My original posts 9 yrs ago

Jun 28, 2010

47 , 5'9", 305 , 2 grown children, been overweight and dieting since 8 yrs old. Have hypertension and high cholestrol, had knee surgery last year. Can only exercise very little because of knee. I'm tired of try this, try that, try this again, and nothing works. I know this will and I'm anxious to start my journey.

4/27/00
Saw my PCP today and talked about surgery. He approved it and will request approval from insurance b4 I can go see the surgeon. Should know in a week. Keep your fingers crossed for me.

5/23/00
Been calling my PCP's assistant for over two weeks now about the insurance denial letter. She told me Dtr was going to write a letter to insurance. Went with my husband today to see the dtr. He forgot all about it and said I should also send in an appeal. He was surprised that they denied an authorization to see the surgeon, and promised to get a letter out this week. Let's hope he doesn't forget again. PS I won't let him forget.

6/23/00
Well I got a letter from the ins. co. that they received my appeal letter and that they have 30 days in which to reply. It seems like this is taking forever, but I am NOT giving up.

7/13/00
yeah! (that's a tiny cheer) cause the news is tiny. Got my letter from the insurance co today. I've been approved to see the surgeon, BUT ONLY for an evaluation. That's ok, at least I got thru the first hoop. Baby steps. My other problem is deciding what type of surgery to have. I've been reading about the duodenal switch and am leaning towards that, but the surgeon here only does the RNY. What to do, what to do?

7/31/00
Following is a condensed version of the past week. Saw the surgeons' coordinator. Told me doc won't do surgery cause my insurance will not pay for hospital. Called insurance, said doc should send letter for special approval. Coordinator won't know till 8/4 if doc will ok and send letter. Insurance said will not pay for me to go out of state. Looks like LEGAL action may be next. Keeping my head up. They're starting to throw curves into these hoops now.

8/04/00
Well spoke with insurance again. Was told that since surgeon cannot do my surgery, I need to go back to PCP and have him request another surgeon for me. But since there is only one surgeon in entire state, they will have to send me out of state, which is what I had wanted in the first place all along. GEEZZ, talk about running in circles. So have appt. next week @ PCP to request he send a letter. I going with all my ammunition, lists of previous diets, all my appeal letters, etc. I think I tell them I'll wait in the lobby for my copy.

8/29/00
Was at my PCP on the 9th, said ok and would send letter to insurance to request out of network surgeon. Then I went on vacation expecting to have an approval when I got home. NO SUCH LUCK! They didn't even send it out. I was told they didn't know where to send it. But got everthing straightened out and a letter was FAXED on the 25th. I called insurance today and was told it would be 2-4 days before they notified my pcp. Those butterfies are starting, it seems like it might actually happen this time.

9/26/00
Bummer. Received my denial letter on 9/8. They said services were available only through contracted physicians. Then they even suggested a contracted provider. I called the referral dept. at my pcp. But she's never called me back. I then called a mediator for the insurance and SHE NEVER called me back either. So now I'm at the point of making an appointment to see my pcp. When I go in to see him, it seems like people get moving. But calling NEVER WORKS!!!!

10/16/00
Hip Hip Hoorraaayy!!!!! Got a call from the referral girl at my pcp's office. Told me I was approved to go for a consultation at UCLA Center of Excellence. F I N A L L Y Whew, many many battles, but I think I'm winning the war!!! Next little tiny problem, I have to wait til January 9 to see the surgeon. That's ok, at least I've made it this far.

12/02/00
Went to my pcp the other day for routine checkup and asked if I could get a copy of my approval letter. They could not find it in my file and said to call referral girl. I did so and she could not find it either, so now I wait til Monday when Pacificare says they will refax to her. Sure hope so, only a little over thirty days before my consult with the surgeon at UCLA. PS. Another sad story is that I've gained again, I'm now up to 331.

01/10/01
Good Day AMOS buddies!!! I have some wonderful news. Had my consultation with the surgeon yesterday and he said "YES", it's a GO!! I am soooo thrilled. I knew in my heart that I would have this surgery, just needed that offical OK. Now on to the hard part, getting approval from that wonderful insurance company, then I will get a date. Bad part in all of this (BooHoo) is that he's booked until JUNE, aaaarrrrgggghhhh. I was kind of hoping for March. But I'll be put on a wait list for cancellations. I told the doc I could be there in 24 hrs since I live in Las Vegas and my surgery will be in LA. So gang, keep your fingers crossed for me, I should know in 2 or 3 weeks for insurance approval. Now I've got to go curl up and fight this awful flu I caught. But even the flu don't seem so bad cause I'm soooo excited. Can't believe it's actually going to happen. Weight at doctors office 329#

03/05/01
FINALLY!!!!!! HIP HIP HOORAAY!!! I've been approved and have a surgery date. My pcp's insurance girl called and left a message on my answering machine that Pacificare approved my surgery at UCLA. Thank God. It's been a long, long, long, battle, but I HAVE WON!!!! The only bad part of this is that Dr. Liu is soooo booked up that my date is not until June 27, 2001. But that's OK too, I've been overweight since 8 years old, that a few more months won't be tuff at all. Now I can relax and get ready for my big day.

06/19/01
Wow, can't believe it's been over three months since I've updated my profile. Over the past months I've been looking up recipes and reading the message board every day. I'm not scared or worried, just excited to start my new beginning. Won't be long now!!!!

07/01/01
Here I ammm!!! The NEW LOSER!!!! I just love it. I am four days post op today and feel fantastic. My preop weight was 314. I had my lap RNY, just like I wanted (THANK YOU Dr. Liu) My total stay in the hospital was 48 hours. YEP, that's right 2 days total. I took my last pain med for the trip home. Slept 90% of the way. Getting better and better every day. I am soooo thankful for this wonderful tool. Now I'm off to being a BIG loser.

05/14/03
Wow!! Sure has a been awhile. Can't say I've done good, but can't say it's been bad either. Anyway I've lost about 90 pounds and hit a wall. Don't know what it was, but can probably guess. Could it have been that I thought this was a CURE ALL!! Could it have been that I thought I could eat anything I wanted and as much as I wanted and still have pounds fall off. Could it have been that I didn't think I needed to work at losing weight. Not that it could have been -- BUT IT WAS!!!! So here I am nearly two years later and starting over. Sure my stomach is still small, but now it's down to discipline and my own will power. I am going to give it a try, all I can lose is weight!


Weight Loss Survey Responses
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Surgeon Info:
Surgeon: Carson D. Liu, MD FACS
10/16/00 I've been officially approved to see Dr. Liu for a consultation. However I have to wait three months for the appointment. Very Busy Man. 1/10/01 Met Dr. Liu yesterday. What a wonderful person!! He's low key, but very thorough. He took his time explaining everything and answered all my questions. I'm extremely comfortable and have every confidence in Dr. Liu. I know I made a good choice for surgeon.
Insurer Info:
PacifiCare, HMO
4/27/00 My PCP said that Pacificare can be tough to deal with and get approval from. Referral girl told me I should hear in about a week. 5/3/00 Received a denial letter for the referral to the surgeon. My pcp was surprised. He is going to write to them and said I should send an appeal letter too. 6/23/00 Just found out that the hospital the surgeon works out of is not associated with Pacificare, so they will not pay for surgery, and he's the ONLY surgeon in the STATE who performs WLS. 7/13/00 Well this is weird. They approved for me to see the surgeon, but only for an evaluation, still no idea about the hospital. 8/29/00 Waiting on another referral to an out of network surgeon. This time I was told would take 2-4 days! I think persistance and prayers are working this time. 9/26/00 Received denial for out of state provider. Said services are availble through contracted providers and to contact pcp for referral to contracted provider. There is only one contracted provider in Nevada and he will not do my surgery cause he only deals with one hospital which is NOT contracted with insurance co. ROCK - HARD PLACE - ROCK - HARD PLACE. HaHa Catch 22

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