Waiting for Insurance Approval

Hello all,
I have jumped through the last insurance hoop and all the paperwork should be set to submit to insurance this week.  Now we wait.  I have a tentative surgery date of 7/8 if the approval comes through as expected.  I'm supposed to start my 2 week prep diet on Wednesday which is no carbs.  I don't really have a problem with that except it does bug me to start a prep diet before I know insurance will approve.  That leads me to something else I find odd.  No one in my doc's office seems worried about that.  They keep referring to the insurance approval as if it's a foregone conclusion…everyone from the patient advocate to the surgery scheduler to the doctor.  They told me they've only had a patient declined once and that they check everything out at the beginning so they don't waste their time bringing a patient through if they won't be approved.  As someone who was previously denied weight loss surgery despite jumping through all these hoops, having appropriate coverage and doing everything they told me to do, this surprises me.  I guess we shall see.

Either way, the time of waiting is done.  I'm looking at the "preop" diet as just a diet and a way to kickstart my weight loss.  I'm done eating like there's no tomorrow or consequences for my actions.  I've hit several new lows (remember when they used to be a number on the scale?) such as:

• I had to shop at Avenue because regular stores are out of the question again.
• I weighed in at 228.2 - Just 2 lbs shy of my highest non pregnancy weight EVER.
• I'm getting winded just walking around the block.
• I don't want to go places just because I can't find anything to wear and don't like the idea of people looking at me.
• I'm nervous as all get out about a presentation I have to give via video conference tomorrow because of how I look.  

These are not good things.  These are things I thought I had moved past but obviously haven't.  So surgery or no, it's time to turn things around.  I can't just sit back and be a bystander anymore.  Fingers crossed an approval or denial comes quickly…just so I know where I stand.

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?

A New Journey?

My band was removed Monday, February 23rd.  Avery unceremonious way to end a 5 year journey.  I highly recommend if your band needs to be removed (and you're not revising the same day), try to find a doctor who can do it endoscopically.  Other than having a REALLY sore throat for a few days, no stitches, no incisions, no staples, no cutting.  I felt really good.  It's interesting to take a pill and not worry about it getting stuck.  It's weird to be able to drink carbonated beverages again.  I had my first beer in 4 years and it was GLORIOUS.  It's weird that it's gone and other than those little things, I don't feel any different.

Not unsurprisingly, I can eat anything and as much of it as I want.  And I am.  Despite my best efforts, I just can't seem to stay on track.  I need to bite the bullet and purge my house of any unhealthy food.  I need to FORCE myself to go the gym.  But going to the gym hurts.  It's hard on my knees, my lungs, my ankles, my arms and it hurts.  I remember it hurting.  I also remember it NOT hurting after a year of going religiously and taking 2 classes a night just because I wanted to challenge myself.  I remember it NOT hurting to walk miles and miles or even run a few of them.  I remember it NOT hurting to lift heavy things and lift my body weight on a rope.  I don't know what hurts most now…my pride or the joints.

I have decided to attempt to get insurance approval to a revision to a gastric sleeve.  I was unsure of how I felt about undergoing yet another weight loss surgery.  The lap band was my "last ditch effort" after everything else had failed and as invasive as I was willing to go.  And it failed.  I failed.  I think a part of me believed I didn't deserve another chance of getting help with this.  A part of me believed that I now needed to sink or swim on my own because even surgery couldn't help.  It was illogical, I realize that but I think I was punishing myself.  I'm done with that.  I need help.  I'm not saying I could never do it completely on my own but I remember how good it was having help.  I want help again.  My current insurance does cover a revision but I have to jump through all the same hoops as I had previously.  I have to do a psych eval, dietary evaluation (nutritionist) and a nutritional class to talk about preop/postop diets.  I have to prove my diet history and have all my records faxed over again.  Doc wants to let the stomach heal from the erosion for at least 4 months.  That gives me plenty of time to jump through the hoops.

I'm actually not holding out much hope that insurance will pay for it.  I had to fight like hell the first time and I don't think I have that much fight left in me but it's worth a shot.  I'm going to do all I can do.  It's a new and different journey.  But as long as I'm walking down a path, I'm going to hope it's the right one.