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The Journey (Post 2)

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makemyownluck

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So, this morning on my drive to work, I got to thinking about "being on a journey". I've always found the whole "this is a journey" thing a little cheeseball, but now that I'm ON IT, I realize it's a completely accurate description. The trick will be staying on it! I started envisioning this process as a road trip (my favorite) and it struck me that I'm still in my driveway, and I'm not getting on the road today! I got the referral to the nutritionist in the mail yesterday but when I called, the scheduling office was already closed. This morning I left the dang paper at home so I couldn't call at work. By the time I got home, it was too late to call again!! Better luck tomorrow, I already put it in my purse for tomorrow, I did make SOME progress today. I called my insurance to verify that WLS is a covered benefit on my ***. She said it is "as long as your PCP says it's medically necessary" but I already know there are other prerequisites. The woman on the phone just kept referring me back to my PCP - she didn't even know what a vertical sleeve gastrectomy was!! Fortunately, I used to work for the company that I'm currently insured through, so I knew how to locate their medical policy online to get the requirements myself. I was surprised to find they haven't changed much in the last 5 years since I worked for them! LOL! AND! VSG IS COVERED! yay!!

 

Eligibility:

be at least 18 years of age. CHECK!

Be BMI 40+. (less enthusiastically) Check.

**the rest I still need to do:

Documentation from the surgeon that I have completed:

- a nutrition program, which may include a VLC diet or recognized commercial diet based weight loss program AND

- Behavior modifications or behavioral health interventions AND

- Counseling and instruction on exercise and increased physical activity AND

- Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health AND

- psych eval w/i 12 mo AND

- absence of psychological comorbidity that could contribute to weight management and/or an eating disorder AND

- patient willingness to comply with preoperative and postoperative treatment instructions.

 

Seems like a lot, but really it's what? Nutritionist consult (working on scheduling that), a psych eval (need to ask about that), and going to the seminar the hospital does should cover the rest. Right? Or am I way off?

 

I'm getting worried about how much this is going to cost. Despite being on an ***, i have a LOT of out of pocket expenses. I have a $500/day copay for the hospital stay. Plus it's $40 copay every time I see the PCP and goes up to $60 for specialists (including the nutritionist I have to see (at least 4 visits, per my referral slip), the psych eval and visits to the bariatric Dr. too!!). I can just see this being a real financial hardship. I know it will be worth it, and it's NOT a deterrent for me, but I'm just realistically trying to see how I can squeeze this money out of my budget right now and the outlook is not good!! I was trying to realistically think about how much time I could AFFORD to take off work when I have surgery and I started getting a little panicky! How am I going to afford this? WHY does my insurance suck so bad (I WORK FOR AN INSURANCE COMPANY - I WOULD THINK I'D GET THE BEST!!! WRONG!)??? And then thinking about long term expenses like how am I going to afford all the new clothes I'm gonna need? And the vitamins and protein shakes, and gym membership and yadda yadda yadda -

 

and then I realized that that's why it's a journey. And why it's especially like a road trip. All this hardship and work and everything is like a long, sweaty ride to The Grand Canyon. The one where you're in a car with a bunch of people and the air went out, and you're all crabby and you've been on the road for a couple of days and starting to stink and you're delayed because the car broke down and then... you get to The Grand Canyon. And it's amazing. It changes your life. You'll always remember the moment you saw it, and chances are, you'll recall the trip as a lot more fun than the reality. It's the destination that's important and makes everything else worthwhile. But the getting there is a real pain in the you-know-what.

 

*sigh* So yeah, I'm already starting to get overwhelmed, but I know that all the sacrifice will pay off. I'm keeping my eye on the prize, but there's a lot I need to work out. IF my timeline for this that's in my mind (based on my various research and talking to my dr.), I could be eligible for surgery as soon as December. And if that's the case, everyone I know is gonna just have to DEAL with not getting a present from me this Christmas!! lol!!

 

In the meantime, I'm just going to have to keep my mind on my money and my money on my mind for a while... and STAY POSITIVE!

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