simplystace

Lots of calls today. No luck. Bottom line is my employer chose not to allow elective surgeries to be a covered benefit. I already have the letter of necessity for a multitude of comorbidities, etc from my PCP. There is a 'clause' in our policy that just says its not gonna happen. For grins I asked the surgeons office what the surgery costs.......around $30K. Yea, not gonna happen either. So for now, I bid you a fond farewell. Good luck to everyone, thank you for your support and never forget that you are number 1. On to strategize plan B. I got this, it's all good. Take care, Simply Stace-

Thanks for all of the encouragement. I am doing my best to not give up. I have a lot of phone calls to make tomorrow. Fingers crossed for better news!

So with fingers crossed I thought this might be the week I hear about a surgery date. Low and behold I got the call today.....and scheduled it for Nov. 1st. I was so happy. She told me about all the pre op prep, blood work, classes etc. I was stoked....and of course asked the question.....so everything is cleared with my insurance, right? She said, oh absolutely....you don't get this far until you have a pre approval, so you're good to go. (I've been working on this process since Jan. 4th). So for my own piece of mind I call my insurance to double check my understanding of a few things, ( deductibles, out of pocket maximums)make sure I'm not missing something.........the woman on the phone says, ma'am...you do know that Bariatric surgery is not a covered benefit for you, right? I asked her to repeat that for me 3 times and no matter how's he said it I still heard the same thing. So I hang up and immediately call the surgeons office to ask for help. I explained my situation and the lady chuckled And said.... Oh, what are they doing.......I'll call them right away and get this straightened out. So sure enough she calls me back and says the following.......I'm very sorry mrs. H---, somewhere in the process someone passed on the wrong information.....your insurance is correct, this IS NOT A COVERED BENEFIT under your policy. Honestly, you would have thought I was just told I was terminally ill........I dropped the phone and stood there with my mouth open for what felt like an eternity. Crushed, heart broken, deflated, sad, depressed, mentally exhausted.......absolutely beside myself. Tonight I am broken, I have cried a thousand tears.

Thanks everyone. I hope to get a call this week and we'll go from there!

Hello all. I had my meet the surgeon appointment 2 weeks ago. Now I'm just waiting for them to call with my approval and a date. My problem is,I've spent all the money I had put away for this on the unexpected medical stuff that cam up. ( knee surgery for torn meniscus and a heart cath). Not to mention the furnace we had to replace in the house and unexpected vehicle repair. I need to call my insurance to understand the deductibles and copays. If I read things correctly, my deductible has been met for the year. My fear is that the copay will be more than I can afford now and after all this I will not be able to have the surgery now. I feel so defeated. I wonder if anyone is willing to share their out of pocket cost for their surgery? Thanks.

Was kind of an uneventful vist. Didn't learn anything new. Other than high cholesterol, I don't have any other comorbidities. So the med chart review was easy. Left there with an " ok, we'll contact your insurance and let you know.". Guess I was expecting something a little different.......no worries tho. It will all come soon enough. It's been since January, so a few more weeks or months wont hurt.

Wednesday.....not edges.

Edges day I meet with the surgeon for the first time. What kind of questions did you ask at your first meeting!

Near mt Clemens

Thanks for the welcome! Looking forward to being a part of the group.

Hi everyone, This is my first post....so a little about my story...... I've been contemplating this surgery for more than 10 years. When I first started thinking about it I was about 260 lbs. I've done every weight loss program known to man. The only success I've had was with Jenny Craig. Too bad it was so expensive...... Fast forward to today.....I'm now 320 lbs. my heaviest ever. I started my journey again on January 6, 2012. My goal was to have surgery in April. Well, that didn't happen. I have been through every test known to man and then some. My weight loss dr heard a heart murmur and this spiraled into an extensive check of my heart. Multiple stress tests, EKG's, cardiac ultrasounds, lung scans and finally a heart cath in July. The diagnosis is slight pulmonary hypertension. In the middle of all of that, I tore the meniscus of my left knee and had to have surgery to fix that. After all of this, I have finally been approved to see the surgeon. I was so excited I cried. Then almost immediately I began to wonder if this was the right thing to do. Oh my gosh....after all of this.....I couldn't believe myself. So I have my appointment with the surgeon the week after Labor Day. I am excited again for this next leg of this trip. I am even more excited to feel better and enjoy life the way I know I should be. I'm glad to be here and look forward to sharing my journey and being inspired by all of you and all you have to share. Here I go.......this time is for real! Stace-