JenE

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 Just a moment to update, my wrist is in a bit of pain today.  (PLEASE no carpal tunnel, PLEASE NO CARPAL TUNNEL!)

I have my consult at the beginning of next month (5/6)!  

So I had my eval this morning.  It's uncomfortable, hearing all the things that are "wrong" with me, even if they're not entirely accurate.  Yes, the testing is complete and accurate (to a fault), but as it is designed to point out problem areas, there is no real interpretation to the results themselves.  The computer simply quantifies your psychological profile, and puts it on a graph.  It's up to the psychiatrist to evaluate and interpret it, hence the appointment to review the results.

Most of the things I was pretty familiar with.  Bi-polar, depression, anxiety... yeah, I know all of those.  Low self esteem wasn't really a shock (gee, I wonder why I might not think much of myself!), and it was pretty understandable that with the kind of pain I'm always in, it would come up with "hypochondria".  The doctor was great with that one, pointing out that he was discounting the test's results in that area because it was obvious I *AM* in that kind of pain.  Yay smart doctors!

The schizoid and masochistic were a bit of a shock, but he did say those may have been due to my current state when I was taking the tests.  My mood at the time may have had an effect on my answers, and since those were minor (barely above the "normal"), he could certainly see where it might crop up.  

He told me that, on simply looking at the results, he was ready to deny my application for the surgery.  Once meeting with me, however, he said he was revising that.  He will recommend me for this surgery to my insurance carrier, on the condition that I get standard psychiatric care BEFOREHAND, and get these things under control.  I've been wanting to do that for a while anyway, so that's no real problem for me!  

So that's one more hurdle overcome.  I feel so lucky that the medical staff here in Sioux Falls has been so supportive.  I can only hope the insurance company is half this encouraging!

I have my psych evaluation on the 17th at 11 AM.  They asked me to come in before then, to get the "pre-testing" done, so they have something to evaluate!  I went in yesterday for it, since I will be out of town for the next 10 days.  

Oh my gosh!  So many questions!!!!!!!  I think I answered a total of over 700 T/F questions, and all in that fun standardized "dot" format.  Ugh!  I thought I was done with those when I graduated high school.  Most of the questions were pretty straight-forward, and the "issues" I believe the psychiatrist will bring up at my appointment are all things I already know... Depression, codependency, abandonment issues, social anxiety, mildly bi-polar.  

I'm looking forward to my break in California, but not looking forward to being apart from my husband that long.  This is the first time I've dreaded going to CA for a vacation!  LoL  Once I get there, I know I won't want to come back. ;)  I'm just not a fan of flying, especially when the seats seem to loom in their tininess.  

Jerry is going to call the insurance company while I'm gone, to see if they got the faxed Part One from my pcp, and then to find out what else they need.  I'd rather head off any problems we might have.  :)

Ok, first of all I love saying "PCP".  It makes my family sit up and take notice.... and makes some of them offer to "pray for me"... and not in the "I support you" way either. ;)  

I went in to see my primary care doc a couple of weeks ago, to have a sit-down consult about getting the DS.  Right away, she was on-board, and knew all the right questions to ask.  She asked for details on my diet history, what comorbidities I had, and was happy that I've found OH.com.  (I wasn't even expecting her to know what it WAS, let alone be supportive).  When I told her I had been fasting already (no food since midnight the night before), she was thrilled.  Said we'd get the tests done that we could right there, and go from that point.

So that morning, I had my blood work done, my x-rays, my EKG, and my tetanus booster (I hadn't had one in several years, and she commented that if they're going to cut me open, I need that to be current).  All in all, it only took about an hour, including the EKG which didn't want to read properly.  She said the insurance might want a pulmonary stress test, but that given my weight and history with asthma, they might be able to bypass that. 

She sent off the lab results to my surgeon, Dr. Inman, and I'm just waiting to hear from SOMEONE what the next step is.  I know I still need the psych evaluation, for insurance AND for Dr. Inman's records.  Her office requires that I get it there, with one of their people, but I am waiting to hear if the insurance needs one as well.  If they do, I'll get theirs done here, and then get approval first.  (Assuming I can, I'm still a little fuzzy on the order of things with all of this.)  

For now, however, I play the waiting game.  Hubby is calling my pcp today on his break to find out if she faxed the stuff off to BCBS/GA.  If so, I can start harassing the hell out of their agents for a denial (since we already know that's what it's going to be... read below if you're not sure what I mean).  If not, I can plan for this Thursday (after we get paid Wednesday night) to take care of whatever else they need from me. 

Yay!

Wow.  Ok, so much changed in such a short time!

My insurance is Blue Cross/Blue Shield of Georgia, as provided through my husband's work at Knology INC, a telecommunications company.  We have a standard PPO, and have been covered since last year (barring the little snafu I had where  MY coverage was cut for a time).  According to our documentation of the policy, given to us when our insurance started, WLS is covered.  Only one, they won't cover a revision, but it's covered.  It's listed in there.  Bariatric Surgery - Covered.  

Today, when the surgeon's office called my insurance company, to get process information, they were informed that bariatric surgery is NOT covered under my policy.  WHAT?!  I had a bit of a panic attack (not healthy for someone just getting over pneumonia, let me assure you), talked to my mother, my husband, my best friend, and my brother... and finally calmed down.

My husband marched down to the HR department at his work to find out what's going on...  Here's where it gets "fun".  Apparently, there WILL be policy changes, but they haven't taken effect yet.  Knology's lawyers and Blue Cross's lawyers are in the process of fighting it out over what will and won't be covered.  In the meantime, Blue Cross has been slamming the door in our faces without any kind of documentation to back up their claim.   

I no longer have the 2009 disc that includes our policy information, and Blue Cross is of course unwilling to furnish Knology OR my family with another copy until the new one comes out.  They won't talk to me, they simply direct me back to the company, who then directs me back to Blue Cross.  Knology in this, I hold no animosity for.  They're doing all they can, but simply don't have any more information than we do.  

I have a paper trail a mile long that says I need this surgery, and a surgeon who IS listed with my insurance company's providers.  So I know it's not what they say, that they're cutting it all over.  Someone is lying to us, and I would really like to know who so I know where to aim the nuclear launch.  

It's always the hardest, right?  Well, this time I think it's probably the easiest one out there.  I have my appointment with my PCP set for 2/4 at 9 AM.  I'm going to get appointments for my psych eval and bloodwork from her.  I just need to hear back from Dr. Inman's office on what else they will need before approaching my insurance.  

The timing of this is tricky, because of the cost associated with travel.  I already know I need at least two trips to Indianapolis before my surgery (once for the initial consult, and once with 2 actual appointments for follow-up and scheduling).  I think I have to go to the first one before my insurance is contacted, and if so, that's going to confuse a few things...

My mother has offered to let me stay with her in Evansville from my first appointment in Indy until 2 months after my surgery, to help me recover.  However, I don't want to put a huge strain on her, so I'm left wondering what kind of time-frame I'd be looking at for this... and what I'll do if my insurance puts up a fight (quite likely with BCBS/GA).  Unfortunately, I'm not really getting much in the way of solid answers from anyone... Hopefully that will change after next Thursday's appointment! 

 My grandfather is going to help with travel expenses!  YAY!  So it looks like I'll be able to have Dr. Inman after all.  

Next step:  Getting a primary care doctor that will give me a referral to Dr. Inman, and contacting Blue Cross about approval.

I am so frustrated right now!!!  It looks like I get to start all over from the beginning, as it is just not going to be possible for me to get from Sioux Falls to Indianapolis multiple times before I even get my surgery date.  I spoke with Dr. Inman's office, and they were extremely considerate and helpful... The bottom line, however, is that I can't afford travel, and a hotel, and food, and cab fare, and everything else to get out there a handful of times before I even know if I'll get the surgery.  I knew I'd have to go out there at least once, but they won't let me do any of the tests or evaluations here, I have to do it all there.  Shoot!

The second option, having my surgery in California, is looking like more and more of an option here.  What is the deal?  Can people only get WLS if they're either fabulously wealthy, or so destitute they are on medicaid?  I'm in that great 90% in the middle.  I have insurance, but can't really afford to shell out nearly $10,000 out of pocket for this. 

 Spoke with Colleen at Dr. Inman's office, and she directed me to Lindsey, to discuss the consultation and pre-approval seminar.  I'm waiting to hear back about any options they might have for out-of-towners (or out-of-state, as the case may be).  If nothing, I may just have to break down and take a bus to Indianapolis for it.  (YUCK!  25 hrs on a bus!!!)

Dr. Inman DOES take my insurance, in a general sense.  Now all I have to do is wait for my ins card to get here so I can start pestering BCBSGA about my specific coverage.  Wish me luck!

Weight: 350
BMI:  51.7
Overall health:  Poor

And I don't mean pennies and nickels!  

Ok, that was a horrible joke.  Give me a break, it's been almost 2 years since I said anything here.  And boy, what a couple of years they've been!  I'm currently still living in South Dakota, caked in snow up to my eyeballs this winter, and struggling to keep a decent diet going.  While it is always hard to keep up good eating habits during the holidays, I find that it's much worse right AFTER those epic family meals, as there is the dangerous combination of leftovers and depression.  

We lost insurance for a few months because of some paperwork SNAFU at my husband's work.  Fortunately, as of this month, I am back on insurance.  And luckily, this time the insurance is nationwide (BCBS/GA), so I won't have any trouble with that side of approval.  Whether or not Blue Cross will actually approve my surgery request... well, that remains to be seen.

Starting next week, I am going to be trying to get back in the good graces of my former doctor, who was gung-ho about getting me on the track for WLS.  I think she means RNY, but she will learn quite quickly that I am gunning for the DS instead.  Dr Van Kelsbeek seemed amenable to any surgery when I talked to her, but as that was quite some time ago, I may have to start over with an entirely different doctor.

I have the official diagnosis for PCOS, which is tricky in and of itself.  It's clear from just a cursory exam that I have the hormone imbalance, but in order to actually give a PCOS diagnosis, they need to see either cystic activity on my ovaries (and lots of it!), or something has to come up in my blood work.  The tricky part is that these things don't occur constantly.  It depends on my cycle, my hormone levels, and a myriad of other factors, each of which can throw off a diagnosis.  So, when I got the official letter from my doctor saying "You have it!" (in a few more words than that), followed by "Get the surgery!!", but with slightly less emphasis in the way of exclamation points, I was pretty thrilled.  Here was my first piece of physical evidence that I wasn't crazy, I wasn't just a lazy fat b--well, you know the rest of the insult.  No, I had medical proof, and a medical professional that believed as I do, that I need surgery.

Let's hope my insurance company agrees!

Because of the upcoming move, I'm being proactive and looking for DS surgeons in Indiana.  My goal for moving is as follows:
1. Get pre-approval from my regular doctor
2. Locate a surgeon that is willing to work with me
3. Send off insurance paperwork
4. Upon approval, move.  

Fortunately, my family down there is being extremely helpful.  My parents are willing to put me up until August, when Jerry can come join me, even if that means I convalesce at their home.  Isn't that sweet of them?