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To Be or Not To Be...

I have been toying with the idea of LapBand surgery for about a year. My favorite cousin and I were on the phone comparing our symptoms from being overweight, I'm 5'9", 243 lbs, BMI 35.5l (heel spurs being my only real complaint :thumbup:) and she said she was going to get banded. Not two months after I spoke to her, she had her appointment and was going in. She had her surgery successfully and I was still hemming and hawwing about me losing it on my own...blah..blah..blah. (gained 15 lbs) Well about 2 months ago she came to visit me and she looked amazing! She and her mother own a restaurant so food is a huge part of her life and when I saw she was able to lose weight it in spite of cooking and being around GREAT tasting food all day, I got inspired, again. I go online, do some research on the procedure, what it entails, doctors, recovery, etc., and I find a doctor, schedule my seminar (this Sunday), I stumble across this site () and YESSSS! I am having LapBand surgery!!!..... What a fool I was being!!! :frown:... First, it never occurred to me that my insurance would have "requirements", it never occurred to me that the doctor I so carefully selected wouldn't accept my insurance, it never occurred to me that I would get totally lost in this process and perhaps not even qualify! After all, I talked to my cousin, she said she was going to do it, did it, lost weight, looks and feels good, and the rest is history. Naturally the process would be as easy for me! NOT! I called my insurance (Aetna Open Access HMO) they point me to the list of "to do's", tell me I need to get an out of network request for the surgeon I have selected from my PCP and if I qualify they will pay 90%. OK, so I make an appointment with my PCP for tomorrow but I really don't know what I am going to see her for (:biggrin:). I will tell her about my desire for LapBand surgery and take it from there. I don't know if she is the one that should be submitting my paperwork to Aetna or if my surgeons office should do it. But since they don't accept Aetna, I'm thinking they won't do any "leg work" for me until I am approved by Aetna and they are sure they are going to get paid. I don't know... I will see what happens tomorrow and see what I need to do/can do/ or can't do after that. To Be or Not To Be continued....
HappyMe2009

HappyMe2009

5
 

Waiting for Monday

Thank you for the PM's and the guidance. I will continue to be in touch! All I can think about is talking to my PCP on Monday to find out about my out of network pre-cert that she has to give me to see my doctor (Robert Pinnar in Reston, VA). I am so tired of the struggle! I have done every diet that you can think of, every weight loss plan that you can join, and even had a botched liposuction, only to end up STILL needing something that fits into my life and works for me!!! I am assuming that once the pre-cert is done my surgeons office is who will submit my medical records and weight loss attempts to Aetna for approval. My PCP is fairly new to practicing and not very knowledgable about all that this is required or could arise. I really feel like this is my last hope to get my weight under control before I do develop serious health problems. My blood pressure is "elevated" but not what doctors consider high. My cholesterol is 2 points over what doctors consider high. I had gestational diabetes with my last pregnancy, which makes me a likely candidate for diabetes, but I am not diabetic now, I am borderline with most co-morbidities and I am just praying that I don't have to become "sick" or have to be on daily medications to control certain illnesses before I can qualify to better my quality of life. *sigh*   To Be or Not To Be...continued...
HappyMe2009

HappyMe2009

2
 

Ooops

I posted my blog entry for today in the "comments" section. :thumbup:. I'm still learning the ins and outs of this whole blog thing, so bare with me.... :biggrin:
HappyMe2009

HappyMe2009

1
 

Trying not to SCREAM....

OK, so yesterday was supposed to be the day that I hear something about my out of network pre-cert being done by my PCP. Of course, I hear nothing! Once I finally go thru to their office on the phone, the receptionist tells me that they don't use their "contact us" link on their website and "haven't used it for years". Well, why the hell is it on the website then and how am I supposed to know you haven't used it for years!?! I am trying to explain to her that I have the link for the doctor to submit my pre-cert on line and she is just talking all over me about how they can't take anything over the email and I need to fax them the information so they can add it to my chart, and on and on about everything they CAN'T do! (:thumbup:) Once she shuts up, I tell her that I can't fax a freakin' link to her, but I can print out the page from Aetna's website that has the information on it and the link information. The fact that I mentioned the word "fax" shut her up and that's all she needed to hear. Fine, I send that to them and still.... nothing. So today I started calling them and trying to get her Medical Asst. on the phone b/c she will remember me from Friday and know what's going on. I finally get her and she remembers and says she is going to see how the doctor can submit my pre-cert over the phone. This was 2 hours ago. She (the M.A.) just called back, and I gave her the 1-800 number for the doctor to get my pre-cert done. I have yet to hear about my medical records being received from previous weight loss programs or my sleep apnea test being scheduled. It's just one obstacle after another. I can't believe I actually went in to this thinking it was going to be a cake walk... :sad:
HappyMe2009

HappyMe2009

1
 

My.... how things have changed....

OK, it's been a minute since I updated on my progress/process. Not sure where I left off but I did get authorization from Aetna to see Dr. Pinnar for 1 visit. I felt like a mission was accomplished, so I decided to take on another mission. I went back online to see if I could find a Dr. closer to me and low and behold I did! Dr. Brian Long! And he was hosting a seminar that coming (last) Saturday! I went online and registered and I went to the seminar last Saturday! ! I was really comfortable with his team and his expertise, so I decided to move forward with my free consultation. I took the first available appointment, which was this past Thursday! I completed all my history online and when I arrived they were prepared and ready to see me. Well imagine my SURPRISE to find out that they had contacted my insurance prior to my arrival and had all documentation filled out and DR. LONG IS A PARTICIPATING SURGEON WITH AETNA!! Now, I am thoroughly surprised because Aetna told me there wasn't a bariatric surgeon in network which meant a higher payment for me and a BUNCH of headache in getting approved. Not taking my surprise for granted, I decided to surprise them and I had 3 years of documented, supervised, medical weight management records! (:tt2:) amd they were soooooooooooooooooo happy that the "hard part" was done. Next they scheduled me for all of my pre-op testing (upper G.I., nutritionist, sleep study, psychologist, personal trainer, and lab work) all for the same day (June 5th) and she told me to have some dates in mind when I want to go to surgery when I come in on the fifth ()!! I can't believe I went for a boulder blocking me to a sled taking me down the hill! GOD IS GOOD! I am nervous, but I am so excited to be taking control of my life and my destiny!!!! I will keep you all posted!
HappyMe2009

HappyMe2009

1
 

One (1) Visit

OMG! Could it be!?!? Aetna approved me for (1) visit to Dr. Pinnar!! I go to my seminar on the 23rd and then I can use my (1) appointment as a consult! I am excited that I have gotten this far. When I go for my consult I will have all of my medical records from the weight loss programs I have tried, and my current chart from my PCP. Hopefully, I will have my sleep apena results back and can just take it from there. I know (1) visit is nothing compared to what I will need to have a success story, but I am dealing with baby steps here... baby steps! :thumbup:
HappyMe2009

HappyMe2009

1
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