eaglelady2006
I have date -- again!!
Jul 17, 2007
I've been reading quite a few posts lately that some are being denied WLS, usually because the insurance are throwing in a few extra hoops, etc. Well, I just want to say that being persistent, to the point of changing surgeons and hospitals, does work!
After being initially denied by insurance for lack of documentation (specifically about my comorbidities being "well controlled" on medication or CPAP," etc.), for which I wrote the insurance company a point-by-point letter following their guidelines and explaining that my comorbidities were, in fact, NOT well controlled over the past few years, then they approved me. Ok, so then I had a date (May 23), I had my preop with the nurse practitioner and my primary, THEN I get a call from the surgeon because his team decided I was too risky for surgery because of my past bile duct problems that required endoscopy and stenting, as well as a moderate sized hiatal hernia.
Although I would totally PO'd about this, It actually turned out to be a blessing because my dad passed away on May 24 (I would have been in the hospital
).
In the meantime, my wonderful friends here at OH suggested that I get a second opinion. So in the midst of setting my dad's funeral and taking stock of what to do now (as he was living with me and sharing expenses), that idea was simmering in the back of my mind. I did some research and found another different Center of Excellence that I could try. I had already picked up my records from the first surgeon's office, so I called the second surgeon's office and explained that I wanted a second opinion. They said to send in my records with a cover letter explaining what I wanted the surgeon to do. So I did this. I have learned so much from OH, as well as looking up articles at NIH, etc., about havine RNY with large hiatal hernias and the endoscopy problem. I had accepted the fact that, OK, I just might need another endoscopy to look at the bile ducts, but I really wanted to just get my hernia fixed, and oh, by the way, a WLS (be it RNY or Lap Band) would help me to NOT gain the weight back, because fixing the hernia would boost my ability to eat 10-fold or more!
I can summarize the rest very briefly: I went to Dr. Lederer's seminar and had a consultation with him. He says that as long as I understand that IF I need a future endoscopy, it would have to be done surgically, he would do the RNY and fix my hiatal hernia. So after all of their paperwork was completed, they re-submitted it to my insurance, and this morning, I got the call that I WAS APPROVED! And my date will be September 6 (his first case of the day). How cool is that!
I could have gotten in on August 20, but we are moving on Sept 1 to a smaller place (save $$), so I think it would be best to have the surgery after we get into the new place.
SO, my advice to those who find themselves off the WLS merry-go-round for whatever reason, pick yourself up and get back on..... and pick yourself and get back on....
SEE YOU ON THE LOSER'S BENCH!!!
After being initially denied by insurance for lack of documentation (specifically about my comorbidities being "well controlled" on medication or CPAP," etc.), for which I wrote the insurance company a point-by-point letter following their guidelines and explaining that my comorbidities were, in fact, NOT well controlled over the past few years, then they approved me. Ok, so then I had a date (May 23), I had my preop with the nurse practitioner and my primary, THEN I get a call from the surgeon because his team decided I was too risky for surgery because of my past bile duct problems that required endoscopy and stenting, as well as a moderate sized hiatal hernia.
Although I would totally PO'd about this, It actually turned out to be a blessing because my dad passed away on May 24 (I would have been in the hospital
).In the meantime, my wonderful friends here at OH suggested that I get a second opinion. So in the midst of setting my dad's funeral and taking stock of what to do now (as he was living with me and sharing expenses), that idea was simmering in the back of my mind. I did some research and found another different Center of Excellence that I could try. I had already picked up my records from the first surgeon's office, so I called the second surgeon's office and explained that I wanted a second opinion. They said to send in my records with a cover letter explaining what I wanted the surgeon to do. So I did this. I have learned so much from OH, as well as looking up articles at NIH, etc., about havine RNY with large hiatal hernias and the endoscopy problem. I had accepted the fact that, OK, I just might need another endoscopy to look at the bile ducts, but I really wanted to just get my hernia fixed, and oh, by the way, a WLS (be it RNY or Lap Band) would help me to NOT gain the weight back, because fixing the hernia would boost my ability to eat 10-fold or more!
I can summarize the rest very briefly: I went to Dr. Lederer's seminar and had a consultation with him. He says that as long as I understand that IF I need a future endoscopy, it would have to be done surgically, he would do the RNY and fix my hiatal hernia. So after all of their paperwork was completed, they re-submitted it to my insurance, and this morning, I got the call that I WAS APPROVED! And my date will be September 6 (his first case of the day). How cool is that!
I could have gotten in on August 20, but we are moving on Sept 1 to a smaller place (save $$), so I think it would be best to have the surgery after we get into the new place.
SO, my advice to those who find themselves off the WLS merry-go-round for whatever reason, pick yourself up and get back on..... and pick yourself and get back on....
SEE YOU ON THE LOSER'S BENCH!!!
Update after 2nd opinion
Jul 06, 2007
I had my consult with Dr. Lederer today for a 2nd opinion after being blocked for surgery by Dr. Ikramuddin because of having liver problems (possibly requiring future ERCPs). Dr. Lederer was very nice and straightforward. As long as I understand that any future ERCPs would need to be done surgically (at present, my liver seems to be fine), he will do the RNY and repair the hiatal hernia (which is the only thing that is giving me problems). SO, they will be resubmitting to insurance within a week or so (as soon as they get the paperwork ready). I don't anticipate a problem as I was already approved for the surgery by insurance at the U of MN; I'm just changing doctors and hospitals, and both are in their list of preferred providers. Dr. Lederer made the statement that the only reason the surgery would be cancelled would be if I cancelled it myself (and I don't see that happening!)
I've been through too much (since January) to turn back now!
So -- onward we go!
I've been through too much (since January) to turn back now!So -- onward we go!
Update - 2nd opinion.
Jun 24, 2007
I have sent my records to another surgeon for a 2nd opinion, and it sounds like he thinks it's doable! I have an appointment to see him coming up on July 6. Since my insurance already approved me for surgery at the U of M, I'm hoping that I won't have to jump through all those hoops again.
Brief update
Jun 02, 2007
I should be recovering from my lap RNY scheduled for 5/23, BUT - my surgeon and his team reversed their opinion about having this surgery due to the fact that I have primary sclerosing cholangitis (inflammation of bile ducts), very early but still requiring endoscopies to the level of the bile ducts; moderate sized hiatal hernia; Barrett's esophagus (also requiring intermittent endoscopies) from significant GERD. I am now in the process of investigating the possibility of lap band and/or sleeve, if I can overcome the insurance obstacle (the sleeve is considered "experimental" and thus not covered). I am also sending my records to another surgeon for a second opinion. I am having significant problems due to the hiatal hernia and a recent bout of diverticulitis, so I'm thinking I will need a repair of the hernia pretty soon. I would be nice to take care of the appetite which I know will return following this repair.
They say, "All things happen for a reason..." The only positive thing about this being postponed is that my dad passed away last Thurs (I would have still been in the hospital). So I was able to take care of the things I needed to for that. He was 95 and still very healthy and active, so at least he did not suffer. He is now with my mom and at peace.
As soon as I get any information, I will update my profile.
Thanks everyone for your continued support.
They say, "All things happen for a reason..." The only positive thing about this being postponed is that my dad passed away last Thurs (I would have still been in the hospital). So I was able to take care of the things I needed to for that. He was 95 and still very healthy and active, so at least he did not suffer. He is now with my mom and at peace.
As soon as I get any information, I will update my profile.
Thanks everyone for your continued support.
Finally Approved!!
May 09, 2007
Two days before my preop appointment with the surgeon, I get a call from my insurance saying I am approved! (Nothing like waiting until the last minute.) Now comes the mixed emotions -- excitement and doubts about whether this will really work or not. Anyway, I only have 2 weeks to ponder this. All I can say is -- IT'S ABOUT TIME!!!
Have a date but still waiting for insurance approval
Apr 29, 2007
Thanks for your messages of support for my surgery. But I am still waiting to hear from my insurance for approval. When I have the chance I will post the whole story. In the meantime, I'm still hoping for a "yes" some time this week.
