Susan H.

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That's it! I got it in the mail! The last denial from the Independent Review Board. I've gone through all of the appeals I can do with this insurance company.
I just cannot believe they say I'm not a candidate. It's beyond me. And I realized if one word was changed, I would've been approved right away.
The doctor that wrote up the analysis from my sleep study wrote the word "MILD" when referred to sleep apneal. If the word was "MAJOR" or another stronger word, I would've been approved.
Crazy...huh?
Of course if I had diabetes (just a matter of time) and other harsher co-morbidities I would also have been approved. But I didn't want to wait until then. 
.....sigh.......
Husband is away on vacation for his mother's family reunion. I don't even have him to lean on right now.

I've been looking into lap RNY in Mexico. I'm worried about that, but need to research more. And worried about financing such a thing.

WHY? Why does this have to be so darned important and sooooooooo difficult????

Makes me sad.....

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Well....as you can see, it's been a long time since I have posted. The reason(s)....denied...denied...denied!!!!!!!!!
Yep.....I cannot tell you how hard it is to hear "DENIED" again and again on a subject that is so important to me. It hurts....to the sole. Because of this, I have not been able to get on OH to see the 'before and after' pictures. Read the positive experiences, etc. It just hurts too bad.
I have been waiting and fighting for my WLS now for over 2 years now. Every holiday or special occasion that comes and goes I thought I would see as the new, healthy me. Instead...it's the same old me.
I'm not a negative person in life. I try to see the glass as half full, not half empty. But this has been the challenge of my life. The test of all tests of patience.And it continues still...
My attorney and I have exhausted all but one last attempt for to hear an "Approved". We have gone through the appeal process as it is written and now are at the Independent Review stage. My only hope is that the independent review stage is outside of the insurance company. Even my attorney has backed off on the communication with me. Which makes me feel that we have already lost this last attempt. 
I have briefly looked at going to Mexico for the surgery. I do not want the Lap Band. That surgery is great, but just not for me. I need more help. Unfortunately, it is hard to find anywhere that does the RNY in mexico. I even thought of Canada, since I'm so close. Nope...cannot locate a clinic.
....sigh.....
I recently decided to get up and get moving in the right direction. Only I can make the changes that I need. And getting some exercise now, will only help if and when I get the surgery.
I LOVE horses and have a few beautiful mares. The timing was such that I had just sold some babies and decieded to put my Percheron mare (draft) into training to get her started so we can hit the trails this summer. Being a draft, she can carry more weight. All was going incredibly well. I had a few lessons under my belt on her and was feeling very confident and so happy that I was actually in the saddle again. Even if it was when I am at my heaviest. It is a great way to get some exercise...believe it or not. 
Until.....
On June 14th, I was at my last lesson. My best friend came with me for support. We were all done with the lesson and I was just sitting on her talkng to my trainer who was on the ground next to me. All of a sudden the 25-30 horses in the pasture behind us ALL started running from fear from something and hollering. Instinct told Bella to move out, and fast. And that is just what she did. Right out from under me. I fell the 6' straight onto my tailbone.....crash! Instinct made me hold onto the reins so she wouldn't run away, but that spun me right into the metal pole of the corral with my forehead for a complete and total stop. BANG! Out like a light!
I don't recall much other than trying to get up because I had SOOOO much to do. My brother was flying in that afternoon, my son's HS graduation was the next day, I had to go grocery shopping, cleaning, and had a big party at my home coming on Saturday. I HAD to get up.
Wasn't happening. 911 was called, I was wisked off to the trauma unit for x-rays and cat scans. I fractured my skull and tailbone. Nice...huh?
My husband rented me a wheelchair so I could make it to his graduation. What a guy! I made it. And even saw my X that I haven't seen in 6 yrs. Not the way I was thinking it was going to be, but I was in so much pain I could care less!
Now it is 3 weeks after the accident. My racoon eyes have almost disappeared. My lump on the forehead is smaller, but still ouchy. It's the tailbone that is the worst! Boy....you don't think about the tailbone at all until you hurt it. OUCH!!!!!!!!!  My doctor was surprised that I was alive let alone walking! I guess that is a testament to my potato picking blood! Low to the ground and squatty! Good hard bones! Thank God! (everyday!)
I do NOT blame my horse. It was not her fault at all. It is and was mine for being so comfortable and unalert while on her. 
Now comes the healing of the body...which is more sore than you can imagine. And the healing of my confidence with my horse. Being older, it is making it a bit harder to bounce back. Excuse the pun...  ;0)

So....there is my last few months. I will try to be better at posting more often.

Sent it off to the “Bad Guys”!!

 

 

 

Sorry for not posting in awhile. Nothing has happened to post concerning my WLS. As my last post stated, I hired an attorney to do my appeal to my insurance provider. I didn’t have the cash up front to retain Walter Lindstrom but that was not a problem for them. They worked with me on payments. I also, scary as it is, applied for a credit card for just this matter. And got it! I really had to step outside of the box for that one. I don’t like credit, for a number of reasons, but I had to do this…for me. Wow…what a concept!

 

 

 

On Monday, March 19, 2007, Walter emailed me and told me that he had sent off my appeal to the “Bad Guys”. They have 10 days to answer.

 

 

 

Wow…10 days. I have been patient, but this is going to kill me!

 

 

 

Stay tuned…..

Happy Post V-day! I hope it was great for everyone!!
Non-eventful here. I had to work super late. Plus (an excuse because he doesn't like thinking ahead) hubby doesn't like Valentines day. He says it isn't for anything but for the stores. It's too commercial and all about money. ....sigh..... It kinda hurts my feelings. But I'll get over it. I will have to buy myself something nice! YEA...that'll do it!

Well, I did it. I finally made a decision to hire an attorney to help me with my appeal for WLS. Because the wording in my denial letter is so vague, I found myself having a hard time trying to word a letter that would change their minds and approve me.

So.....I'll let you know how it goes!

Stay tuned....

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I am just sitting here watching the Superbowl and thought I would put in a little post.
Nothing much is happening towards the WLS at this point. I am on my 4th week of WW (weight watchers) and really don't like it. I am just not "in that place" right now, so it sounds like a lot of born again preaching. Hope that doesn't offend anyone, I just didn't know how to explain it. Sorry.... I feel that way because I know I am just there to wait my time. YES....I am hearing a lot of important things that will help me on the other side. But I've been fighting my weight for years and years, I pretty much know everything they are talking about. You know what I mean? I could teach the class! All though I sure wouldn't be as cute and energetic and the lil thing they have teaching it!
I have posted and have asked people about their denials and challeges. I wanted to know how people got through this part of the journey. I will call this....the UPHILL part of the journey. You know? the part right before the crest of the hill? That is where I feel I am at.
I have met and chatted with some really nice and supportive people since I've posted. I sure hope I can help people on the other side like they have for me. They keep me going.
Right now I am fighting within myself if I want to hire obesitylaw.com to help me with my appeal or try on my own. If I had a cc I would charge it and make payments. But I don't....we cut them up a few years back. ....sigh.....  I am leaning toward retaining him though. I feel this is going to be a tough fight. 
For most criteria, I make it hands down. But because mine was rewritten for the new year, they have some pretty vague and strange language in their criteria that I feel will make it very tough to be approved if I did it on my own.
OK....I think that does it. I answered my own question by posting this. I will see what I can come up with to retain him.
I hope this finds you ALL having a great new year!

Till next time,
Susan
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Against all the cells in my body, I have waited patiently to hear back from my inusurance company about my WLS application. It went in on January 5th. Well....."The Letter" came in the mail...on a Saturday to boot. Probably so I couldn't call them. ;0)  
As suspected, figured, known....I am "DENIED" for surgery. I read on to see what the reason...reasonS, were. The first one was so suprising to me. It said "...you do not have diabetes or another rare disease that would qualify you for the procedure." WHAT!? Rare disease??? HUH??? Shoot...If I had a "rare disease" I think WLS wouldn't even be on my mind!
It went on..." In addition there is not documentation of a psychological examination performed by a licensed menthal health worker indicating your mental health status or ability to comply with pre-operative requirements and post-operative lifestyle and dietary changes. Also not included in the documentation is an assessment of your pre-operative physical condition or surgical risk assessment by a bariatric surgeon. There is no evidence of participation in a medically structured weight loss program with at least 5% wieght loss that must be maintained up until the time of surgery." And then, of course, it went on to tell me about the appeal process.

.....sigh......

Yes...it was what was expected. Actually a little more difficult of a Denial than expected. Somewhere inside, I was really hoping, Praying....for the letter to read ACCEPTED.

I have to admit, I was sad and disappointed....and I allowed myself those feelings. I cried, pouted, etc. for half the day. Than I worked out in the barn (and 25 degree weather) and by the end of the day, plus a nice hot shower, the sadness has passed, and I can begin to see and feel the fighter coming out. 
I am a fighter. I don't give up. This is for ME! MY LIFE...dammit. I will go and appeal and get this done. The psch eval, and the other eval....no problem. The 6 mo. weight loss program.....darn....I really thought they did out with that 2 yrs. ago. But what the heck do I do about the "not have diabetes or other rare disease"????  Has anyone ever heard that one? 
It sounds like...you are not sick or dying enough for us to consider you. Well that is extremely judgemental. Who says that I am not a good candidate for WLS? Come and see me and my life. See all the things that I cannot do because of my weight. Or the things that I do, but would be quicker, and MUCH easier being a thinner & healther person. THAN tell me that I am not a good candidate!!

OH....hear that???  That is the fighter showing her teeth!! ;0) Here she comes....Watch out Group Health Cooperative....
I'm coming and I only want to hear one thing...ACCEPTED!

=0)

Against all cells in my body, I have waited patiently to hear back from my inusurance company about my WLS application. It went in on January 5th. Well.....it came in...on a Saturday to boot. Probably so I couldn't call them. ;0)  
As suspected, figured, known....I am "DENIED" for surgery. I read on to see what the reason...reasonS, were. The first one was so suprising to me. It said "...you do not have diabetes or another rare disease that would qualify you for the procedure. In addition there is not documentation of a psychological examination performed by a licensed menthal health worker indicating your mental health status or ability to comply with pre-operative requirements and post-operative lifestyle and dietary changes. Also not included in the documentation is an assessment of your pre-operative physical condition or surgical risk assessment by a bariatric surgeon. There is no evidence of participation in a medically structured weight loss program with at least 5% wieght loss that must be maintained up until the time of surgery." And then it went on to tell me about the appeal process.

.....sigh......

Yes...it was what was expected. Actually a little more difficult of an appeal than expected. But somewhere inside, I was really hoping, Praying....for the letter to read accepted.

I have to admit, I was sad and disappointed....and I allowed myself those feelings. I cried, pouted, etc for half the day. I worked out in the barn (and 25 degree weather) and by the end of the day, plus a nice hot shower, the sadness has passed, and I can begin to see and feel the fighter coming out. 
I am a fighter. I don't give up. This is for ME! MY life...dammit. I will go and appeal and get this done. The pschy eval, and the other eval....no problem. The 6 mo. weight loss program.....darn....I really thought they did out with that 2 yrs. ago. But what the heck do I do about the "not have diabetes or other rare disease"????  Has anyone ever heard that one? 
It sounds like...you are not sick or dying enough for us to consider you. Well that is extremely judgemental. Who says that I am not a good candidate for WLS? Come and see me and my life. See all the things that I cannot do because of my weight. Or the things that I do, but would be quicker, and MUCH easier being a thinner & healther person. THAN tell me that I am not a good candidate!!

OH....hear that???  That is the fighter showing her teeth!! ;0) Here she comes....Watch out Group Health Cooperative....
I'm coming and I only want to hear one thing...ACCEPTED!

=0)

HAPPY NEW YEAR!!! Hears to a great 2007!!!  Well....my WLS application was submitted today to the medical board for review and hopefully accepted.
There was a bit of hesitation by my PCP, however. It seems that the criteria has changed. By last years standards, I was a slam dunk. This year they took off GERD as one of the check marks. He said he supposes it is because many people have it and it is not necessarily related totally to weight.  And they added back, after two years off, the 6 months of documented weightloss classes/courses/etc.

....sigh......

Dang the bad luck! He sent me to get my knees xrayed for arthritis due to weight bearing.  The thing is....I'm a pretty healthy fat person. My blood pressure is good. My chloresterol (sp?) is good. Although, my good chloresterol is low, but can be changed quickly with diet. And my iron is low....again....diet.  I really, really had to really face myself and do a head to toe evaluation of what I was really feeling and hiding. OH MY...did the aches and pains pop up! It is amazing to me how much I lied to myself. How horrible is that!!?? I guess it started with not looking in mirrors, avoiding cameras, avoiding other things like chairs, movies, booths...etc. You know what I am talking about? I'm sure you do....or at least some of you. Then came the documentation ....fast forward...here I am.
Ok...patience is not in my vocabulary. I hae the patience of a Thoroughbred at the starting gate. NIL! NADA! ZIP!  So now that the ball is rolling I find myself thinking about the surgery and life after it, all the time. Is that normal?
One thing is that the holidays caught up with me in full force and has finally laid me out! I finally went to the doctor for some help to clear this up. I don't like to take antibiotics if I don't have to. I like colds to take their course while I up the vitamin C and such. Well....that didn't work this time. My immune system could not beat this and now I have horrible vertigo! I've never had it before, nor would I like it again. It is not fun. But.....the scale said 4 lbs. lighter!!!   hahaha...I do not suggest sickness as a way to lose weight.

Alright....enough babble....I just wanted to update on what was going on in my WLS journey.

Till next time....
Susan
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.....sigh.....
I've been have a rough time lately....and it all seems to center around my weight. 
I am so sick and tired of being FAT! It hurts hurting all the time. It sucks having to think about having to go out and walk around to do anything. I find myself being lazier and lazier because it absolutely kills my feet lately to walk. Not to mention my knees....my back (when standing too long) etc.....
So hence....the pity party. It's not right! I don't want to be like this! All I hearis the ugly, little voice....well you got yourself here. Get up...get moving. Stop eating! And it will be all better.

....sigh.....

Why does it hurt so bad when you hurt?

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