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About this blog
This blog is for me and anyone who wants to read it. I can be quite long-winded at times, so be ware. :wink2: This blog will chronicle my experience from start to finish, which means it will never end so long as I am alive. :rolleyes2:
Entries in this blog
2
11/13/09: Oh so many thoughts
11/11/09: Two great things...and one frustrating computer
11/10/09: Do you want some cheese with that?
11/08/09: I had an interesting break through yesterday...
11/07/09: I love the fall!
11/06/09: Ok, I'm not really a daily double-poster, but this is worth another blog.
11/06/09: Can I have a do-over?
11/05/09: Really? Seriously?
11/05/09: Sigh....part 2
11/05/09: Sigh....part 1
a nutrition consult
a pysch eval
a 6 month supervised weightloss program
letters of medical necessity from all treating physicians.
On the other hand, Aetna's requirements for my husbands optional plans are: A BMI over 40
a nutrition consult
a pysch eval
a 3 month supervised weightloss program
letters of medical necessity from my PCP
and a 2 year history of obesity
So my question going in was is obesity a BMI over 40? Or is over 35 sufficient since I am NOW over 40? Yep, gotta have a minimum of 40 for all two years or more. I have no comorbidities. I don't want any. My dad died from type II diabetes and heart disease and my mom died from colon cancer. I have PLENTY of risks already - I don't need to add the weight, dagnabit!!!! I love that word! And then this advocate lady says - Aetna is the same as what you need for Cigna, so I'd recommend switching. No. I have this form RIGHT here that THIS office gave me that says my requirements are: A BMI over 40
a nutrition consult
a pysch eval
a 6 month supervised weightloss program
letters of medical necessity from all treating physicians
And she says, no, for your group on Cigna you need: A BMI over 40
a nutrition consult
a pysch eval
a 6 month supervised weightloss program
letters of medical necessity from my PCP
and a 2 year history of obesity
And follows that with - what piece of paper do you have? So I pull it out of my handy dandy little folder and hand it to her. And she reads the top line. And she says - you shouldn't have this form, this isn't YOUR group. So I'm not eligible. Now. After doing the pysch consult. The nutrition consult. After redoing the stress test and my cardiologist I never saw in the first place signing off on it. After having my PCP and my OB/GYN agree to it. After ALL of that - and 4-8 missed hours of work EACH week since I started down this path - I find out I AM NOT ELIGIBLE :ohmy::mad::frown::crying::smile2::scared2::wub::mad: So she starts digging further. How did I get given this misinformation? Turns out THIS lady IS my advocate. Who knows why the other lady's name is written all over my chart - the one I am talking to is the one that has handled everything for my case so far. And now it makes sense. See. The problem is that I have not even been at this weight for a year let alone two. And my advocate breaks it down like this. If I do Aetna, I will be done with the weightloss program in early Jan. They submit my package, I get my approval, surgery in Feb. OK. Since they submit the package in Jan, Aetna will want two years which means going back to Jan of 2008. Jan 2008 = 132 pounds. For me that's a BMI of 37.4 Jan 2009 = 138 pounds. For me that's a BMI of 38.4. It was in March/April of this year that my weight went crazy putting me over the BMI of 40. I gain weight when I get OFF of birth control. I have gotten off of birth control four times and four times I have had the same reaction - 30-40 pounds before my hormones are back to normal and then I can hold steady from there. It is generally fairly easy for me to maintain a weight. It is literally when I play with my hormones that I get in trouble. With that said, sometimes my hormones play with themselves - and I know as I get older they will do that even more. And those times are just as damaging for my weight control. So that part that "makes sense". In October I went into my surgeon's office. And the RNP there told me that I would qualify if I proved two comorbidities along with my BMI of 40. And to prove those comorbidities I would need to go to this other clinic in the medical center where I would also do my six month supervised weight loss program. I have high cholesterol. She told me that would be one comorbidity and probably doing a sleep study would prove the second one. So I should be good. But I get to this other clinic a few days later and they say - no, you don't need any comorbidities. So this advocate - still scared to call her mine cause am I gonna end up with someone else later? - says well then lets get a sleep study. Are you drowsy in the afternoon? No. Do you wake up with headaches? No. Do you snore? My husband says No. Hmmm...then I won't qualify as needing a sleep study. And then she says - get this - well, you could do some things to prove type 2 diabetes? Excuse me? Excuse me? Excuse me? Excuse me? The disease that KILLED my dad - you want me to "play around with that"? Really? My blood pressure is absurdly LOW. Got any tricks for screwing that up? My heart has been deamed healthy by none other than a cardiologist. So she goes and gets the RNP eventually. Apparently you can be determined as qualified for a sleep study if 1) your neck is too big, 2) your waist is too big, and 3) if you say you are sleepy during the day. 1) my neck is huge. :tt2: I call it a football neck. It works on my body, I have a very strong neck and if we have boys when my husband and I have kids - they will have a good build for being football players. I like my neck. I will be happy when it loses weight, but I don't have an issue with my "huge" neck. 2) my waist is large. I'm fat. That was easy. 3) sure - I can say I'm sleepy. I sit at a computer all day long and around mid afternoon I get bored. And when I get bored, I get sleepy.
11/04/09: How is it that...
11/03/09
10/30/09: Yay!
10/29/09: Can I?
10/28/09
10/27/09: And the journey continues...
10/20/09: A hurdle?
10/19/09: It's a Monday...
10/15/09: A pound in 6 days
10/14/09: I like to blog!!!
10/13/09: This is scary...
10/12/09: And so it goes...
10/08/09: Who's in control - me or them?
10/07/09: Well then...
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