legs outstretched for any period of time.
It has become extremely difficult to exercise with arthritic knees and feet. But the surgeon's office staff said that they will and are still sifting through my medical records, and more keep coming into the SWCC office.
So, in the mean-time, I've been trying to cut back on the foods I eat, smaller portion-size, staying away from sugary-foods (trying is the right word for that -- it's VERY TRYING)...eating more veggies, chicken, & fish.
I've been practicing chewing my food more. I know that when I do have my surgery, I will have to chew the food much more than I do now. Is there a way to do it ... better than counting your chews. Do you allow your saliva to start to break down the food and then start chewing?
I practiced on salmon last night. I noticed that the fish doesn't seem to break down as easily as say vegetable or rice.
My husband and I got rid of our giant stoneware plates
and got smaller CorelleWare dishes. I'm sure they are still
too big for the 3-4 oz meals I'll be having down the road.
When we were shopping I saw some "baby" yogurt and the cups were only 4oz big. I showed it to my husband, and said "This is a 4 oz cup." And he was amazed (and me too) how incredibly small it was.
However, I want to succeed in this plan, with a new tool to
help me be full, without stuffing my face. I know it will
be difficult too, but reading your posts, and seeing all the
websites of your successes has boosted my confidence that I can get through this .... if I can just get through the red-tape (B.S.) paperwork of insurance companies. If all else fails, we'll go into further debt to help pay for it.
I can not go on living in this body of death much longer. I know that even if my blood-work is good (lowered cholesterol, lowered blood sugar levels, etc.) the strain of carrying around 200+ extra pounds puts on my heart and lungs...it would only be a matter of time.
(I watch "Dr. G - Medical Examiner" Programs and see all the deaths that she attributes to obesity)
This is scary enough to make this change before I become a statistic.
