RhondaShoemaker

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In early September 2004, I decided that after 32 years of being overweight, enough was enough, and I called the Henry Ford Bariatric Center in Detroit. They sent me some information, and in the meantime, on September 13, 2004, I made an appointment with my PCP to get a referral.

When my appointment came, I was very pleased and my doctor (who I had never seen before, let alone pronounce her name) and she understood my problems.

So the journey has begun! Today, September 26th, I found this site and decided to join. I hope that I can find answers and help others as I gain experience.

After my second call to Wanda at Henry Ford (September 28th), I was told that IF I met HAP creditals, I would not need pre-approval from Medicare. This is a relief, as I was not sure how I could come up with the $1000.00 co-pay!

October 4, 2004 - not a good day as I was DENIED! I guess I don't have at least two of the co-morbities they listed that are uncontrolled. Give me a break. If I didn't take the medications, they would be!

So now goes the appear process!

October 5, 2004 - I called Tammy back and left a message that I needed a copy of the letter the doctor wrote and the full lab report. She called me back this afternoon and we believe that the dr just sent in the notes from the appointment I had with her on Sep 22nd. Those items will be ready for me to pick up in the morning. In the meantime, I told Tammy to tell the doctor to read my denial letter and to write a more forceful one for me.

I'm also having fun reading my journals from 20 years ago, while trying to document my various weight loss attempts.


October 6, 2004 - Got the "letter" my doctor sent - it was the Office Notes that she sent. Probably didn't even have the codes that I gave her. NEVER said I tried the South Beach Diet. Otherwise, it seems to follow what I said.

I am up to 1999 in my journals. I hope to have something together by Friday.

Also called HAP and they are supposed to send me an appeal packet.

October 7, 2004 - I'm downloading a trial version which is supposed to keep track of my weight. I'm hoping that I can use it to document my weight - so far 70 entries in my journals between 1978 - 2000. That's not including my Weight Watcher entries - I have the card from them for that, and it probably has at least a year's worth of entries there.

October 8, 2004 - I think I have my appeal letter pretty much in order. I'm waiting to get a letter from a doctor I see outside the Henry Ford System (he doesn't accept HAP) for documentation of my blood pressure, cholestrol, and a prescription for Meredia a few years back. I also made mention of a cousin who died last December - he weighed 578 lbs!!! Maybe that will turn the trick!

October 12, 2004 - As of 10:33 am EDT, I sent in my appeal to Health Alliance Plan. It went certified mail so I hope they realize I mean business!

October 15, 2004 - I got my return receipt today wso they can't say that they don't have it, as I now have proof!. I can't understand why it took two days to get to Detroit when I only live less than 25 miles from there, but took only one day to get the return receipt back to me!

October 19, 2004 - I called HAP this morning, and they said that the Grievance Unit had received my appeal on the 15th and that a letter of confirmation was sent on the 18th. I got this letter today, which states that I will be notified (in writing) of the outcome of my request, or provide me an update within 15 days if the case requires more time.

So I hope to know something by November 2nd.....

October 26, 2004 My appeal has been DENIED. I'm upset - I have to think about what to do next.

Ocotber 30, 2004 Ok, I was denied because I didn't have two life threatening co-morbidities. If I didn't take my medications, would my cholesterol and blood pressure be life threatening??

Anyhow, I called HAP and found out some interesting things! First of all, my medical records were supposedly requested - if they were, then the doctor never got them - only the stuff I sent in with my appeal letter was used. I got the name of the doctor - Muntaz Ibrahin. When I asked if he was a MD or DO, they wouldn't tell me. They couldn't tell me if he was practicing or not and if I wanted his schooling, education, and where he got his training, I'd have to write for it! It was not on either the HAP website or that of Henry Ford Hospital.

Yesterday I went to the State of Michigan website and went to the medical licensing, and put in his name for MD - NO RETURN!! Kinda makes me wonder if he is just some kid fresh out of medical school with no experience of ANY kind or some old man who is too old to practice medicine and hasn't kept up his license.

In the meantime, I have gotten my medical records from Henry Ford for the last 10 YEARS!! Since 1994, I have been descibed as obese, moderately obese and morbidly obese. HELLO???

To put the icing on the cake, I got on the scales and I am now at 235 lbs - with a BMI of 40.3, and according to HAP's Coverage, I am qualified to have bariatric surgery with or without co-morbidities! I may go and see my PCP next week and have a letter ready for her to sign and send it in with my appeal.

I have also talked to a friend of my sister's, who has had the surgery. I hope to get together with her sometime soon. I think it will be of a great help.

November 2 Well, today I went to see my PCP again, and she is going to fax information regarding my BMI, which is 40.42 (since I am now 235.5). She wants me to go on a diet, but I don't think I will until I see the surgeon and see what HE says. I may not have to lose any weight!

If this doesn't work (but I'm sure it will), then it's another appeal letter, this time to the Grievence Comittee....

November 10, 2004 Well, it only took two days to find out that my PCP DIDN'T do as I politely asked - no additional information was sent (fax or snail mail). I did find out the name of the lady for the Grievance Committee so you can bet I sent her a nice letter and the papers that my PCP was supposed to send. I also told her that I would be sending the info CERTIFIED MAIL (but didn't say I was sending it RESTRICTED DELIVERY). I hope that will show her how serious I am!!

November 15, 2004 I went to the USPS website to track and confirm my Certified Letter, and according to the website, it arrived on the 13th but wasn't delivered until this morning. I probably won't get the card back until tomorrow.

In the meantime, I have found out that MEDICARE also covers this surgery and I need a referral from my PCP specifying MEDICARE. I called Henry Ford Lakeside and talked to a really nice operator who took down all the info. I told her it MUST be done today. I even gave her the name of Tammy who had done my paperwork before. I don't know if Henry Ford Bariatric Surgery will need that document that I had my PCP sign or what.

I have managed to lose about 7 lbs, but I'm afraid that because I am now < 40 BMI, I will not be accepted, as I don't have co-morbidities that are uncontrolled....

November 19, 2004 One hand doesn't know what the other is doing. When HAP approves me, Medicare should approve me (says Wanda, the bariatric nurse at Henry Ford).

Today I call HAP on the status of my appeal - seems that I just got someone to sign for my additional info - not the person that it was addressed to. I was told that I would have a letter on Tuesday. When I asked if I was getting a letter saying they got my information, I was told no, it would be a YEAH or NAY. They would not tell me the decision over the phone. I told them that if I was denied, I would be appealing to the state.

I'm hoping for the best, but this will be the longest 96 hours I've waited out in a LONG time!

November 20, 2004At 2:38 pm I received word from HAP that I was approved for ONE visit with the psycharitist, and if that goes ok, then I will be approved for surgery!

November 23, 2004I've made my appointment with Dr. Cathy B. Frank for December 21, 2004. I asked if they could put me on a list if someone should cancel their appointment, I would like to get in earlier. I'd have to call, not them.

I guess I'm surprised that HAP would fork over money to have me see a psychartist instead of a psychologist or a social worker.

December 20, 2004 Tomorrow is my psych evaluation and I'm nervous like a cat in a room full of rocking chairs. It also doesn't help that my BMI is now 38.6. I have lost 10 lbs since November 2nd.

I'm scared shitless that I will be rejected, and I will NEVER get this surgery! Right now I feel ugly, unloved, and unwanted, and I will be trapped in this body FOREVER!!!

December 29, 2004 Well, between calling HAP and the doctor's office, I have found out that HAP has not gotten the evaluation because the transcription has not been returned to be sent out! UGH!! I wish I would hear something by Friday! It would be a great way to end the year.

January 5, 2005 It hasn't been a Happy New Year so far. After calling both HAP and the doctor's office for the last two days, Sheryl FINALLY called me back yesterday. I guess she is the unit secretary. Apparently my transcription of my psych evaluation was finished last week, and sent to HAP yesterday. I was able to provide her with a FAX Number to HAP, so MAYBE that will speed things up. I'm antsy as it is, and it doesn't help that we have a snow advisory out and that cribbage was cancelled.

Anyhow, Sheryl said to give it until Thursday to see if I hear something. Oh, and to make matters worse, she couldn't tell me if there was anything positive or negative in the report that might give me a thumbs-up or down to whether or not she recommended I have the surgery.

Oh, and mom was at it again - what if you aren't approved?? I need to hear that like I need a hole in my head. Doesn't sound like she's being positive to me...

January 6, 2005 I've been DENIED. No reason was given.

January 13, 2005 Well, I got my appeal letter to the Michigan Insurance Commissioner in Lansing, MI today. I made sure that it went Priority Mail, Certified, and Return Receipt.

At first the appeal was FOUR pages long, but I got it down to 1 1/2 pages (including the address and enclosures). Basically I told them that Dr. Cathy Frank was not fully prepared to do my evaluation, as she didn't have ANY of the information I had provided to HAP. I made sure to mention that her speciality was GERIATRIC psychiatry, not BARIATRIC.

So, in a nutshell, I gave them THREE options. The first was to reverse the denial. Second was to have another psychiatric evaluation with some guidelines. The third was to have 2-6 counseling sessions (on a weekly basis) and then to have another psychiatric evaluation (with the same guidelines as above). I hope and pray that this will take and that I can go thru with the surgery before too long!

January 31, 2005 Just a quick update - I was contacted by Valerie Glosson, who does the HMO appeals for the Michigan Insurance Commission on January 18th. She told me that they had received my packet, but the most inportant thing was missing - the release form that they require! UGH! I explained to her that HAP NEVER sent me these forms, only their address. I told her that I would download the forms and get them to her in the next few days.

Before I sent in the forms, I sent some additional information that I hope will help me. One of the items was a list of psychologists in the area that perform psych evaluations on people wishing to pursue bariatric surgery. I am hoping that this, as well as documentation to my being obese, moderately obese and morbidly obese, will help.

I also noted that at no time did HAP EVER ask me to sign any medical release forms.

March 4, 2005At 11:15 am I got a call from Valerie Glosson at the State Insurance Commission and the state is gonna REVERSE HAP's denial of surgery based on my 'failed' psych exam!!!

Right now I'm doing the "Happy dance"!! My angel must have been looking out for me and gave me this belated birthday present, which is the best, even better than my brother's $100 gift card (tho I will now probably used it to buy some NEW clothes when I get down to my goal weight)!!

So, this is what happens now - the state will send me a letter (along with one to HAP) giving their decision. HAP does have 60 days to appeal this decision, but most likely they will not. HAP will send me a letter with an authorization number, so then I can make my appointment with the surgeon.


At that time I will have them do the MEDICARE part, and that should be a piece of cake (pardon the pun).

By the way, my birthday was March 1st - I'm 44 and damn proud of it!

Right now I am for joy and could everyone I see!! Thank you everyone for all the that you have given me! Now this is what I call FANTASTIC!!


March 18, 2005My first consult has been scheduled for May 26, 2005!!! I can call myself a pre-op!!

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April 19, 2005 Today I OFFICIALLY received a letter from HAP stating that the decision had been reversed by the Michigan Office of Financial & Insurance Services, and that I can make my appointment with Dr. Genaw. DUH!!! I had an answer SEVEN WEEKS AGO! I made the appointment a month ago, but what really gets me is that I was told to take my psych eval with me to the appointment! DOUBLE DUH!! I signed a release form for them to get a copy of my eval, but why would it matter? I mean, I failed it, explained why in my final appeal, gave options, and HAP's decision was overturned.

I am also concerned that HAP may try to hold things up if Dr. Genaw has to write a letter getting pre-surgical authorization; I personally feel that he would not. The State has ordered HAP to pay, so I feel that this step is totally unnecessary and a waste of his time (as well as mine).

June 8, 2005 Today was my surgical consult with Dr. Genaw. It was over an hour before he actually came in, but I was able to spend 1/2 hour with him. Hey, he even liked my shirt!

I have to lose 5 lbs - wish I didn't have to lose a damn pound, but I will try to handle it as best as possible. My exercise physiologist is to be seen on June 30th, my medical clearance on July 11th and my second surgical consult is July 22nd. Somewhere in there I need to have some pre-op blood work and a chest x-ray done....Now I just have to wait and see what happens!

July 12, 2005 The exercise evluation on June 29th went fairly smooth. I have been walking each day, and right now I'm up to 20-22 minutes a day. Because of the weather being so hot, I break it into two segments.

I went to have my bloodwork and chest x-ray on July 8th. My medical clearance was yesterday, and everything looked great except my chest x-ray. It seems that I have a slight touch of arthritis on the spine! No wonder why I haven't been sleeping that great for the last few years! Guess who will be getting a new mattress very soon.

I'm down to 228 lbs. and I don't know who's scale is correct. That is one of the things I'm worried about when I see Dr. Genaw on the 22nd.

July 22, 2005 Well, I was scared this morning when I got on the scale before I left to see Dr. Genaw for my second surgical visit. I was 225.5 - half a pound shy of his "goal" of 5 pounds. I was afraid that my colitis would start acting up from my nerves. Between that and my parents coming along was not actually helping!

I got to the hospital and as soon as I got to the floor, I quickly checked in and then it was off to the bathroom for a last visit. As soon as I got out I had been called. They took my blood pressure (127/76) and I was shocked that my weight was 223.7 lbs - down 7.8 lbs from my visit with him on June 8th.

Dr. Genaw was about 30 minutes late, but spent over a half an hour with me. Everything seemed to be in order. My one concern was traveling after surgery. He did not recommend it, therefore I resigned myself to scheduling my suregery for September 15, 2005.

The one stipulation is that I MUST maintain my weight at 223.7 OR LESS. I will have a weigh in on September 7th and start my liquid diet the next day.

You would think it would have ended there, but now the soap opera begins!! I had to go down to pre-op testing, PLUS see the nurse! I had to wait 30 minutes before I was brought in for my blood work (a CBC and glucose). Then it was off to see the nurse, sorta!

Right after she started to interview me, someone yelled for her. Seems that one of the lab technicians was trying to pass out. She came back after a few minutes and got some crackers from her drawer, and left again. I even saw someone bring in a wheelchair. The next thing I knew I heard someone yelling for oxygen and getting a gurney instead of the wheelchair. At least this person was in the hospital!

Well, they lady came back and asked if someone could call me to finish the interview, and I said ok. I figured that she was needed somewhere else. I'm still waiting for the call....

August 11, 2005 It was interesting last week. Wanda called me late on Wednesday night (the 3rd) and told me that she couldn't find my psych eval as she needed it to submit to Medicare for approval on their end. She asked me where I had it done and I told her with Dr. Frank via Henry Ford, as that was what HAP assigned me to. Also, there was NO RECORD of the fax I sent to them regarding my order from the state or the decision of the IRO (independent review organization). Wanda is gonna try to get a copy of my psych eval.

She calls the next day and tells me that she now has the psych evail (which I so graciously failed). I ended up faxing here the additional info of the state's order.

August 31, 2005 Upon the advice of Dr. Genaw, I went ahead and went to the family reunion in KY this past weekend and enjoyed myself - probably my 'last fling' before I have my WLS. The only thing that wasn't right was my dad's snoring!

Surprisingly, I DID NOT GAIN ANY WEIGHT!!! That's enough to do the Happy Dance!!

I only have one week to go before my final weigh in. I haven't had any unusual cravings and I'm really afraid of going thru the 'last supper syndrome' and gaining weight. I must be at 223.7 lbs or less, otherwise they will cancel my surgery, and I don't want that.

I'm not really looking forward to a week of liquids, but I realize that this is only a small price to pay for the ultimate goal. It's hard to believe that my surgery will be two weeks from tomorrow!

September 7, 2005 Well, today was Judgement Day, as it was my final weigh in. I was scared to death that I hadn't maintained, as I had FOUR slices of pizza last night. But low and behold I was now 222.3 when I got on their scales!! I was 222.5 on mine (which, my brother decided to swipe this morning for some damn thing he was doing at work).

So now I have my 'last supper' tonight with my friends Cristie & KP tonight. I don't plan on chowing out until I am sick or anything like that. It's just not worth it!

Tomorrow I start my liquid diet and will be on it until my surgery. I just hope that I can get thru this part - I may be a harder hoop to jump thru than the others.

September 11, 2005 Day Four of my liquid diet and so far so good, but I'm having problems with dry mouth.