Heyher

Appeal was denied because I don't meet the minimum requirements. Uh duh if I met the minimum requirements there wouldn't be an appeal needed. So did they even look at the letters of medical necessity? Or the diagnosis of sleep apnea? Or did they say nope not fat enough long enough? Why file an appeal if they are just going to say here is our cookie cutter and you don't fit. So you can continue to have your health decline. Can't self pay because extra money is going to home repairs nd wedding. With my ms I'm wondering if I need to put myself through this much stress. As I type this through tears I'm thinking of just giving up.

I'm on Gilenya for the ms. Also on Zoloft for the ms. Adding meloxicam to get through until surgery. Then after neurologist, surgeon, and PCP will decide a treatment that will be safe and effective... I thought the pain was ms and I had to live with it. If I wasn't having all these tests for the surgery then probably would have just kept thinking it was ms and try to deal...

My fibro isn't crazy to the point of disabling. But the fatigue from fibro and ms with apnea gets me pretty bad. Pain is kind of manageable but there are days I want to lay in bed. Though that doesn't help at all because it just makes the stiffness that much worse. Hope the meds help me. I am dealing with this because I have not been at a BMI of 40+ for over five years. Thing is I was diagnosed with ms 9 years ago and I was trying so hard to keep weight off. My BMI has been above 30 for 4 of the 9 and 35 for 5. But they say I don't meet the minimum requirements. So I have to go through the appeals and get denied. Peer to peer already took place. Once I exhaust appeals I can go to my employer to plea for an exception. I think I have someone on my side in hr. So just keep fighting. Though I'm sure I may have more defeated moments... :-(

Spent a good 45 minutes describing area of pain, type of pain, length of pain, intensity, stiffness in muscles ect. Knowing ms and fibro have similar sensations and ms meds don't help pain. They are putting me on meloxicam to help with pain. It is an NSAID but it is one of the most tolerated. After the sleeve we may need a different type. But I guess a lot of my docs patients with fibro take meloxicam and do very good with it. So I may be able to function this winter. Also found out when appeals are exhausted employer may allow an exception for me.

And....... Fibromyalgia it is. Start on my med soon to help with pain...

Well on top of multiple sclerosis and sleep apnea they think I may have fibromyalgia. But still not enough for surgery. Going to the doc to talk to them about what my options may be to help with pain...

Hard not to get discouraged when you see other people starting the process after me, and I am still waiting for approval. The 45 day limit on the appeal is fast approaching, and am still waiting for letter of medical necessity from my neurologist. What stings is that the request was sent over almost three weeks ago. Doc dictated it the next day and sent it off to be transcribed. Well I guess there was nothing in the file so the transcriptionist just moved on. No follow up. No question. No nothing. Just dumped it and moved on. So now I may miss the deadline for the appeal because they did nothing about it for three weeks. I started in July and didn't have the six month diet. I was told late September or early October and I would be sleeved. Mid October and I am still trying to get stuff submitted. Trying to keep hopes up and anxiety in check. But getting more and more discouraged every day.

Also some plans will work with people if they don't have the 40 BMI for over 5 years. If you have any comorbidities use those to get letters of medical necessity. I have sleep apnea. So the surgeon and my neurologist wrote letters stating I needed surgery. It would improve my apnea and help with quality of life dealing with my ms and arthritis from a massive knee injury.

My advice is be honest and candid with him about why you are taking this journey. It helps so much to have support both pre and post op. I told my fiancé about it and he went to the seminar so he could better understand the surgery and what most of us are dealing with. That insight gave him the confidence to support my decision 100%.

I know the cpap is going to help. Especially with the fatigue since I have ms. I just don't know how well I'll handle the mask because of my phobia.

Well got the results from my sleep study. I have moderate sleep apnea. They will deliver the cpap in a few days. Mask still freaks me out, but we shall give it a try...

Also I have the HDHP Choice Plus. My MS meds put me at my deductable January every year. So if the surgery happens in the next two months it will cost me $100.

I have UHC and had to have documentation that I was at or above 40 BMI for at least five years. Well I was hanging out in the mid 30's for the past 8 years. And they denied me. Now the surgeon and neurologist are submitting a letter of medical necessity and I had a sleep study which determined I have moderate sleep apnea. These were the things my surgeon was told to provide when he did the peer to peer with the medical director. So fingers crossed once all the new information is sent in they can approve me. Six month diet is non negotiable. If that's the plans requirement then you have to do six months. 5+ years of BMI of 40+ is also non negotiable. Unless you have any comorbitities. Like Diabetis, high blood pressure, sleep apnea. Those are the three main comorbitities. I would call the number on your card and ask for your plans exact requirements for approval.

Oh and in preop I think if you switch to tea for the duration, that shouldn't interfere with preop. A good one is a blend of green tea and white tea. Still has caffeine, but not near as much as soda or coffee.

What has worked for me is cutting out one serving at a time. Start with the last caffeinated drink. Cut that out, then a few days later cut out the next one, then the next one, so on until you are down to one serving. Then the pain should be manigable with a tylonal or if still preop ibuprofen works good too if you get a headache. Caffeine is a drug and your body is detoxing. And it SUCKS!!! :-) Putting a warm washcloth on the back of your neck can help ease some of the tension in your neck and will help. Even if you do that during their nap time, it can help relax the muscles. Hope it helps...

Well I get to do the sleep study tomorrow night. My blood oxygen level dropped to 73% furring the pulse ox home test. I don't stop breathing, but I start breathing really shallow. So then I will begin breathing rapidly to try to get oxygen. Sound like I am running in my sleep.

Yeah I'm so viewing cpap as a negative thing. You do know what claustrophobic means right? You put something over my nose or mouth then say to relax, it's not happening. I started to panic when they put it on last night. sleep tech did a great job calming me down and made sure I was able to fall back asleep. Never said it was negative. Said I was worried.

Hope that I can sleep some. Cpap worries me because I'm claustrophobic and can't stand things covering my nose and mouth. Don't wanna freak out and start ripping wires off me... :-)

Gunna name it squishy and it shall be mine and be my squishy. Or hank.

Was submitted to insurance in early September. Got denied. Got a call from the sleep study center wanting to go over results they got back from when I did my test with the pulse ox about three weeks ago. Come on man!!!!

Told I will be sent home with a drain that will be in place for one week. That is if they ever approve me....

Ugh I'm so pissed with the coordinator right now.

So we have the peer to peer tomorrow and the vendor manager is meeting with UHC early this week to try and get an exception. I pray they say yes. They already fork over $2500 a month for my ms meds. (retail its $4400) So I would think its wise to fix this before we have to add bp meds and insulin to the mix. Because it will be enevitable that I will need those. Already on my way to needing those. Self pay is not an option for a long while. We have to pay to fix the clay drain pipe that busted over the weekend. So that's a large chunk of money that we don't have already.

So medical director called to do the peer to peer and no one did the peer to peer or called them back.