Here we go again

[leag78 469]

Well for those that don't know, I started this process back in July 2014 and because I have Optima Family Care ( medicaid) there is a 6 months waiting period filled with pre op testing, psych evals, nutrition and surgeon visits. We'll I completed my lab work back in Dec and found out that my Protein was too low to operate and my goal was to increase my Protein to normal in order to have the surgery.

I had to also wait an additional 30 days before I can get tested again. Fast forward to 30 days later and not only did my protein remain below the norm but it in fact dropped some more. Keep in mind I started drinking Protein shakes, I have eggs for Breakfast every morning. I bought a huge container of peanuts from Sam's Club and I eat a lot of chicken and fish, so how could this be, right? Now I have to go back to nutritionist Monday to get me on a high protein diet. Now I have to wait another month to be tested again.

If my protein is still too low I have to go back to PCP to determine if there is an underlying problem that is affecting my protein.

This is the best part, I received a letter from medicaid stating that my medical coverage will be expiring effective 1/31, because according to them they never received my renewal form that they claimed to have mailed out that I never received. Unfortunately there was no way for me to stop them from cancelling my insurance coverage so I had to re apply by phone yesterday for like an hour. So now my insurance have to be reinstated before I can have my blood drawn again. And according to medicaid policy, it takes up to 45 days to process an application.

I'm starting to feel that I'm not meant to have this surgery. Please someone help me keep my sanity and stay focus because I'm this close to saying nevermind.

[della street 213]

@@leag78 Hang in there---MANY of us have crazy stories like that, here's a synopsis of mine:

--Hubby's work policy has specifically excluded WLS for at least 10 years

--Last fall (early Oct), I looked into purchasing a policy for just me on the Affordable Care Marketplace ("Obamacare")

--I'm in AZ, and all Marketplace policies must cover WLS -- not a well-known fact. I think it's 23 states ACA policies must cover WLS. Who knew? A fluke I found out...

--Found a policy thru BCBS of AZ that costs about $600/month, but we save about $200/month by not included me on hubby's work policy. Expensive, kind of, but $3500 out of pocket max, after that, all is 100% covered.

--Waited for open enrollment; purchased policy

--BCBS sent me bariatric guidelines -- said 8-week pre-op diet; covers band, sleeve or bypass

--Surgeon's office said have to do 6-month dr-supervised diet. Went round and round w/them since BCBS told me 8-week diet, not 6 months.

--Yada, yada, yada -- finally, BCBS told me that they accidentally gave me the wrong guidelines.

--UGH UGH UGH

--'Real' guidelines say 6-month dr-supervised diet (which I'd done elsewhere, so that was ok for me), but only cover band and bypass, exclude sleeve. I have no idea why.

--I get everything set up w/surgeon's office, have them change my file from wanting sleeve to bypass. They confirmed they had done that so when submitted to BCBS, it would say bypass since they don't cover sleeve on my policy.

--Surgeon submits paperwork, I get call that my sleeve is approved. Yes, sleeve.

--Dead silence on my part, then I ask 'so they now cover sleeve on my policy?"

--Surgeon's office: "yes, they've specifically approved sleeve." I said, BUT IT'S NOT COVERED.

--Surgeon's office checks w/BCBS again and lo and behold, sleeve is not covered. they were extremely apologetic, but I could have had sleeve surgery and they could have said 'oops', you're not covered for that!!!!

--Plus, my surgeon's office had confirmed they'd changed my file to say bypass, but they obviously hadn't, and submitted me for sleeve (mistake) which BCBS approved (mistake)

--Bottom line: Bypass surgery scheduled this Friday, day after tomorrow

--Other bottom line: YOU have to be in charge of everything and know what's covered, what's not, get it all in writing, and triple-check EVERYTHING. Not to discourage you AT ALL, just offering advice.

HANG IN THERE and keep your eye on the prize!

Feel so very fortunate to have bypass covered, but what a huge hassle!!!

I keep a spreadsheet of "to do's" and who I spoke with, etc. Names, dates, etc.

[leag78 469]

Thank you for that. I needed to know that I wasn't alone because what really hurts is That I started this process about 2 months before my brother did and he is scheduled to have his surgery 2/11. He's going through a different practice than me. They were going to schedule him for 1/28 but that was too soon for him to get time off work. I thought the reason why his process is going so smoothly is because he has better insurance than my medicaid. I just feel discouraged. @@della street thanks again for sharing your story because it really does help.

[Djmohr 6,965]

Trust me, you are definitely not alone! It took me 9 months to get through a six month process. And I did not miss a single appointment along the way. Other people do not care as much as you do about how long a person has to wait. You have to be your own advocate, that is for sure.

Good luck with the next steps!

[leag78 469]

@@Djmohr, thank you! Like you I haven't missed a single appointment so I thought that I would've had the surgery by now, but not looking that way. So I went from having my surgery in Jan to possibly having it in March or early April. Oy!

[Djmohr 6,965]

I am so sorry this is taking so long for you! I hope things get moving forward.

[leag78 469]

Thank god for this site because I'd go crazy without it. It's nice to talk with others who understand and have some what an idea of what I'm going through.

[drmeow 323]

Since you have to wait anyway, I would be pushing more to find out why your Protein is low. You may be losing Protein through your kidneys or your liver is not processing it well, or your GI tract is not absorbing it well. Unless you've previously been a very low protein diet, just adding more protein to your diet is not likely to improve your levels without knowing why it's low to begin with. Was all the rest of your blood work normal?

But they are right to wait - low protein means your incisions won't heal well and you may have leakage. Plus, depending on the underlying reason for it, there may be other complications as well. Good luck!

[leag78 469]

@@drmeow, I didn't know that. The surgeon is sending me back to the nutritionist on Monday to get me on a higher Protein diet. If my protein still doesn't increase to a normal level then they want me to follow up with my PCP to determine the real cause. And to my knowledge all of my other tests must have came back normal and they only mentioned the protein and my Iron being a little too low. So I'm starting a supplement for iron. But no one ever told me about the affect the protein will have on your recovery so I thank you for that. And I'm glad that my surgeon is taking it serious as well.

[leag78 469]

Well again Protein not normal for surgery so now I have to go back to my PCP so he can determine why my body isn't getting enough protein. I'm really starting to feel like this surgery isn't going to happen for me. I literally cried for 2 hrs once I found out. Please pray for me, because I'm on the verge of saying forget it and accept the fact that I am meant to be fat.

[nicern99 0]

So sorry you're having so many troubles. I started my process last May, had to have a hysterectomy in August, which delayed the process for 3 months. Went back into the program in early October but psychosocial denied me In November, said I needed counseling before I could move forward. Would have been nice if they would have told ME that but they just cancelled my December appointments without letting me know. I drove 180 miles each way to my monthly appointments. I never missed any appointments . I had to go to a blue distinction center which is required by BCBS and there weren't any near me. So I appealed only to be told too bad. I can't conceive of driving 180 miles for counseling, so 7 months down the drain! After January 1st, a local hospital was named a blue distinction centers, thank you Lord!! I started my process again the end of January. I can empathize with the frustration of all this. Will pray for you!

[leag78 469]

@@nicern99, thank you for sharing your story. I was really upset yesterday because this is something I want really bad and to be told that something like Protein is the only thing stopping me right now is really hurtful. I'm gonna go to my doctor tomorrow if the snow isn't too bad and try to figure out what's going on with my protein.