Tammy_in_PA
Badly needed update
Nov 24, 2009
After all failed trying to go through insurance, I thought for sure the DS would never happen. When one door closes, a window usually opens. My open window came with very unfortunate circumstances, but a window nonetheless. My father-in-law passed away this past spring. With his passing, we became the beneficiaries of money we didn't plan on having. My husband handed me a check and said go book your surgery. With that, I immediately made plans to fly to Brazil to have my surgery with Dr. Marchesini.
I arrived in Curitiba by myself on June 29th, had my appointment with Dr M that evening, and surgery was scheduled for the following afternoon. I woke from anesthesia and immediately began throwing up. It took three shots of three different medications to make it stop. Once it did, I haven't thrown up since. Surgery went perfectly and aside from having difficulty sleeping, I had no complaints. I was NPO for 5 days, not that I wanted anything, but water woulda been nice.
I left the hospital for the hotel where I met my mom who flew in to be with me for a week. My first night was very restless. The recliner they put in my room was extremely uncomfortable and it was impossible to lay down in the bed and be comfortable. The following day, later in the evening, I realized I had a fever. I called Dr M, who immediately left his office and came to the hotel. He thought it would benefit me more being back in the hospital. He personally drove my mom and I there. They did a leak test, which I passed with no problem and then they took some chest x-rays. It showed I had a partially collapsed lung.
I was readmitted to the hospital for 24 hours of IV antibiotics and more therapy. Went back to the hotel the next day and had to have therapy once a day for the next couple of days, as well as shots once a day of whatever antibiotic I was on.
Aside from this little drama, I have had a relatively easy recovery. I don't remember having any pain, very little discomfort, and tolerated everything I put in my mouth. I hit the Brazilian BBQ with some other Americans at about 2 weeks out, where I sampled chicken, beef, a little of this, and a little of that. No issues, no problems.
My last 5 days or so, after my mom left, was the worst time. I was starting to get homesick, I was lonely, and it was winter there so I was cold all the time, the tv sucked, and I had to sit at the little table to use the computer. I was just ready to come home. The flight home was miserably long, but I was really happy to be back.
I am now almost 5 months out. I have had 0 complications or problems. I have no food intolerances. I hit 50% EWL on my 4 month surgiversary, and as of today have lost 76 pounds.
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I arrived in Curitiba by myself on June 29th, had my appointment with Dr M that evening, and surgery was scheduled for the following afternoon. I woke from anesthesia and immediately began throwing up. It took three shots of three different medications to make it stop. Once it did, I haven't thrown up since. Surgery went perfectly and aside from having difficulty sleeping, I had no complaints. I was NPO for 5 days, not that I wanted anything, but water woulda been nice.
I left the hospital for the hotel where I met my mom who flew in to be with me for a week. My first night was very restless. The recliner they put in my room was extremely uncomfortable and it was impossible to lay down in the bed and be comfortable. The following day, later in the evening, I realized I had a fever. I called Dr M, who immediately left his office and came to the hotel. He thought it would benefit me more being back in the hospital. He personally drove my mom and I there. They did a leak test, which I passed with no problem and then they took some chest x-rays. It showed I had a partially collapsed lung.
I was readmitted to the hospital for 24 hours of IV antibiotics and more therapy. Went back to the hotel the next day and had to have therapy once a day for the next couple of days, as well as shots once a day of whatever antibiotic I was on.
Aside from this little drama, I have had a relatively easy recovery. I don't remember having any pain, very little discomfort, and tolerated everything I put in my mouth. I hit the Brazilian BBQ with some other Americans at about 2 weeks out, where I sampled chicken, beef, a little of this, and a little of that. No issues, no problems.
My last 5 days or so, after my mom left, was the worst time. I was starting to get homesick, I was lonely, and it was winter there so I was cold all the time, the tv sucked, and I had to sit at the little table to use the computer. I was just ready to come home. The flight home was miserably long, but I was really happy to be back.
I am now almost 5 months out. I have had 0 complications or problems. I have no food intolerances. I hit 50% EWL on my 4 month surgiversary, and as of today have lost 76 pounds.
Tammy is out of surgery and in recovery
Jun 30, 2009
Hi I am pleased to report that Tammy is out of surgery and doing just fine. We just received the call from the doctor and he has assured us that all went very well, she is out of anesthesia, and doing well. Thank you to all of you for your prayers and warm wishes. Sincerely Rob Harding
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September 27, 2008
Sep 27, 2008
Since my last update...
Dr. Anderson made the call for the peer-to-peer review with the medical director of BCBS. She spent an hour and twenty minutes on the phone beating her head against a wall. By the end of the conversation BCBS asked for 48 hours to make their decision. Two weeks later they came back with their denial. The denial was based on the DS being experimental (not approved by the FDA or medicare, not approved by other insurance companies, no long-term data). All of these things are easy to prove wrong, but it will still take another appeal to do it. When Susie called to give me my options she recommended that I call Walt Lindstrom at Obesitylaw.com to help with the next appeal. So I did.
It cost me 1100.00 (including a fee to expedite the process). This will see me through any available appeals, paperwork, phone calls etc etc. We started the process last Wednesday. We are currently waiting on Dr. Paras's copies of my medical records arriving to their office in CA because instead of faxing my records, they decided to MAIL them. I was so pissed....paid an expediting fee for nothing.
Anyway, according to my insurance policy the next step is to have another internal appeal. This appeal will be in front of a board of 3 people, none of which were on the original medical board and none of which can be a subordinate of anyone on the original board. We are fully expecting another denial just because even though it's a new group of people, they still work for BCBS. After that, I will be allowed to take my appeal to either the PA Dept of Health or the PA Board of Insurance. At this stage we should be able to have the denial overturned.
Patience, Patience, Patience. There's still a chance I can have this done by the end of the year. 30 days for appeal 2, 30 days for appeal 3, 3 weeks for surgery date...Merry Christmas to me!!
Dr. Anderson made the call for the peer-to-peer review with the medical director of BCBS. She spent an hour and twenty minutes on the phone beating her head against a wall. By the end of the conversation BCBS asked for 48 hours to make their decision. Two weeks later they came back with their denial. The denial was based on the DS being experimental (not approved by the FDA or medicare, not approved by other insurance companies, no long-term data). All of these things are easy to prove wrong, but it will still take another appeal to do it. When Susie called to give me my options she recommended that I call Walt Lindstrom at Obesitylaw.com to help with the next appeal. So I did.
It cost me 1100.00 (including a fee to expedite the process). This will see me through any available appeals, paperwork, phone calls etc etc. We started the process last Wednesday. We are currently waiting on Dr. Paras's copies of my medical records arriving to their office in CA because instead of faxing my records, they decided to MAIL them. I was so pissed....paid an expediting fee for nothing.
Anyway, according to my insurance policy the next step is to have another internal appeal. This appeal will be in front of a board of 3 people, none of which were on the original medical board and none of which can be a subordinate of anyone on the original board. We are fully expecting another denial just because even though it's a new group of people, they still work for BCBS. After that, I will be allowed to take my appeal to either the PA Dept of Health or the PA Board of Insurance. At this stage we should be able to have the denial overturned.
Patience, Patience, Patience. There's still a chance I can have this done by the end of the year. 30 days for appeal 2, 30 days for appeal 3, 3 weeks for surgery date...Merry Christmas to me!!
Update - August 19, 2008
Aug 19, 2008
Obviously I haven't been too diligent in keeping up with my blog and what's been going on. So, since I last posted in April...
I have switched surgeons...twice. After discovering that Dr. Courcoulas does not regularly perform the DS, I contacted Dr. Brian Lane, who was in Bowling Green, OH and made an appointment with him. I was to see him at the end of June. Two weeks before my appt. I got a call from his office saying that he was cancelling all appts because he was moving his office to Toledo Univ. and if I still wanted to see him, I had to make an appt there. So, I called there and was told that he wasn't even in the system yet, but that they would take my name and number and call me once he was set up and a schedule was in place. At this point, I wasn't willing to wait especially when they had no idea how long the process of moving would take. My next call was to Dr. Rita Anderson in Dayton, OH.
Keep in mind that this is a five hour drive for me. I did not want to travel that far, but I figure if people can go to Brazil I can go to Ohio, right? Anyway, her office staff (Susie, in particular) was extremely helpful when I called. She arranged a phone consult with Dr. Anderson which I had within a week. She was very open, answered the few questions I had, made sure I knew about the decision I was making, then referred me back to Susie to get the paperwork started. She sent me "the packet", I filled it out, returned it, she called and had all of my appointments scheduled for one day so that I could come into town, get everything taken care of and then head home rather than making several trips to Dayton.
I made the trip to Dr. Anderson's on August 5. We (me and my mom) drove in on Monday night and stayed in a hotel as my first appt was Tuesday morning at 9. I had a group appt (me as the DSer with 4 lapbander wannabes, aaaggghhhh!!!) in the morning, went and had my consult with Susie, then went back down for my one-on-one nutrition consult, exercise consult, and psych consult (these appts were so insignificant that they are not worth more than a mere mention that I actually had them). After those were finished I headed back up and got to meet Dr. Anderson face to face.
Upon my return home, I contacted my PCP and had them fax my last 2 years worth of medical records (including the paperwork from my 6 month supervised diet) to Dr. Anderson's office. I called the next week to make sure they received everything, but Susie was out of the office till the following Monday (Aug. 18) so I figured I would call her then and find out when she thought I might get submitted to insurance.
First thing Monday morning, my phone rings and it's Susie (I didn't even have to call her). I had already been submitted to insurance and received my first denial. She reassured me that we knew it was coming because BCBS still has the DS as investigational/experimental. She assured me that Dr. Anderson will contact the BCBS Medical Director either Tuesday or Thursday (her office hours) this week to have a peer-to-peer review which may overturn my denial.
So, this is Tuesday evening and I didn't hear anything today so I'm assuming that the phone call did not get made today. I know Susie will push it through so I'm trying to remain patient. I have a feeling that if this doesn't get approved quickly during the peer-to-peer I will be in for a long, drawn-out battle. BCBS is famous for holding this process up as long as possible. I've seen people be approved quickly, but overall most fight and fight. I will get it, the question is how long will it take. I have a tendency to get frustrated and impatient quickly...I just need to remember that this is worth it......stay tuned..............................
I have switched surgeons...twice. After discovering that Dr. Courcoulas does not regularly perform the DS, I contacted Dr. Brian Lane, who was in Bowling Green, OH and made an appointment with him. I was to see him at the end of June. Two weeks before my appt. I got a call from his office saying that he was cancelling all appts because he was moving his office to Toledo Univ. and if I still wanted to see him, I had to make an appt there. So, I called there and was told that he wasn't even in the system yet, but that they would take my name and number and call me once he was set up and a schedule was in place. At this point, I wasn't willing to wait especially when they had no idea how long the process of moving would take. My next call was to Dr. Rita Anderson in Dayton, OH.
Keep in mind that this is a five hour drive for me. I did not want to travel that far, but I figure if people can go to Brazil I can go to Ohio, right? Anyway, her office staff (Susie, in particular) was extremely helpful when I called. She arranged a phone consult with Dr. Anderson which I had within a week. She was very open, answered the few questions I had, made sure I knew about the decision I was making, then referred me back to Susie to get the paperwork started. She sent me "the packet", I filled it out, returned it, she called and had all of my appointments scheduled for one day so that I could come into town, get everything taken care of and then head home rather than making several trips to Dayton.
I made the trip to Dr. Anderson's on August 5. We (me and my mom) drove in on Monday night and stayed in a hotel as my first appt was Tuesday morning at 9. I had a group appt (me as the DSer with 4 lapbander wannabes, aaaggghhhh!!!) in the morning, went and had my consult with Susie, then went back down for my one-on-one nutrition consult, exercise consult, and psych consult (these appts were so insignificant that they are not worth more than a mere mention that I actually had them). After those were finished I headed back up and got to meet Dr. Anderson face to face.
Upon my return home, I contacted my PCP and had them fax my last 2 years worth of medical records (including the paperwork from my 6 month supervised diet) to Dr. Anderson's office. I called the next week to make sure they received everything, but Susie was out of the office till the following Monday (Aug. 18) so I figured I would call her then and find out when she thought I might get submitted to insurance.
First thing Monday morning, my phone rings and it's Susie (I didn't even have to call her). I had already been submitted to insurance and received my first denial. She reassured me that we knew it was coming because BCBS still has the DS as investigational/experimental. She assured me that Dr. Anderson will contact the BCBS Medical Director either Tuesday or Thursday (her office hours) this week to have a peer-to-peer review which may overturn my denial.
So, this is Tuesday evening and I didn't hear anything today so I'm assuming that the phone call did not get made today. I know Susie will push it through so I'm trying to remain patient. I have a feeling that if this doesn't get approved quickly during the peer-to-peer I will be in for a long, drawn-out battle. BCBS is famous for holding this process up as long as possible. I've seen people be approved quickly, but overall most fight and fight. I will get it, the question is how long will it take. I have a tendency to get frustrated and impatient quickly...I just need to remember that this is worth it......stay tuned..............................
April 12, 2008
Apr 12, 2008
Ok, so I attended the weight management meeting last Monday, April 7. Since it was the first one, we just did weigh-ins and were given information on what was expected of us and what we should expect from them. All in all a dissappointing meeting. I was hoping to get to talk to someone one-on-one concerning where I sit with my 6 month supervised diet since I have previous visits with my PCP. The good news: according to their scale, I only weigh 265.5 whereas my PCP has me at 275. So it looks like I lost 10 pounds (but I know I didn't because the hospital scale is closer to mine than my PCPs...hers is just off).
Anyway, I called the weight management center's office this week to get information on whether or not I am further along in my 6 month process. I spoke to a girl who told me basically that it's a crapshoot with the insurance on whether or not they'll accept my PCP visits and the only way to find out is to submit and see what happens, but that for now we would go ahead like I'm sitting at 4 months into it. I was given permission to call the surgeon's office and make my appointment for the initial consult. YEAH! I called immediately, of course. They are able to get me in May 5. I thought I would have to wait longer so that was a pleasant surprise.
At this point at least I feel like I'm doing something other than just waiting. I have a feeling that my insurance will not accept my PCP visits (just the feeling I got from the girl I spoke to in the office), so I may still have 5 1/2 months to go, but I'm still looking forward to seeing the surgeon. I'm afraid that I will be looking for another one after my consult with her. I just can't find anyone who's had the DS with her and she's not registered on duodenalswitch.com which concerns me, but her office has assured me that she does, in fact, perform the lap DS. My concern is how many she's actually done and who she trained under. I guess we shall see, and I'll know all I need to know after May 5!
Anyway, I called the weight management center's office this week to get information on whether or not I am further along in my 6 month process. I spoke to a girl who told me basically that it's a crapshoot with the insurance on whether or not they'll accept my PCP visits and the only way to find out is to submit and see what happens, but that for now we would go ahead like I'm sitting at 4 months into it. I was given permission to call the surgeon's office and make my appointment for the initial consult. YEAH! I called immediately, of course. They are able to get me in May 5. I thought I would have to wait longer so that was a pleasant surprise.
At this point at least I feel like I'm doing something other than just waiting. I have a feeling that my insurance will not accept my PCP visits (just the feeling I got from the girl I spoke to in the office), so I may still have 5 1/2 months to go, but I'm still looking forward to seeing the surgeon. I'm afraid that I will be looking for another one after my consult with her. I just can't find anyone who's had the DS with her and she's not registered on duodenalswitch.com which concerns me, but her office has assured me that she does, in fact, perform the lap DS. My concern is how many she's actually done and who she trained under. I guess we shall see, and I'll know all I need to know after May 5!
April 1, 2008
Mar 31, 2008
April 1, 2008: I have decided to journal my progress through this adventure, so that I may "pay it forward" to others who will be in my position one day.
I attended the educational seminar on Monday, March 10 and am scheduled to begin weight management classes on Monday, April 7. I saw my pcp this morning and got a prescription for Chantix as I have to be smoke-free at least 30 days before my surgery. That officially makes 4 visits with her concerning some aspect of my weight loss. I gained another 4 pounds....I don't know how that's possible!! Anyway, I'll find out on Monday whether or not my previous visits to my pcp will count toward my 6 months supervised diet required by my insurance company ( I don't need 6 consecutive months like a lot of other insurances require).
I have definitely decided on the BPD/DS. Dr Courcoulas at Magee Women's Hospital in Pittsburgh is the only one in the area that does it. I will discuss with her staff as soon as possible how many she's done. I don't want to be her guinnea pig. I know she's done a ton of RNYs, but I haven't been able to locate anyone who has had the DS with her. If she doesn't have adequate experience I will probably be contacting Dr Brian Lane in Bowling Green, OH. He took over for Dr.Hess, the original DS doctor. How much more experience can you get than that?
I finally feel that I'm on my way, slow progress but progress nonetheless. OH has been my lifeline....I sign in several times a day just to read and absorb the massive amounts of information being presented here. You can't get this kind of honest, accurate information and support anywhere else. My advice to any newbie: READ, READ, READ!
I attended the educational seminar on Monday, March 10 and am scheduled to begin weight management classes on Monday, April 7. I saw my pcp this morning and got a prescription for Chantix as I have to be smoke-free at least 30 days before my surgery. That officially makes 4 visits with her concerning some aspect of my weight loss. I gained another 4 pounds....I don't know how that's possible!! Anyway, I'll find out on Monday whether or not my previous visits to my pcp will count toward my 6 months supervised diet required by my insurance company ( I don't need 6 consecutive months like a lot of other insurances require).
I have definitely decided on the BPD/DS. Dr Courcoulas at Magee Women's Hospital in Pittsburgh is the only one in the area that does it. I will discuss with her staff as soon as possible how many she's done. I don't want to be her guinnea pig. I know she's done a ton of RNYs, but I haven't been able to locate anyone who has had the DS with her. If she doesn't have adequate experience I will probably be contacting Dr Brian Lane in Bowling Green, OH. He took over for Dr.Hess, the original DS doctor. How much more experience can you get than that?
I finally feel that I'm on my way, slow progress but progress nonetheless. OH has been my lifeline....I sign in several times a day just to read and absorb the massive amounts of information being presented here. You can't get this kind of honest, accurate information and support anywhere else. My advice to any newbie: READ, READ, READ!
About Me
New Castle, PA
Location
43.1
BMI
Surgery
06/30/2009
Surgery Date
Mar 03, 2008
Member Since
