WOW It's been awhile since I posted But I'm on my way again!

Apr 18, 2009

Back in August I asked my Care Plus Insurance what was required for me to get the Adjustable Gastric Banding. They replied first to do the 6 month required Doctor Supervise Diet. I went to Seminares and decided on the Realize Banding. With the Surgeon Dr.Enerst Rehnke, who did my Gastric Bypass. And thus with my Primary Doctor, Dr.Pamela Grover in August  We started my 6 month program seeing her monthly as she documented my progress.

In the end of Jaruary I completed this Program and Dr.Grover has me complete a few other Medical Test such as my yearly Colonoscopy, Prostate and eye exam. Thuis took the month of February. But then we submitted to my InsuranceCompany asking for Approval to receive the Adjustable Gastric Banding. They sent a letter back saying NO as it wasn't a Surgery Paid for by Medicare. Which I've been on since 2004. And it paid for my Gastric Bypass. Which I received because in 2006 it wasn't paying for the Banding. But I had PROOF from three reliable sources that NOW Medicare does pay for it. Plus they were naming the WRONG Hospital. Since I have Medicare it now has to be performed at a "Center of Excellence" which is awarded to Surgery cewnters who qualify under the ASBS - American Society of Bariatric Surgery and the Surgical Reveiw Corporation. Which the Palms of Pasadena Hospital has had since the begining of 2007.

So I as well as Dr.Grover sent in APPAELs with this Documentation of it being paid for. They re-sent a letter stating they received our appeals and they's have 30 days to Review them. Well 28 days went by slowly, so I started calling. Finally get to the person handling my case. He stating they were about to make a decission just be patient.
He finally called at 11 AM on the last day of the Appeal and a week later I got another letter. Stating that I was APPROVED!! 
With the Surgeon and Hospital I had chosen. Assisting Dr.Rehnke will be Dr.Grossbard (who has a Band himself).

So now my surgeon requires ALL of his patients to complete a OPTIFAST Liquid program leading up to the Surgery date. Which was then set for Tuesday April 21st. I'll get a call the day before to tell me what time to be at the Palms Of Pasadena Hospital. It is now Saturday 3 days to go. 11 Days into the Optifast and I've lost 33 pounds. I'm hoping to lose another 17 but we'll see, as that alone would be 10% of my starting weight already.

Dr.Rehnke's office staff has all of the required documents and test results (EKG, Blood Works and Chest X-Rays) they need EXCEPT my Medical Clearance Letter from my Primary Dr.Grover. But she insists it will be in Dr.Rehnke's hands by 8 AM Monday. My final Pre-op Consultation with Dr.Rehnke is Monday at 10:45 AM.

I've attended sevewral Prayer Groups and feel very positive and motivated to reciving this Realize Banding and will chart on here of my future progress. Bye for now. Mike

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About Me
Largo, FL
Location
69.0
BMI
Surgery
04/21/2009
Surgery Date
Apr 02, 2005
Member Since

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Latest Blog 8
Well It's been quite a ride!
My Life Continues to Grow Healthier 4/20/07
November Progress Update 11/13/06
"'Twas The Night Before Bypass"

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