I AM APPROVED!!!!

Dec 24, 2009

I GOT THE CALL AND I HAVE BEEN APPROVED FOR SURGERY, BECAUSE I AM IN NURSING SCHOOL I AM HAVING MY SURGERY ON 2-15-10. I HAVE BECOME SUPER EXCITED AND NERVOUS ALL AT THE SAME TIME. I AM SOOOO READY TO START THIS NEW CHAPTER IN MY LIFE. I WAS DENIED AT FIRST, BUT I AM GLAD THAT I APPEALED MY CASE. I WROTE A LETTER AND I THINK THAT REALLY GAVE THEM MY PERSPECTIVE ON THINGS NOT JUST OFFICE NOTES AND LABS. THE LETTER GOES AS FOLLOWS:



November 24, 2009     To Whom It May Concern:                 I am writing this letter to appeal the denial decision rendered by DMCare insurance review. I am presently 32 years old, 5’9” and 437 pounds and I have been large all of my life. I am Type II diabetic, and hypertensive with no one to blame but myself.  This has been a continuous struggle since the age of six years old. I can say that I am a very active super obese woman. I am presently enrolled in Davenport University’s nursing program full time for my Bachelor’s of Science in Nursing, and working full time at the Detroit Medical Center as a Telemetry Tech for the past six years, and have recently become a Licensed Practical Nurse. I want to have physical stamina required to give great care to my patients that matches my mental stamina.             For the past year I have been doing everything that was asked of me by DMCare to meet the requirements for gastric bypass surgery approval. I have always done some sort of exercise. I documented that I exercise thirty minutes a day. I do my exercise video “Leslie Sansone’s, Walking Away the Pounds”, and in this video you power walk in place for up to forty-five minutes. Every fifteen (15) minutes of her video is equivalent to one mile of regular walking. So, when I do thirty minutes, that is two (2) miles which is what my physician, Dr. Porter is referring to in her letter of approval. Not to mention, that I have a 2 dogs that have to be walked two times a day. I walk them at Palmer Park across the street from me. I did not log that because that is my everyday routine. By making myself do the video for thirty minutes, is what I consider extra exercise.             I also have seen Dr. Porter every two to four weeks for weight documentation for the past few months, and the nutritionist for over a year. When there was a slight gap in the time, it was due to the fact that I was flying back and forth to California to see my father that was stricken with Guillain-Barre last year; 2008.He is still recovering from this devastating syndrome.  So, when I would come back in town I got the next available appointment with Dr. Porter. I never purposely missed any appointments, and there were times that Dr.Porter’s office rescheduled me.  This year was a very stressful year for me, and I felt like giving up many times, but I persevered to keep things on track so that I could hopefully get approved for my surgery.             I have lost weight before with great success, but stressors in my life have gotten the best of me and caused me to gain it back and more. If I could have lose the weight and kept it off, then I would not have even considered this surgery. My effort of losing weight has been a life long journey. The information submitted to DMCare is only one year of over 25 years of struggle. So, upon doing extensive research on the different surgeries, I know that this is the best option for me. I am not giving up on myself, but I am improving on what I know I am capable of in hopes the surgery will aid in my personal goal of permanent weight loss. I truly hope that you could reconsider your decision and see that I would make a great and successful candidate for this surgery. Thank you in advance for your reconsideration in this matter.       Respectfully,       Michelle A. Barnett

3 Comments