Chandra A.
My New Birthday!
May 27, 2008
Journey to Approval
Apr 12, 2008
I suppose that while going through the 6 month doctor supervised diet I could have gotten other things out of the way like the psych evaluation. But, in all honesty, the psych evaluation was $295 and I knew I wouldn't have the money until Jan 08 when money was put into my medical spending account. Because of that, I spent 07 concentrating on the documented diet. I met with a nutrionist through my PCP. I really didn't like the nutrionist. It had nothing to do with nutrional information but rather with his demeanor. Before I met with him, we spoke on the phone and he was vague about how I'd be billed and went on to say that he would work with my insurance if there was any issue with him being covered. But, once I got there, all of a sudden he didn't remember our conversation. He rushed through the consultation and went on to lecture me about what insurance would and wouldn't cover. However, he knew very little about my insurance requirements. I made sure to tell my PCP at my next follow up appt.
I then started on my 6 month diet. I was my PCP's first patient to try to get gastric bypass but he and his office was very supportive. I knew that I had to have 6 month of documented diet. My policy did not say it had to be consecutive but Centennial said it was best for it to be so that they could not come back later and deny me for that reason. I found through all of this how important it is to surround yourself with those who are knowledgeable. I primarily used OH to research hospitals and surgeons. Now let me preface this by saying that in no way am I demeaning other surgeons or hospitals. But, when I read reviews of area hospitals, Centennial consistantly came out on top. While the facility is important, to me the staff was as much so if not more. I've never had major surgery or be in the hospital overnight.
So, I tried very hard to maintain the diet and made sure I went in and weighed every month. This went from Feb 07 until Sept 07. I gained then I lost. At the end, I was 1 lb less then when I started. Frustrating, but just further went to show why I "needed" this. Once the new year started, I had funds in my medical spending acct to have the psych evaluation done. I had my psych eval done on Jan 18 08. I then began gathering my medical records. This took longer than I would have liked because I had to get a medical release form mailed from my prior PCP out of state. I got her records faxed to my current PCP. I faxed over the packet/ forms that Centennial gave me the prior year at the seminar to Centennial. I had my PCP do the "letter of support". Once all of the medical records were together they were faxed to Centennial on March 10th. Centennial called me back and asked for lab work to be done and to schedule a nutrional evaluation with them. I went into my PCP on March 14th for the lab work and the nutrional eval was done on March 24th
At the nutrional eval, I met with Centennial's nutrionist and she went over a packet detailing my diet after WLS. It was very informational and I have wore it out already reading and re-reading. And highlighting. Centennial faxed my paper work to BCBS of NY (Excellus) on March 27th.
At this point, after burning the diet packet into my brain, I started thinking about a few things. I had seen a post on the OH TN board about soda after WLS. And, I got to really thinking. Soda has always been a huge addiction for me. And, I must tell on myself. Because food is an addiction like alcohol, cigarettes or drugs. There were times that I would run out of coke and frankly be too lazy to drive to the grocery. So, I would order delivery pizza just to get a 2 litre of Coke. In hindsight, it was overly ridiculous. But, that has been one of the ugly things about my diet or lack there of. I'm ashamed when I think about that. I could put away a 2 litre in a couple hours. I could come home from work and easily drink 6 cans of soda. Very stupid on my part considering the high calorie and sugar content.
But, now I know that I'm getting ready to make probably the biggest life altering choice I will ever make. I got to thinking that if I'm going to be really dedicated to this, I needed to go ahead and get on with it. On March 28th, I started weening myself off of soda. I guess it's kind of funny now. Once I set my mind to it, it wasn't as hard as I thought it would be. Yet again, I paced myself. I just didn't bring the same amount into the house. I bought a big case of bottled of water and bought cold brew tea. Now for the first week I was still making tea with granulated sugar. But, I replaced the majority of soda with water or tea. After the first week, I then cut back the coke more and replaced sugar with a Wal Mart knock off of Splenda. Now, I had heard mixed reviews on the "fake" sugar. I've heard some say it tastes bad because of an after taste. Being a southern woman who's drunk sweet tea my whole life, I have to tell you that I think it's OK. I don't find it offensive to the palette. I actually think it's pretty good for the fake stuff. I'm find more and more than soda is not tasting as good to me. Who'd thunk that would have ever happened.
I want to be fully ready the day of my surgery when I walk into the hospital. I want to know that I'm going to be OK mentally that I can't drink soda anymore. Right now, I am OK with that. My next thing is to get the carbs out. So, over the next couple weeks I'll be weening myself off of bread, pasta and potatoes. I'm really don't crave those kind of foods much. So, I hope that process will be painless.
On March 31st Centennial called to say that BCBS is requesting additional information on my diet. BCBS wanted "information on the last 6 months of diet". Huh? I hadn't been on a documented diet during that timeframe. Centennial suggested I just work up a food journal as best as I could for the last 6 months. I decided to do double duty. I went back to Feb 07 through current just to make sure they couldn't come back and say what I gave them wasn't what they wanted. I faxed that to Centennial on April 4th and they faxed it then to BCBS. I called BCBS on April 7th just to make sure that what I sent was acceptable. I spoke with a frontline claims rep who really wasn't very helpful. He said he could not yet see the document I faxed and that it takes 5 days for it to be in their system to be reviewed. Well OK. I asked if there was someone assigned to my claim and he could not answer that. He said there is a dept who reviews claims. OK, then can I speak to them? "Ma'am, I can't even speak to them." Well, OK. He said to give it until April 14th. I called Centennial and they assured me everything is OK and not to worry. This is normal. So, I thought to myself, I'll make my next call on the 14th.
On April 9th, I was at work and was wallking outside on my first break. I had my cell phone in my hand and it began to ring. I flipped it open and looked at the display and realized from the prefix that it is coming from the area of Centennial.
"May I speak with Chandra?" I said "This is she". "This is Holly from Dr. Houston's office and I was just calling to tell you that you are approved and to set up your consultation appt." I stopped dead where I was standing. My legs went weak and I thought they were about to go out from under neath me. I started shaking and I tried to talk but I was choked up and my voice caught in my throat. I started to cry. I was not crying over how long it had taken to get there. I was not crying because I got scared of having my guts sliced and diced. I cried from relief. I cried from joy. I cried for the past 13 yrs that I've been overweight. I cried for the blessing I just received and how blessed I felt in that very moment.
Holly asked if I was OK and if she needed to call me back. Well, I dried them tears up real quick and told her that wasn't necessary. I wanted to get this ball rolling. My appt for my consultation with Dr. Houston is set for April 21st. It is now just 8 days away and I couldn't be more excited. This is the rest of my life. I know that this will add years where as the weight was taking years away. I cannot wait for all the changes to happen and for me to have a chance to be more proactive at a better life.
For all the people who may read this, and wonder "Will I ever get where she is?". You will. Be determined. Don't give up. Don't get frustrated over how long it takes to meet insurance requirements. We didn't become obese over night. For the years we spent doing the wrong things then 6 months or a year to do the right thing is pocket change.
I was once where you are. Watching folks get approved. Watching them go through the joy of losing weight and having that better life that I dream of. Let them, us, be your inspiration and motivation. May God give you strength to continue on your journey to surgery and beyond surgery. Be blessed!
Seminare at Centennial Today
Feb 06, 2007
So, I went to my PCP and had them weigh me while I was there. But, I didn't want them to say the number out loud. I told my doctor just to write it down. I have not know my exact weight since I was 20 and 145 pounds. At that time, I was walking and jogging a couple miles a day. But, I went on birth control and they tell you that you may gain "a few pounds" but they don't tell you what can really happen. In a year's time my weight doubled and my blood pressure sky rocketed. The weight came on with such a fury that it was so hard on my body that I couldn't excercise the way I once did. Even then I didn't know my exact weight. I only knew that I went from wearing 8/10 to 24's. It was heart breaking.
When I left the doctor's office and got out to my car I pulled out the slip of paper he wrote my weight on. While I would love to say I was shocked I really wasn't. I knew my weight had gotten completely out of control and I was way past chunky. I had been guessing 350 and I was close. I weight 365. That is so hard to admit and come to terms with. I'm the size of 3 people.
But, I also rode a high all day long because of the seminar this evening. I'm so glad I've chosen Centennial. They are very comprehensive. Dr. Dyer gave the presentation about the surgery and Lisa (insurance specialist) and Debbie (RN) presented regarding insurance requirements. They were all so very thorough and so willing to answer questions. They really let you know what you are getting into. They place as much emphasis on the risks as the benefits. I feel very confident in their ability to aid me in my journey.
Centennial is a huge medical complex. I would suggest to anyone to leave early if it's your first time there. I got turned around about 3 times trying to find it and then got my fair share of exercise in trying to find my car in the parking garage when I was leaving. But, the facility is absolutely beautiful. Not at all the typical hospital vibe. It was very clean and aesthetic.
Now, I have to start a 6 month doctor supervised diet. But you know how things go with age, time just flies by and I'm sure the next 6 months will. I plan to do a lot of camping, swimming and sun tanning over the summer so that will help move things along. Hopefully with summer coming and me being more active outside will help the diet along it's path and maybe shed a few pounds to make my surgery go a little easier.
I also want to quit smoking before then. It's such a hard habit to break. My PCP did write a prescription for Chantix (smoking cessation) but I've just been very stressed lately. I know I'm using that as an excuse and there will always be stress in varying amounts. I just have to pull up my big girl panties and do what I need to do.
The Journey Begins
Jan 30, 2007
I had been doing some research through OH and looked at review for doctors and hospitals. I decided to have the WLS done by Dr. Houston at Centennial. I called Dr. Houston's office last week and was advised that before I could make my initial appointment that I had to go to a seminar. I have schedule to attend the seminar on Feb. 6th from 6-9PM. Wow! Three hours! Though I'm not shocked by the length of time the seminar takes because this is a HUGE decision. But, I'm prepared for this journey and this is the first step.
The same day I called Dr. Houston's office I also called my insurance company BCBS of NY. I had called them last year (2006) to just get a little bit of information about coverage. The had advised me then that the surgery is covered with a letter of medical necessity. Considering how overweight I am and the toll it's taking on my body I figure that letter should be the easy part.
As of Jan. 1st, 2007 I had my coverage with BCBS changed to 100% coverage so I called BCBS again about coverage. They informed me that to this date no one has been denied for the WLS under this plan. They again told me about the letter of medical necessity and a psych evaluation. Again, that I think is the easy part.
So, I'm getting excited about attending the seminar and I know that from here on out each thing I do is just another step closer to living my life the way I want to live it without the fat rolls tagging along for the ride. I was told that at the seminar is when I will name Dr. Houston as the surgeon and that they will assign a financial advisor. I'm not quite sure how much advising they will do because I am covered 100% and there is no deductible because Dr. Houston and Centennial are both in network. I was advised to check on the anethesia group to make sure that they are also in network.
So, as questions are coming up I am going to the message boards. I think this site is really what helped me to make the final decision. There is so much information here for research and the members know exactly every high and low you could possibly go through because they've been there.
I'm getting so ramped up and excited. I'm prepared to take 2 weeks off of work for recovery. I know that I can use FMLA through work to cover any attendance issue and protect my job while I'm off. Now, I'm just working on building up the paid time off so that financially I'll be OK. I think that is a fair and reasonable expectation. I work an office job and no physical labor and don't foresee going back to work to be an issue. I've heard some people say that a week recovery may be all I need. But, I'd rather be over prepared than under prepared. Plus, I need a vacation LOL The only difference is that my couch or bed will take place of a lounge chair and a protein drink the place of a fruity alchoholic beverage with a little umbrella. Well, I don't know that I'll have a cabana boy at my beck and call but I don't think I'd know what to do with him during recovery anyhow.
I'm feeling so blessed right now. I have faith that all will go well!