Stacy H.

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Ok so obviously this was MUCH quicker than I expected to be updating this.  I mailed out my appeal one week ago today, I got a call today from the company that does the reviews (that is who I had to appeal to) to let me know MY SURGERY IS APPROVED!!! HOLY COW THAT WAS QUICK!!!!  I still can't believe it.  When I found out they had called I was so scared to call them back, I had all these thoughts in my mind.  First I figured they just wanted more info, then I thought what if they tell me I am denied, then I thought surely they wouldn't tell me that over the phone...but if they wouldn't tell me I'm denied over they phone they aren't going to tell me I'm approved either...they must just want more info. I went in the bathroom at work and prayed before I called the lady back, I was so nervous. So I called back and the lady says real calmly because it's no big deal to her "I was calling to let you know your appeal was reviewed and your request for gastric bypass surgery has been approved"!!! I thought I was going to fall out of my chair. She said they will call the Dr. and get a surgery date because they will put that specific date in the approval letter.  The approval only covers one night in the hospital but if I need more time they can call and tell them. As soon as I got off the phone I jumped up and gave Jennie a hug (the friend I work with who had RNY with my Dr last year and has been a tremendous help and support to me) then I went back to the bathroom, prayed again to THANK GOD and cried for a few minutes, LOL. I was so overwhelmed with joy. I just can't believe this has finally happened. I am so happy and I can't wait to start my new life.  I will get to be the healthy, active, fun Mommy that Hannah deserves.  I could not ask for more than that.  I will update when I get my surgery date!

Wow sorry it has been so long since I updated this.  Not much has happened really but believe me this surgery has been on my mind every single day.  If there was anything I do can do ensure that this would all work out, I would do it.  I want and need this surgery so bad I just can't stand to think of not having it.  Anyway as for the last two months a few things have happened I guess. First off, I had applied for life insurance back before my denial ever happened.  I figured if I was going to have this surgery I should have life insurance just in case.  Well I got denied for surgery and kind of forgot about the whole life ins thing until I got a letter from that company.  It stated that they could not offer me life insurance!!  My husband who is 8.5yrs older than me AND uses tobacco products got approved, but not me at 25yrs old and non tobacco user.  Hmmm I wonder why it could have been denied?! The letter said I could request more info.  Well I knew damn well the denial was 100% because of my obesity and I thought what better way to prove that my obesity is "a threat to member's life" than to be able to send evidence that my life cannot be insured for that exact reason.  It was a blow and a hard thing to realize I am so bad off that someone will not insure me but I tried to only look at the positive side which was that this COULD greatly help my chances of approval, worth a shot anyway.  Well it took a month for me to get that stinkin letter from the life ins.  I just got it two days ago and I mailed in my appeal yesterday.  I included a 4 page letter from me, it had a lot of statistical stuff but also a lot of personal practical begging please save me for my daughter type stuff.  I felt like a drama queen writing it but I guess this life ins thing proves that this is more serious than even what I like to admit to.  Anyway I also included the life ins letter, some pics of me in a bathing suit (EEK!!) and picture of my beautiful daughter who I do not want to leave without a Mommy.  I even put a post it note on the pictures that said "I am a real person with a real family, not just a case number please remember that.  You have the ability and opportunity to greatly change and improve our lives" in hopes that I will get someone with a heart to review my case this time.  I am so scared now.  Just knowing that there is an "end in sight" so to speak.  I mean if it got denied again yes I could appeal AGAIN but if it happened I really don't know what I would do or how well I would handle it.  I feel like this is the end good or bad and I hate not knowing and having my future in someone else's hands.  I mean if I could lose and maintain the weight loss I would have never decided to have surgery.  So if I don't get surgery, where does that leave me?  Destined to spend my life like this?  I sure hope not.  I just want it to work out so bad and I am so afraid but all I can do is pray.  I am pestering God to death I think, He is probably so sick of me LOL.  Anyway that is the update here and now once they get this packet they have 30 days to decide.  So I will know something by the end of August or so at the latest, I will upate as soon as I find out!

Ok I guess I totally jinxed myself with the last time I wrote. I just got off the phone with my insurance company and they said my surgery has been denied. They said your BMI has to be above 40 for more than 4 years. I was totally unprepared for this, as you can tell from my last post I never dreamed I would not get approved.  They said my weight is not an immediate threat to my life, I guess I have to be about to die before they will pay for it.  I don't know what to think my head is just kind of spinning and I am still at work (on lunch right now) and I have to try to function the rest of the day.  This is so horrible.  Well maybe I will come back when I can think, I am going to appeal this but who knows if it will help or not. I will try that's all I can do.

Well luckily I decided to keep checking up on and pestering my insurance company last week.  I called on Monday (the day after I last updated) and they told me there was no update and the file must still be in review.  The send the file to another company that does the review for medical necessity. Well I had been told that it had been forwarded to those people when I talked to my insurance on 5-9.  Anyway I got the phone number for the other people and called them and guess what? They had NOTHING on me, had never heard of me, no "file built for me" yet. So that girl called my insurance and they said they would fax it to her that day.  She said she would call and let me know when she got it.  Well she never called so I called back that night around 5pm and she was already gone of course. I left her a voice mail.  Anyway the next day she called me back and said she had called my insurance 3 times the day before and every time they said they had faxed it yet she had not received. So when I was talking to her she said she did finally have all 55 pages (LOL) in her hand and it was actually going to be reviewed now.  This was on Thursday May 19. She said it should take 72hrs-4 days SO I SHOULD definately know something by this time next week, should be before this time next week but I'm learning not to count on anything.  I just want this part to be over and to get a date set.  I talked to my manager at work yesterday and told her about it.  She was soooo understanding and that made me feel a lot better. She said whatever comes up with the date and everything we will work it out.  So now I just need to get the approval so I can find out what the date will be.  See how positive I'm being? I'm not even going to let myself worry about being denied, it's just a matter of WHEN I will get my approval not IF (I hope)!!

Well it has now been 2 months since my initial consultation which I guess is really not that long and things are moving along smoothly.  I had my cardiology evaluation done on 4-20, unfortunately it took until 5-5 for me to get the info from the cardiolgist so that I could turn it in to my insurance. I was NOT happy about the wait but at least it is done now and that is the last thing they needed. I called last Monday 5-9 and the ins said they had everything now and would be fowarding it to the nurses that review the info to determine the medical necessity.  I will most likely get my approval by the end of this coming week! If that happens and Dr. Cacucci is still scheduled out about 1.5 month then my surgery should be late June or early July.  I am really hoping for surgery to be around June 23 because I will need 2 weeks off after and that is a time I can get off work. If that does not work out I may have to wait until August! Please pray that everything will work out as well as everything has so far.  I am getting so excited, I just can't wait to be approved! Be back soon I hope!

Thought I should update what has been going on with me. I finally got my ccc that I needed and mailed my packet of info to the insurance on 3-31.  I sent it certified mail with a return receipt and I did not get the receipt back until 4-7 on the same day I got a letter in the mail from the insurance asking for basically the same thing I had faxed them the week before, the ccc. I guess they had crossed paths or something who knows.  I called and they told me they did receive it and it was being reviewed and the pre existing conditions limitation should be lifted within 10 days. Then today I got another letter in the mail from my insurance requesting more info in order for approval. The three things they want are info about the experience of my surgeon, info about the aftercare program and a cardiology evaluation. A friend of mine who had surgery last year who has the same insurance got this exact same letter. Once she provided those things she was approved within 2 weeks. So now I am starting to get really excited. Of course it is the weekend so I have to wait until Monday but I am going to call first thing Monday morning and get everything set up. I think if I see a cardiologist here instead of going to St.V's I can get the info for them in about a week plus not have to miss a day of work. That means if I get the info to them in 1-2 weeks and it takes 2 weeks after that for approval I would be approved by the first part of May!!!!!! Ok I'm getting ahead of myself. Anyway I happy about this much and I'll keep you updated on what happens next.

Not a whole lot has changed but I thought I'd update what has happened. I had my initial consultation with Dr.Cacucci on Monday 3-14.  The first part was in a classroom setting where she explained everything about the surgery iteself, the risks and complications, the diet and lifestyle changes after surgery, restrictions, etc.  I knew most of it from all the research I have done on my own LOL.  Then we met with her one on one for like 5 minutes maybe.  I had my psych evaluation after that and it went well.  Dr.Smith (psychologist) said I was a really good candidate and gave me his letter for my insurance.  As of today I have everything together to submit to the insurance including med record copies, letter from Dr.Cacucci (surgeon), letter from Dr.Smith (psychologist), letter from Dr.Landry (OB/GYN), weight loss history including records from WW attempts, and a photo collage I made of myself from 1999-present.  The only problem is I still do not have the stupid certificate of credible coverage I need in order to get the preexisting limitation lifted. GRRR, I have called 3 times trying to get it and will call again tomorrow. Hoping I can get it by the end of the week and send everything in by Friday, keep your fingers crossed that it works out that way. I am so excited, I just want to get the show on the road.

Yesterday I received my cards for my new insurance coverage so today I called to schedule my initial consultaton. Turns out they can get me in on Monday (today is Friday)!!! WOW! I am so nervous, anxious, excited, etc I just don't know what to feel. Then when I got home today I had a letter in the mail from my ins company saying I would be under the pre existing conditions limitation until 12-28-05! I called and they said if I can send in proof of credible coverage for the past year then there will not be any limitation on me. I have had other insurance for longer than that so it should not be a problem but it scared me at first. I tried to call the other ins company to get the certificate of credible coverage and they were already closed so now I have to wait until Monday for that. I am also scheduled for a psych evaluation Monday after my consult with the surgeon. Please pray this will all work out and quickly, I am so ready to get this surgery!!