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Last week I emailed LapSF regarding the status of my request for authorization.  I have completed all pre-surgical orders except for the blood test which has to wait until 2 weeks before surgery.  I have not completed the 6 month supervised diet (May - October), but want my insurance company to clearly state that that is the only thing that keeps me from getting approval.  I.e. I want the confusion over whether they cover the VSG cleared up, because if they don't I will self pay.

So, Premera had NOTHING from LapSF in my file!!!  I emailed LapSF, Marily said that she had faxed stuff there on July 3rd, but would send it again.  So I called the insurance company the next day, and once again NOTHING!  WHOA!  So I emailed Marilyn again and hopefully they got it straightened out with Premera.  I will call Premera tomorrow, I had to take a day off to stay sane!

I really hate being a nag but apparently that is the only way to make sure things are happening.  I had asked Marilyn at LapSF if they acted as my advocate with the insurance company, and she assured me that they would, but thank goodness I called Premera.  Guess I am learning how to be proactive here.

Meanwhile I am exercising again, it feels so good the rest of the time.  My legs feel strong, my back doesn't hurt and I don't feel guilty about not going to the gym when I am paying for it!

It is very hard to think of staying heavy while I wait for the insurance game to wind its way through the channels.  We are going on a vacation to warm locations to see inlaws and friends, and I wish I was 2 post  surgery, so that I could feel more comfortable and look better in clothes.  Oh well, that will come, I feel confident.

Maybe I will have to wait till October if insurance pays, that would be OK I guess, but from this end of the story, its damn hard.

I did get a call from Michelle, finally.  She offered to send me the pre-op orders (I guess Dr. C didn't remind her to send them to me - whatever).  I contacted the nutritionist and had a nice little phone chat.  I have been churning through the other pre-op orders since I saw my PCP last week:  xray, results of recent tests like mammogram, etc.  Have my physc. consult on Friday.

Meanwhile Marilyn sent my request to the insurance, (I expect to be rejected initially because of the 6 month dr. diet, but I want to find out if the insurance will cover the VSG at all.)  If they do, then I'll finish the dr. diet, but if they don't I may just go ahead and do the self pay.

Its really hard to play this insurance game!!!  I got the CPT code from Dr. Cirangle's office, and each time I have called my insurance company, they have said that they cover it, if I can show medical necessity under the plan requirements.  But Dr. Cirangle's office seems to think that the insurance co. will NOT cover it for some reason.

The thing is that each plan is different, each administrative company is different, so how can they be so sure it will be denied?

Another confusing thing is that Marilyn insisted that I had to have the nutritional consult and psyc eval before sending in my insurance request, even though my insurance plan does not require that to show medical necessity.  Finally she said that even if the insurance co. doesn't, the surgeon does.  Well, that is fine, no problem, but I really couldn't understand how the insurance company could require something not in the plan.  A contract is a contract!

So we shall see.  I have a feeling that mid August may not be happening for me.  .  .  .

I am sorry to report that my contact with Dr. Cirangle's office has not been ideal this past week.  2 phone calls unreturned.  One email not responded to.

Finally tried to call Michelle, the patient coordinator, phone mail box is full!  Sent an urgent email with my questions, and got a response from Marilyn, insurance guru but the email said that my insurance didn't cover the VG, which is the procedure i want.   However the response indicated to me that she wasn't looking at the requirements for my plan.

So I am very frustrated.  VERY frustrated.    My family is going on a trip at the end of July and after we get back to the West Coast, my plan is to go to SF and get the surgery before going home.  That means that I have about 6 weeks to get all the pre-op stuff done.  Also to get the insurance on board.  So its very frustrating to be wasting time by not getting my calls responded to.

This surgery is a HUGH thing for me, the more I read and learn the more I want to get started.  I feel very much in LIMBO.  I am planning for the surgery in mid August, but everything has to be in line for the insurance to cover it.  I really don't want to wait any longer.  Insurance should cover me.  

Yeah, I finally got to talk to Dr. Cirangle.  It was great.  I wasn't sure of how many questions to ask, since so many of them are answered here at OH by members as well as the VSG FAQ at http://www.vsgfaq.com/index.php.

Mostly about how long to plan on being in SF (get there one day in advance of surgery, day of surgery plus 5 days after, so about 7 days.)  About follow-up long distance:  he said I could call and talk to him periodically about what was working, and what wasn't, and that he is in Hawaii the first weekend of each month, so I might be able to schedule a trip there and do follow up.  (My parents live there and would love to have me visit more.)

Said that the VSG would be a great surgery for me, I could definitely expect to lose 100 pounds.  (That is so mind-blowingly unbelieveable!!!)  That would put my BMI at 23 (I'm 5'9").  I can't even imagine how it would feel to not have to haul an extra 100 pounds around!!! (But I bet it would feel GREAT!)  Vanity aside (which is a significant motivator) I have been feeling encumbered by the weight, its hard to be active, harder to walk fast, harder to manouever when hiking or getting in and out of chairs, cars, (trains, planes and automobiles!).

My mom has had 2 knee replacements, and I have the same build as her, so I am sure that the weight would make that operation necessary for me as well.  Maybe I can avoid it!

This is starting to seem real to me.  I am so excited.