Kristen B.

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So, I had my consultation this morning. I met Dr Schweitzer, he seems very smart and to the point. Prior to meeting with Dr S, I met with another Dr (on his team? I missed what he said...) who was very nice and went over my medical history with me. He really seemed to want to push me away from DS and to RNY, but I think I'm pretty determined to go with the DS at this point. Before I left, I met with a lady named Teresa who called my insurance company to try to get some straight answers out of them. They essentially said what they've been saying all along - that it is excluded from my benefits. I know there is a clause in my benefits that states that all things listed were not all-inclusive and whether something was listed as excluded or not, the final determination is made at the time I file a claim. So pretty much, they won't tell me what I need to try to get approved. This leaves me with 2 options.

Option #1 
Begin a 6month doctor monitored weight loss plan and after completing my psych and nutricianist consults, file for approval and hope they approve me. This option would mean I probably wouldn't be able to have surgery until January 2009, and even then, Dr S is not in network, so his fees will only be 70% of 'reasonable and customary' covered - rest on me.  It would take me longer, but it would be much cheaper.

Option #2
Get a loan and pay for everything myself. If I take this option, it will be expensive. They estimated I would have to pay ~ $27,000 for the surgery (including surgeon's fees, anesthesia, hospital fees and some follow up- 9 wks maybe? I don't remember at the moment..) I would also have to pay for any follow up visits ($200-$300) and possibly lab work (the lab work could be covered if they code it as being malnutriction related and not obesity related)

So what to do... I know my mom will not like option #2 (I don't think she'll like option #1 either though!!) I keep trying to tell myself 'it's only 6 months' and 'it's not like I'm gonna die tomorrow from my obesity!' but at the same time I am very anxious to have it done.

As much as I hate to delay surgery, I'm thinking I might just have to go to option #1 and work hard to get approved by my insurance. I'm not made of money, and even if I work so hard and still get denied, that's 6months I can be saving up to pay for the surgery myself. (Well, maybe more like 4 or 5 months... my current savings money is going towards my new apartment at end of june...)

Anyway.. I have to make some decisions and talk it over with my boyfriend... and maybe mom. I dunno though.. I don't think I'm gonna say anything to her just yet >.<;

To do list:
Schedule psych appt
Schedule nut appt
Look into 6mo WL plan options w/ my PCP or John Hopkins

I've been told again and again.. 'we'll call you' but was never called. Finally yesertdary I called and sat with their line ringing for like.. 20 MINUTES before someone picked up the line. Monique, who schedules appointments, was at lunch, but I was assured she would call me back later. And she did! I am having my first consultation with Dr S on Monday 4/21!

I am now leaning more towards DS surgery so I am eager to hear what Dr S has to say about my options and what he thinks will be best for me.

I'm still unsure of if my insurance will pay or not. I'm kind of suspecting they will deny my initial request for not having a very strongly documented weight loss history, but I am planning to join curves and weight watchers and begin documenting my progress so that hopefully I will be able to convince them on appeals. I just hate that I will have to wait so long before anything really happens! This is important enough to me that I am willing to pay for it myself, but it would really require me to take out a loan and have more debt.. which I would like to avoid!

But at least having the consultation date set, I feel more assured that things are moving along..

I have had sleep problems for a long time now, but since my sleep specialist prescribed me Ambien I have been dreaming again. My main sleep problems are that I am always tired throughout the day and I have trouble both falling asleep and staying asleep. I had a sleep study back in October - no sleep apnea (I do snore though). 

The study did show that my sleep is abnormal, primarily because I do not go into stage 4 sleep or REM sleep as much as I should (and those are the restorative stages of sleep - probably why I always feel tired regardless of amount of sleep).

So anyway - seeing my sleep specialist again next week, but in this time between my first visit with him and when I'll see him again, he did prescribe Ambien and it has been helpful in falling asleep. I don't often remember having dreams, but when I do, they are almost always very strange and sometimes disturbing.

Last night in my dream, I looked in the mirror and the face I saw was very different. For one thing, I had bright blue eyes - unnaturally blue. (My eyes are a grey-green). My hair was very dark and very thin, but still curly (I have naturally curly hair which is usually full of volume) and probably the strangest of all.. my face looked extremely gaunt, like I had been starving.

That is the only part of the dream I can remember. I've thought about what it could mean, and I suspect it's the result of my worries of what could happen after I have WLS (malnutrition). I still don't get the blue eyes though... >.>;

I'm getting really frustrated with my insurance. First, I feared they wouldn't cover it because it's excluded. I called my insurance company and was told that my plan will cover the surgery on a case by case basis. GREAT! So I ask him about what's needed to make my case. He beats around the bush and doesn't really give me any solid info. Some OH members suggested contacting them again and getting some information in writing. So I think okay, I'll contact them this time via their web messaging feature instead of the phone so I have a written response. This time I am told the surgery IS excluded and they won't pay for it. WTF?? I replied and asked again to clarify, informing them of how I was previously told otherwise. No response yet, but I am getting very discouraged. 

I've also been frustrated because I can't seem to call Dr. S's office directly to make an appointment. I've tried called the number he lists on his site (which apparently you can't call for consultations) and I tried calling several other numbers with no success. When asking for a consultation online I'm told 'his office will call me.' Chances are I will miss that call when it comes, as it will be while I'm working and can't answer - I'd much rather call and schedule myself at my own convenience. 

I'm really trying not to let this turn me off. I have been so happy and motivated looking to do this and I'm just not sure where I can get any information I can trust from my insurance company :(