Inspirational Song Choice

Jan 25, 2010

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From the Beginning for Medicaid to Help Me

Jan 12, 2010

~ 05/05/2005 ~
I came across this site and have been checking it out and thought I would join in too.  My doctor suggested wls and I had been interested in it some prior now.  I found out earlier this year that DSHS will cover gastric bypass surgery. Don't know what to do next? How does the process get started? Who does the surgery in Eastern Washington? This is all I know so far:
DSHS covers gastric bypass surgery if the client meets the strict criteria. There are three stages of criteria to be met and the doctor will have to submit for authorization for each stage and get approval for each stage.  In the section under my profile that OH has titled "My Story," I have posted the detailed information on the stages that include the WAC codes.  Briefly,  the stages are as follows: 
STAGE 1... is the preliminary approval stage. You must be between 21 and 60 years of age, significantly overweight with a BMI of greater than 35, and you must have specific medical issues associated with your weight.
STAGE 2... is the pre surgical approval stage. You must not be abusing drugs or alcohol, you must undergo extensive psychosocial testing and mental health evaluation, and for at least 6 months you must receive nutritional counseling and lose 5% of your total weight through diet and exercise programs (surgery candidates also receive therapy).
STAGE 3...is the surgical approval stage. For this stage reports and documents are reviewed and surgery is scheduled if the criteria in stages one and two have been met.



~ 06/27/2006 ~
I had given up hope there for awhile. I am still trying to find any co-morbidities that would help me to be approved for Medicaid's Stage 1. I do not have diabetes!  I am still seeing my PCP, Dr. Heather Diaz for my obesity.  I am finding out this is a long process and seems like it will be much longer as I have to educate myself about what steps I need to take and what needs to be done and educate my pcp it seems...shouldn't that be the other way around?



~ 07/15/2006 ~
My blood lab results are in for this year. Everything looked good again except this time my HDL (good cholesterol) was abnormal. It was 37. Normal is greater than 45.
My knees and ankles (DJD in ankles) have been bothering me. Dr. Diaz referrered me to Dr. Hank Vejvoda, a orthopaedic from Central Washington Hospital. I seen him on Thursday, July 13, 2006. His diagnosis for me is Bilateral Patellofemoral Chondromalacia. Being overweight I guess makes it worse. I also have osteoarthritis in my lower back.  But I don't know if having my BMI greater than 35% (53%) and the PF Chrondromalacia is enough for DSHS and a few other things is enough to approve me for the first stage. I am worried about it.
I really want to lose all this weight! It depresses me. I am on SSI for my depression but I know being overweight has a lot to do with it too. I am so ashame of myself. I am very embarrassed with how I look. I don't care to look at myself much. Especially at my body. I use to wear make up and if you met me today, you would never know I use to wear make up. I try to in a blue moon. Like last May when I had to attend a wedding.
Dr. Diaz will be moving out of state soon. This Wednesday, July 19th is her last day. I will sure miss her. She got one of her patients approved for every stage with DSHS. Besides myself, I know she had another patient who also has DSHS and wanted the surgery. I will no longer be going to the clinic where I would see Dr. Diaz. I am going to try another clinic. I am worried though about how the next doctor will feel about the gastric bypass surgery. I don't know of any doctors in my small town or outside of it that has helped patients with WLS and dealing with their insurance companies. Doctors use to be able to refer DSHS patients to the doctors that do the WLS. Now they can't. It makes it more difficult for the pcp doctors to now have to deal with DSHS. I just pray that it will all work out for me.



~ 07/17/2006 ~
I went to my last doctor visit today and I walked out so upset, down, disappointed, and angry. My doctor is moving and I can't believe how this last appointment went with her. It was the worse doctor appointment that I have ever had. I can't get into it all right now. I need to let reality hit as I am still in shock.



~ 07/28/2006 ~
When I went to my last appt with my PCP, Dr. Diaz, this is how it went: She tells me that I should pay for the wls myself because of DSHS's strict criteria. I sure didn't understand this. Than she tells me that I was denied last Aug 2005 for surgery. I'm like "What?" and told her that I never received anything from DSHS dening me. I also never knew that she wrote this letter. During all my weight management appt, she had never said anything about this and has sent me to specialists even. She continued to over talk me when I was trying to say something. I was just really upset. She opens my chart to show me and she discovered that they never replied to her letter and she gives me a copy of her letter to DSHS. You wouldn't believe it yourself. I was 4 sentences long in 1 short paragraph. Nothing else included with it. And she was trying to get me approved for this surgery and I never knew she was going to do this quite yet. I was just amazed seeing this so called letter for approval. I sure didn't think she had been making much effort by what she wrote. I felt so disappointed, hurt, depressed, and let down. I didn't understand why she never mention this to me during this last year since she wrote it. I felt led on. I thought pretty highly of her ever since I started seeing her. Just in one day, one appt, and it all changed how I felt. Anyway, enough about that.
I still haven't met my new PCP. I will next week. I have written her a letter about helping me with my obesity. I enclosed the MAA Clinical Guidelines, the WAC law code information about bariatric surgery, along with some copies that I have collected from specialists. I feel more confident now that I had written this letter and enclosing information so that she can have a better understanding of things. I am anxious about seeing her and talking to her more about it. I contacted DSHS to fax her the paperwork she'll need (even though I know it is the guidelines I enclosed with my letter). I also e-mailed DSHS about the first stage and the comorbid conditions that I have. I printed what they e-mailed me for a reference to my new PCP.
I have written to a lot of OH members for help and support and I GREATLY appreciate all the feedback. So thank you from the bottom of my heart!


~ 12/13/2006 ~
These new profiles sure are different.  I like the new change and will have to find time and figure out how to spice it up a bit!  Lately, I haven't kept up on OH much at all since my Grandpa pass.  I guess the first year after a love one passes is the toughest.  I can't believe I haven't posted anything since July on my profile!  I was really starting to get into it and than Grandpa passed.  I have however, continued to go to my doctor appointments.  She says that we should have enough medical information to fax for approval.  So I am now actually "waiting for approval"...finally!  I just hope and pray that I will be approved.  I will keep ya posted when I find out more.  In the meantime...I will be anxiously waiting for approval.  I am nervious about it with hopes that their really is enough information faxed and enough comorbidities.  I do realize that this can go either way and not to give up!  I love my new doctor by the way.  Dr. Amy Hutton.  She is so understanding and so helpful.  And her nurse Carol is great and has faxed so much paperwork in for me.  Thank you, thank you, thank you! 


~ 01/19/2007 ~ 
Received letter from HRSA and was denied for stage one.  I have asked for a fair hearing to appeal their decision.  This is what I expected as I have been warned that this is when a lot of people will just give up.  Not me, it makes me want to rebel and fight.  So now I wait for a hearing date.  I also have a advocate to help me and am VERY lucky to have her.


~ 06/07/2007 ~
My hearing was set for today but I had to continue it to a later date due my pcp on maturnity leave.  She is going to speak at my hearing.  I asked for it to be continued in August to be safe and so my advocate can also take her bar exam in July as well.
Very disappointed to learn that Rockwood Clinic is no longer excepting new medicaid/medicare patients.  This is the sencond place that I have found that I wanted to have surgery at that this has happened.  So it is either the U of W, Idaho, or Oregon.  Most likely the U of W.  I hear a lot of good about their surgeons.  I just pray I get the surgery right now. 


~ 07/31/2007 ~ 
My hearing is set and in 7 days...August 7th.  I am very nervious.  Everything has been turned in.  All my latest co-morbidities including mild sleep apnea from a overnight oximetry test done here at home has been sent all in.  It can go either way and my advocate said we will appeal it again if I am denied.  So I know it won't be over if I am denied.  Please keep me in your prayers though. 


~ 08/08/07 ~
Good news!!!  First let me explain...my advocate and the department representative agreed to have a pre-conference phone hearing with the two of them, myself, and a judge.  My advocate and I won and the judge agreed to allow me to have a sleep study done with a board-certified sleep specialist, have a appointment with a bariatric surgeon at the University of Washington Bariatric Program, and with a qualified psychiatrist.  The decision will be based on what my sleep study states and if the other two agree, etc.  My hearing has been continued.  At first the department rep had the floor and I wasn't sure how it was going to go and than I felt more towards not.  The judge than gave my advocate the floor and she put it in such well spoken words and the judge agreed with her.  And the state will cover the expenses too.  Now to get through these appointments and keep my chin up.  It will be awhile longer for these three appointments and the last hearing on it.  Hope to know in a few months.  He was a very understanding judge and I hope he does my next hearing.


~ 03/20/09 ~      
Wow!  Here it is March 20th...the first day of Spring in 2009 and I am still fighting the good fight to get my weight loss surgery!  DSHS had denied me in 2007 and I appealed their decision.  It has been a long time now and I am still hear and not giving up my long term goal to be thin.  The judge ruled that I do 3 things.  So far I have been able to get 2 of those things done.  DSHS has to get those things set up for me and then it takes awhile out before I can finally go to the appointment.  I have had to travel to Spokane and Seattle.  The first one was to do a psychiatric evaluation in Spokane...passed.  Second, a sleep apnea test in Seattle...yes, I do have it.  Third, a 2nd opinion with a bariatric surgeon...appointment in late May with Dr. Flum at the University of Washington.  Then it will all go back to the judge.  I don't know how much longer that will take but I hope they put a rush on it as we all are getting tired of my case!


~ 01/13/10 ~
Haven't posted in a VERY long time.  With the appointments I had to go through...it made a big difference in the decision if I get approved for stage one or not in the appeal process.  Having sleep apnea, the opinion from the psy. evaluation and from meeting with Dr. Flum made a BIG difference.  Thanks to my advocate who asked for this to be done at my appeal to show just how much this surgery would benefit me.  I don't know if she would like her name to be mentioned, but she is my angel who has helped me through this whole thing.  I am posting my process to try and help those to are caught up in this process like I was.  i started this all in 2005 and didn't get anywhere until I had help from someone who went through it herself.  It has taken me the last 2 years but I have REALLY wanted this and have not given up!  And I hope anyone else in the process will keep at it as well because it will happen for you too.  It took my advocate 5 years with the state alone.  Stick to it.  My process didn't even have to go back to the judge the 2nd time because with the 3 appointments my advocate requested, it worked out in my favor and I got my first phone call to cancel the process with the judge because they approved me for stage 1!!!  Following that call was a letter of approval and my next steps with the proper WAC codes to move onto stage 2.  In a few months, I will be done with that.  To date in the last 2 years, I have lost 57 pounds on my own.  Slowly this time and so far I have done very well.  They won't count what I have lost prior to what I have lost in stage 2 for the 5% that I must lose during this time frame.  but that is okay.  I wasn't losing there for awhile...staying pretty much the same.  Now I have myself got myself losing again and hope to have all of stage 2 completed and approved.  My advocate has warned me that surgery still could be up to a year away.  But that is okay.  I am on my way now!!!  The key is don't give up! 


~ 01/24/10 ~
Dan and I just had our birthdays a couple of days ago.  Yes we have the same birthdate except for year.  We have gone through so much together and have a very strong relationship.  I am blessed to have him.  He and my girls are my world.  Dan recently got dianoised with prostate cancer.  Sadly, it runs in his family.  We didn't know that and accidently found out he had a high PSA level at the hospital during a emergency visit.  When he went in for the biopsy, that is when he found out through his dad that indeed it is in the family.  A week later, the doctor told us he has cancer.  We were devistated.  Further test were done: CT scan and a bone scan...thankfully, no cancer has spread and this can be treated.  Dan choose surgery.  Originally surgery was scheduled for Monday, Jan 25th but now has been moved to Feb 15th to do a robotic surgery.  This will be a longer sugery but less recovery time for Dan.  Here he just got back to work after a L & I injury to his knee that required sugery and was actually out of work for 6 long months!  This all has effected us finacially big time.  But that is okay.  Somehow, we have made it. 

My two girls have taken the cancer news badly.  They are very close to their daddy.  We have pulled together as a family and stay strong.  We will get through this. 

As this all goes on, my Mom and step father have decided to divorce after 27 years.  My Mom's decision.  She has now moved on with her life and is now involved with someone else.  She was a big part of our lives and has just vanished.  My girls are shattered and don't understand this.  My neices as well.  We don't know my Mom anymore.  It hurts us all deeply.  My entire family. 

Dan and I must keep things going.  God walks with us everyday and His angels surround us.  We will make it!  Dan will fight this cancer.  My girls will be strong.  And I will not give up.

I was looking at my box of paperwork the other day and noticed that I have been denied several times before I got to move on to stage 2.  I remember getting upset about it and asking why do I keep getting all these denial letters to my advocate.  She told me don't pay attention to them. Every time the doctor goes to send any new information in about my health, Health and Recovery Services Administration (HRSA) are going to deny it.  This is also when I was getting my appeal started.  So I had LOTS of denial letters!  It just slipped my mind because of what my advocate said...not to pay attention to them.

I have been getting worried because even though I did my psychiatric evaluation before stage 1, the guy I seen, Dr. Baum in Spokane, still wanted to see me do a MMPI with a psychologist.  Dr. Flum, the bariatric surgeon at the UW had agreed with him so that is one of the requirements I must met during this stage.  Well, I am in a small town and on medicaid.  We are now having a very difficult time finding someone who will take medicaid that will do a MMPI for me.  I may have to go as far as Yakima, Seattle or Spokane to have this done.  This is tough on me with all the appointments Dan is having to go through and a surgery coming up.  Plus I have kids.  I try and not worry but this is what is making it difficult for me.  The other part about it is that the person that was suppose to get in contact with me about it didn't for a couple of months.  I was left with that they were trying to get approval for me to see someone local.  Well, I got tired of waiting and called them and it is a good thing I did because I have now got the ball rolling again and that wasn't the case.  They can't get the approval.  It just has to go to someone else and I believe I got forgotten about.  And here I was waiting like they wanted me too like I was going to be able to have a local doctor do this for me.  Nope!  Not unless this doctor WANTS to fill out the paperwork with the state so he can get what the state will pay him for it and take me as a patient.  I had to find all this out on my own.  That is one thing about this all...you want this surgery, you better stay on top of things and do your homework.  Stay in contact with people and aske questions and make sure things are getting done.

I also need to see an Internal Medicine doctor to be checked out to see if I can undergo surgey.  My doctor thinks she can do this for me but this is something we need to make sure it can be done so I am approve and nothing gets screwed up anywhere.

I have now myself been in contact with the lady from HRSA lately who wrote me the letter of approval.  She is aware that I want to make sure I do everything right.

By the way, I have lost 63 pounds on my own and since Oct 4th when I started going to the dietitian, I have lost 14.5 pounds!  I am not into losing it fast because in the past when I did, I always gained it back and then more!  I am doing this slowly.  My support is Dan, my girls, my doctor and her nurse, my dietitian, the diabetes class I go to with Dan for his diabetes, my advocate, and of coarse God.  I also find support in watching The Biggest Loser and Big Medicine.  I also turn to OH as well.  I want to help others as well to the best that I can.  

Please know I am a person with major depression and I am fighting for a better life.  I'm on my way.  If I can so can you.  A day at a time.  


~ 01/31/2010 ~
I went to see an Internal Medicine doctor in Wenatchee last Friday on the 29th, by the name of Brian C. Derrick, D.O. to see if I can go through bariatric surgery.  I was there just over two hours!  First we met and talked about my health history.  He was very impressed with my weight loss.  That was definitely a plus!  We talk about everything it seemed with my health.  I don't believe we missed a thing.  I have to admit, I was impressed.  He examined me as well.  He also did a EKG and a chest x-ray.  He did blood work on me to check out my organs too.  He believs from what he see that I will do just fine but can't say 100% until he sees the blood work.  He wished me all the best.  It was a true pleasure to meet him.  The visit to him is a part of what I have to do to be approved for stage two and move on to get my WLS.  I am getting closer!!!  I still need to continue with my dietitian visits every 2 weeks, my food journals, losing weight, my monthly doctor visits and then I need to finish up with the psychiatry part.  I did the evaluation already but they want me to do a MMPI and maybe some follow up counseling.  It sounds like a lot but this is all helping me making changes in my life now and preparing myself for further changes after WLS.  It is for my own good and anyone else who has to do this as well.  So smile!  


~ 02/13/2010 ~
I got the results back from the Internal Medicine doctor to see if I would be able to undergo the gastric bypass surgery.  I am good to go.  That is great!  I have had a extremely difficult time trying to find a psycologist who does MMPI's and who will take my Medicaid.  I did find one about and hour and a half from me that does except medicare and medicaid both but not just the medicaid that I am on.  I was given a list by HRSA/ DSHS and it hasn't been very sugcessful even though it is a list of providers that have been paid by the state for giving the MMPI to patients.  This sure has caused more road blocks for me until I kept having this feeling that I should talk to this one doctor here in my town myself.  He doesn't except state insurance and that is why others wouldn't go any further with it.  So my instincts keep telling me to see if I could speak with him and tell him the problem I am having with finding a provider, and if anything see if maybe he could recommend me to someone.  As of now, he has called me back and is willing to help me.  HRSA and he are working together so that he is paid to give me the MMPI.  Just need to be patient in the meantime.  I am a believer in following your insticts and always tell people that.  Sometimes I am better at giving the advice then taking it, but am glad that this instict was so strong.
This weekend is a tough one for my family.  My honey, Dan will be having robotic protate surgery Monday morning.  It is a 6 hour surgery to remove his prostate gland.  He has a gleason 7 cancer rating.  He was diagnosed with prostate cancer on one of his brothers birthday's, 12/10/2009.  He first was scheduled to have surgery Jan 25th but they rescheduled to be able to do the robotic way instead.  This weekend he is starting to prep with diet for Monday's surgery.  Today is a low residue diet and tomorrow is clear liquids.  Then tomorrow at 4pm, he begins to take his meds to clean him out.  
Tomorrow we will take prayer with our Pastor and Church for Dan.  I understand many have made it through prostate cancer.  And we have caught this in time.  Dan will be tested quite oftan to make sure that the cancer is all removed and that it doesn't return to his body.  Please pray for him.  Thank you.  It means so much to us to have this prayer chain. 


~ 09/17/2010 ~
YES!!!  I have now been approved!!!  I can now move onto stage 3 which is the weight loss sugery!!! The final stage is here!!!!!!!!  Huray!  But get this...at the same time, I am nevious as hell!  After all these years of collecting the medical records with the doctors and getting it all together, sending it off, getting denied over and over, appealing the decision...on and on...I finally get my dream and I am really, really nervious about it all.  I think about the odds that Dan beat with prostate cancer and currently my dad just beating kidney cancer and still in the hospital recovering and I am going to put myself through this on purpose...okay Deb...it is so that obesity doesn't kill you off!!!  Just need to put my faith in God.s hands and continue to lose weight so I can have a healthy surgery and recovery!  Still a bit unsure if I want Dr. Flum or Dr. Dellinger...Time to call the UW! I have decided to go with Dr. Dellinger. Overall, after meeting with both, I was more comfortable with him and really like what all I had been hearing and reading.  Many say he is the best in the country.  And has taught many bariatric surgerons out there.

 

~ 10/22/2012 ~

As unbelievable as this may not seem, I had to move from Washington State to North Dakota and in a weeks time.  It was a fast and sudden move due to a job change for Dan.  So after the long fight for this surgery...yep...I have to start completely all over!  Supposely it won't be as hard in this state like it was in WA.  I sure hope not.  I felt I had the BEST bariatric doc to do it too.  Interested in Dr. Brent Bruderer in Bismarck but just not sure if he is still in action.  Can't seem to find a location for him.  WOW!  Just can't believe I am starting all over again!  I believe 7 years have gone by and still no WLS for me. :(  But I am strong and when I really want something I will go for it!

 


 

 

  
 


           

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Chelan, WA
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May 05, 2005
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