Friday, April 10, 2015

Insurance Hoops Again

It's funny.  Often, I think I need to write a post and I'll ponder it for a few days and just when I'm about ready, someone will leave a comment or email me asking how I'm doing.  This time, that person was Bonnie and it much appreciated and coincidental timing.

This week, I checked off 2 to-do items for insurance approval of a revision to a sleeve.  I had my psychological evaluation and nutritionist consultation.  I'll break these down and since I've already done both of these, I'll compare it with my first experience (which you can find here.)

Psychological Evaluation: My first psych eval was fairly uneventful.  I was creeped out by the guy who did it and spent 20 minutes chatting and had to fill out a HUGE questionnaire.  This time, it was obvious that this woman only approves people.  The questionnaire was fairly short in comparison and mostly focused on figuring out if I have an eating disorder.  I had to laugh because a couple questions totally aim to get you to admit to something (they're all agree/disagree type things) "My current bad mood is impacting how I answer these questions," "I'm answering these questions to make my life sound worse than it is," etc.  Cracked me up.  The psychologist wasn't creepy and she was actually very nice.  She basically just said "You've already been through this once, you know what to expect.  Let me get some details for your letter and you'll be on your way."  Such a racket.

Nutritional Consultation:  In my first consultation, I was really irritated with the nutritionist.  This time around, it was still annoying but not as bad.  Once again, the woman was rail thin.  I'm pretty sure it's a requirement to be rail thin.  I will say this for her though, while she was a bit condescending, she didn't treat me like an idiot.  At one point, she even said "I can see knowledge isn't a problem for you so I'm not going to bore you with telling you the type of food you should eat.  You already know that.  What I will tell you is Dr. Uchal's opinions on how you should eat (slowly, chew well, etc.) and a little about pre-op."  It wasn't awful.  I liked her so much more than the first one but was still a useless conversation.

Diet History & Medical Records:  My old lap band doc sent all the records over and I filled out my diet history form.  Check and check.

So what's next?  I have a fairly small to-do list of clearances that need to be handled prior to submitting to insurance:
EKG - Make sure I don't die in surgery?
Chest Xray - Ditto to top?
Thyroid Test - My insurance apparently makes you try to resolve this issue with medication before approving the surgery
Esophogram - To ensure my stomach is healed from the band removal
Pre-Op Class - To learn how to eat before and after surgery

Once all this is complete, we'll submit the packet to insurance for approval.  They are thinking sometime in late May and then surgery in late June/early July.  They don't seem to have any doubts the insurance will approve it.  I, of course, have many.

It's interesting that I'm just not as excited this time around.  When I was jumping through hoops with the band, I was constantly researching and working towards insurance approvals.  I was reading tips on appeals and how to get approved.  The time seemed to be dragging and the whole process seemed to take FOREVER.  This time, if I don't get approved, I doubt I'll even appeal it.  Is it that I'm unsure that I want it or unsure that even if I get it, that it'll work?


Leigh Costa said...

Hey there:-)So many blogs I lost contact with b/c I'm not blogging nearly as much and not on here too often. My very best wishes that things work out for you. Positive thoughts your way:-) xx

#fatfreefloozy said...

I'm not sure of the approval process, it seems very different here because we have to put it through private health insurance and it's jut a matter of how much they will cover. I hope you find out soon.

Amy W. said...

I sometimes wonder if there are EVER people that go into the nutritional part and actually have no idea about calories, protein, etc. I have long said that fat people (talking about myself here), well we know...probably better than most...all about healthy foods and calorie counting because we have done that our entire lives! I wish it was more nutrition 301 instead of 101. Tell people about quinoa. Tell people how food breaks down in your body, etc. But maybe some programs are like that.

Amanda Kiska said...

I had my Band relocated in February, but I still had to do all the pre-op stuff again. I agree that it is a racket. Most of my visits were pretty much like yours, "You know what to do. I'm not going to tell you anything you don't know..."

Good luck with the approval process! I'm sure all will be well. said...
This comment has been removed by the author. said...

I think the pre-op psych eval is meant to find seriously mentally ill patients who should not have surgery without a lot of support. I'm a surgeon so I didn't have to go to the nutritionist but I wanted to see her pre-op to discuss how to get enough nutrition from the food I could eat. She was condescending to me and I'm a doctor so regular folks do not have a chance. She kept talking about how I couldn't eat pizza and burgers when I wanted to know how to get enough veggies into my diet. Worthless interaction and I'm still struggling to get anything besides protein and a few tablespoons of veggies in. Reach out if you have questions. Good luck. It's a huge lifestyle change. Tracey

Bonnie said...

I'm so glad you posted because we are so in sync!! I just did a post that ends with my lamenting that my surgery is 2 weeks away and I still haven't received insurance approval. What I didn't post is exactly what you said. I'm definitely not as excited this time around as I was with the band. Before the idea of being denied was devastating - not I'm kind of like "ehhh - if they don't approve it maybe it isn't meant to be." I'm not sure what that means either. But I tell you, it's really nice that somebody else feels the same way as I do! We'll get through this together. :)

Beth Ann said...

Hoping things go smoothly. Sending good mojo!

Theresa said...

OMG! I have been terrible about keeping up with folks, I've just read a bunch of your post and see you had your band removed. I'm so sorry for all that you've gone through! I hope all goes well and that you can get a revision. Hang in there!!!