Heyher

I'm just wondering what these coordinators do all day at the doctors office. I know they have to meet with prospective patients and call insurance. But why does it seem to take them a week to get back to you every time you call? I just want a time frame for when she plans to submit for approval. It has been a week and nothing. Inma bout ready to be a pain in her bum that even preperation-h cant cure.

Peer to peer Wednesday. Also the people at my work are going to talk to UHC to see if an exception can be made within the perameters of my companies plan.

So got the denial because I don't have 5+ years of BMI of 40+. I am an excellent candidate for surgery and I can't sit around waiting for the next few years for my health to decline so I have the 5+ years. With my multiple sclorosis and reconstructive knee surgery that would just be cruel. So surgeon is going to do a peer to peer with the medical director and if that still doesn't work we move to making a plea to my company to allow an exception in this case because of the additional health risk with the obesity, ms, and reconstructed knee.

But I hear they bend over backwards and are so compassionate. :-) Vent away sir.

Peer to peer is next week. ugh!!!! Another week of not knowing.... My nerves are shot! I work for a utility company. We have coverage. But the five years at 40 or higher is the sticky part Not sure if it will work. But I sent in my plea to my employer to please cover it. Because I can't just sit around letting my health decline. That is the exact opposite of what I need with my ms. Thanks for the positive thoughts and prayers.

But for those of us paying these crazy insurance premiums, deductibles, copays, out of pocket expenses should have more say in what we get. Some deuce in an office shouldn't be the final verdict in how we choose to use these services we pay for.

So I called to find out the status of my approval. Because I had a decent attempt at losing weight in 2008-2009 they will probably deny my claim. I hate the fact that I have evidence of me trying to lose weight on my own has caused them to probably deny my approval. Why do they want me to just sit around for 5 years being fat so I can have surgery? I lost weight, but I can't keep it off on my own. So even though I have been overweight for about 75% of my life that doesn't count. I just don't get it. Because I fought and fought and never really succeeded, but wasn't at 40+ for five years (mid to upper 30's) they say no?

Thank you for the encouragement. I actually called back to talk to a different rep and got a lot more info. Like all bariatric surgeries go to the director. And that there were no notes about me possibly being denied. She said the reps can't say if someone might be denied or approved because they don't have that info. So she said to just hang tight and think positive. And she apologized for the other reps pessimistic approach this morning. While it wasn't a yes, it was better then the expect to be denied from the other rep.

Finally submitted to insurance. And finally tracked down weight from 2001-2007. They only require 5 years. But there was that break in my insurance for a few years. So they will have every weight from 18-23 and 26-29. Ohhhhhhhh this is going to be a long wait to hear.

I reached a point with the claims people at my insurance where I told the lady " well I hope you guys determine my life is worth the financial burden and you approve me." Not my best moment but oh how I hate that they get the final say in who is worth helping and who isn't. Or weather or not you have been fat enough for long enough.

I feel ya. My coordinator has been slightly lax in the coordinating. So I have coordinated everything and just gave her the info. Hope to GOD I get submitted this week. Even had to give her the phone number for the care coordination team at my insurance and fax for where it should be sent. Grrrrrrrr.....

Well I'm 40.8. So I qualify on that alone. I guess I'm just surprised that my doc didn't mention the low HDL and a1c. Diabetics and heart disease run in my family. So just surprised that there wasn't even the mention of hey your HDL is too low. Or anything to that fact. He is great, probably why I'm just so surprised nothing was mentioned or plan of action wasn't set forth to work on this if surgery isn't approved.

So I am confused about blood test results. My A1c came back at 5.8 so that would put my fasting at a rough average of 120 a day. PCP said that is normal. 5.8 isn't extremely high, but I is above the normal range. Also my LDL is slightly elivated at 114. But my HDL is crazy low at 31. Made no mention of that to me. My normal blood pressure has been around 100/60 (lucky with that part) but this year it has been at 120/70. I know none of these are catastrophic, but to me it would have been helpful to my case for insurance approval if those elevated levels had been noted. Why??? (I know medical advise is not given on this site, but I still don't get why he wouldn't mention it in his office note. Turd)

My coordinator is not coordinating ANYTHING!!! Told her insurance requirements when we met on Aug 16th. She was holding my file because she assumed there was a 6 month diet. I have one of the last few policies that doesn't require it. Told her again the requirements when I told her no diet needed. Got the rest if my testing done. She said she would submit yesterday morning. I sent her an email to ask if she sent me for approval. She told me she called insurance to find where to fax to. She said she was informed by them we needed 5+ years weight. Well duh. I told you that and you said you would work on it since I had a 3 year gap in coverage when we meet and in two emails where I explained coverage. She said I needed to get any weight history I had. Why didn't she say I needed to do that when we met? Now it will be Monday at the earliest that she can submit. This roller coaster with her is starting to get to me. I was trying to be as proactive as I could be. I understand she has a lot of people to work with. But I have given her all information she requested more then once. And I have all the email communication with the information. Sorry had to vent...

I have no pre-op diet. No supervised 6 month diet. Im not required to lose any weight. But that is my insurance. The requirements depend on your insurance and your employer have determined. I just have to show I am over 21, have struggled with weight for more then five years, and have a BMI of 40+.

M going to be nothing but nerves until I hear. Doesn't help that they screwed up on the last paycheck so this paycheck is basically nothing. Thanks payroll and timekeepers. Really I WANTED more stress. And nothing adds stress like being broke.

Mine will be submitted today. My fingers are crossed for you!!!

Make sure to tell your doc every med you take and is prescribed to you. If they fear the surgery is too dangerous for you, then they will tell you. If you are on BP meds, diabetes meds, or other meds for comorbitities, a lot of people are able to cut down or even stop after surgery. If you are on an antidepressant before surgery don't stop taking them after. Hormones go nuts after surgery and those can help even them out some. Most of all voice any and all concerns with your doc. Even if they seem silly, it's best to get the reassurance. If your PCP and surgeon clear you, odds are they are confident you will pull through with bells on. :-) Please don't take my advise as a medical opinion. My only medical training was operation in my youth and I always lit up the nose. Nerves are normal. But you'll do great.

So did the pulminology test Tuesday. Was supposed to meet with NUT today so the insurance could be submitted next week. Well I guess there was an error on my pulminology results and they need to retest. So hope I can get that done soon. I had set up my NUT appointment a few weeks ago and I was told it was today at 11:30. I showed up at 11:20 and the receptionist told me I didn't have an appointment set up for today. She said they scheduled me for September 28th. What??? So the receptionist squeezed me in in Tuesday. I just want these tests done already! :-( Little things that have been so aggravating.

I called insurance and verified coverage before I went to the seminar. They cover like 5 forms of bariatric surgery. I paid psych eval out of pocket. They are submitting my pulminology test for coverage and the preop consult was covered. Also I get 5 NUT visits covered by my plan. So the requirements aren't too bad. BMI 40+ 5+ years of obesity (don't have all 5 years because of no insurance for 2 of 5 years) 21 or older My mom was approved for bypass and also to correct her fistula pretty quick. I pay a lot for insurance, so they better approve me!! Also the doc is at a COE and is the in network preferred provider. They submit in the morning. FINGERS CROSSED!!!!

Attempt #2 to meet with nutritionist. Fingers crossed this drive will be successful. Oh and coordinator still avoids me like the plague. Oh once I hear approved I will let the surgeon know how my experience was working with that coordinator. >:-(

I don't even have to do the six months! I just had to meet with her once so they can send in to insurance! Arg! I just want an answer now! But only if it is approved. Just let me be thin people!!!

Off to meet with NUT. Need to redo pulminology test. But then it should be all sent to insurance for approval. Yay!

Went and had my head shrunk yesterday. And the psychologist said I'm not too crazy for surgery!! Yay! Okay not quite like that but she told me I'm a great candidate for surgery!! I meet with a different hypnotist to***ht to quit smoking. He is a former smoker, so he understands more about mental cravings vs. physical cravings. He has spent over 10 years developing his program, so I feel confident that I will soon be smoke free!! Blood test in the morning. Explaining different reactions to when I go too long without food, ect PCP and psychologist (she specializes in bariatric patients) both worry about pre-diabetes. But three steps checked off this week. WOO HOO!! Oh and my fiance said he is not going to support my Dr Pepper addiction. So he isn't buying me soda any more. Getting requirements done so my PCP will clear me for surgery.

So I had a set back. I was cruising along doing great with not smoking. Then a whole bunch of little things started happening. Not big enough where alone it would cause me too much grief. But tons of little things piling up and I caved. I smoked. I've been smoking for almost a week. Work and medical testing and a puppy who is sick from getting into onions the old owners of the house planted and migraines and 63 days of 90+ heat and I just had it. Other things here and there. But it was smoke or have a melt down. Just one little thing on top of the other while I am already stressed about surgery and insurance just set me over. I won't take the meds to stop because I have no idea what they might do with my ms meds or my insomnia or anxiety. Just don't want that. *sigh* :-(