RachaelThomas

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I was looking on my insurance website and noticed that the upper endoscope I had done last month said denied on my insurance status. I could not figure out why it would cover everything else but this procedure. I decided to call the insurance hotline yesterday morning. The lady I spoke with actually seemed to know what she was talking about. She assured me that everything had been covered and it was just a mistake and it had not been changed online yet. I decided to take the opportunity to see if she could tell me what the requirements were for bariatric surgery since this has been an issue from the beginning. I was told that I did not have to do the 6 month diet and that it was required through another plan under UHC but not mine. I decided to call my Weight Loss Clinic and talk to the insurance woman to explain that I finally had gotten an answer and the 6 months was not a requirement. Upon speaking to her, she informed me that she has all of my medical records and I have completed all of the classes they require. I have also completed the surgeons requirements. My last and final appointment will be on November the 13th. The last step of this journey is my psy eval.  I do not have to do anything else until after the approval. She told me that after I finish my psy eval that that they will be submitting the information to get the approval for the surgeon that day. Apparently, there was miscommunication at my last appointment. She went on to tell me that she had finally gotten answers from my insurance and that she was putting my file together. She said that she was going to call me once she was finished to tell me the good news but I beat her to it. I thought my last weigh in was going to be in December and I wasnt expecting to even submit the information until the beginning of the year. So its looking like at the end of November I will find out if I am going to be joining the losers bench. I was also informed that I needed to get a letter from my doctor sent in saying that she supports me and that she feels like surgery is the only cure for my obesity. My doctor hasnt always been on board with my  weight loss journey and I was very nervous to ask her for this letter. I thought you know what to heck with it, this is my life and I am not letting anything or anyone stop me. SO I stopped in her office and sat down with her and told her everything  I was feeling. I told her what the letter needed to contain and told her I was ready for this and I had appreciated her support thus far and that I was almost to the finish line. To my astonishment, it went well. She is actually going to write the letter for me. She will be submitting that letter next week. Today is the 1st.. Really, the 13th??? It isn't that far away! I was told that the approval process can take up to 2 weeks which I am ok with. I will probably have my finger nails chewed down to the quick but whatever. LOL

This all seems surreal. I keep trying to tell myself that I need to stay positive. Sometimes I can convince myself this is going to happen for me and then other times I am filled with nothing but doubt. I feel like I have never wanted something so bad in all my life! 

I really hope that the next post I have will be titled APPROVED.

I thought that in November that we would be submitting information to get approval for the surgeon but as it turns out plans have changed. My insurance says that I have to do a 6 month diet before going forward. Finally, some sort of answer from them. I am ok with the 6 month diet because we expected that I would have to do this all along and so I started it already back in July. December will be my last weigh in month. My birthday is in January so I am kindly hoping that this is the way it was supposed be so I could have the best birthday present ever. I had an exercise and psy class yesterday. It was actually beneficial. It was nice to interact with others who will be embarking on the same journey. That completes everything that I have to do for the weight loss program. I have already met the surgeons requirements so this 6 month diet is the grand finale. I still will meet with the diet and nut once a month as well as my PCP but those are easy. I am hoping for smooth sailing from here. I told the lady that I am so scared of being denied and she just kept reassuring me that it will be ok. If I get denied, I will have an answer as to why and we will go from there. The most important thing is to be patient. Yeah, about that, def not one of my strong suits. I do not wait patiently. You'd think that since I have been on this journey since July that I would be ok, whats another few months, right? Not! The closer that it I get the more spastic I become. The good news, I am still going forward. Nothing is going to stop me.

I am feeling pretty overwhelmed today. The closer I get to finding out if I get an approval it's like the crazier I get. I have done as much research as possible to confirm that this is really what I want to do. I just can't help but be anxious when I think about what will happen if I get denied. Just thinking about a denial, makes my heart feel heavy on the inside. I think at one point I had convinced myself that if I got no for answer, no big deal. Yea, well, it is a very big deal! This is my life. I am scared that in the insurance eyes this surgery will not be medically necessary. Having medicaid is just another negative thing that puts icing on my negative cake. I have looked through all kinds of things on the internet to try to comfort myself in knowing that I really do have a good chance of a yes. I called my insurance again the other day hoping she could tell me requirements other than "medically necessary" which she couldnt. There are no real answers there yet. My PCP and Surgeons office are kinda stumped at the way this whole thing has played and out because we have all called and just keep being told medically necessary. I hope that if I get a denial I will have someone there for support such as my weight loss team and my pcp.. BUT my PCP really isnt much on board. I feel like so many people are uneducated with this type of surgery that it always is followed by.. Just diet and exercise, you can do it yourself. I wanna smack these people right in the face. I do find this odd tho.. my doctor called to put in a prior authorization a few months back bc when I first spoke to my insurance company they said that is what I needed ( I actually needed a referral).. When she called they asked when my surgery date was... Im not sure if I am just clinging to any form of hope, but oh how I pray. The other thing positive thing I try to keep telling myself is, would they really be covering all this appointments and tests IF they did not possibly plan to approve me? I dunno, again, it could just be me clinging on to any possible hope. Until I guess I shall just keep on keeping on. I am so ready to join the losers bench!

I am getting anxious. I have 2 classes left and and a psych eval at the end of the month. In November we will be submitting approval for the surgeon. I am trying to mentally prepare myself just in case I am denied. I keep thinking that this is a shot in the dark. I was optimistic in the beginning but the closer I get to finding out and answer the more pessimistic I get. I have been working so hard to get to this day. I have even started to have dreams about actually going into surgery. I cant help but chuckle at this. I am going to continue to pray and do everything in my power get this surgery. I want to live. I want to be happy. Being overweight my whole life, this is kinda like the light at the end of the tunnel. I am very thankful for this website. Without it, I do not think I would be as informed about things as I am. I feel more prepared by talking to people on here. I have learned more on here from people first hand than anywhere else. I will have family support if I am able to have this surgery but I feel like it is also important to have other means of support in this journey. It would be nice to relate to someone who has been there or someone who may be having the same struggles and issues. Being overweight is the hardest thing I have ever had to deal with in my life. It has plagued me since early childhood. I feel like people try to relate to how I feel but one does not fully understand obesity until they have been there. It's more about just being fat. Ya know?

Well hopefully my next post on here will be titled APPROVED..LOL Until then guys, send good thoughts, vibes, and prayers..

Yesterday I had an upper endoscope. I had a little bit of a rough experience starting out. The nurse infiltrated my IV and I thought the pain was normal and did not say anything like an idiot. When the nurse lifted the sleeve on my gown and I saw the huge bump on my arm it freaked me out and I started to cry. She assured me it would be fine and it was. I am a grown woman acting like a child. LOL  I have never been put under and what an experience it has been. I have felt so much like a slug since yesterday. I am working til 11 tonight and then back at it at 7 so hopefully come tomorrow I will feel better. This was the last test I had to do that was required by my surgeon. I have a few more dietary classes and exercise classes and I am done with all  the requirements. Then late in October we will put in a request for an approval. I am so excited. I have been on this journey since July and I am hoping and praying that I am approved. Until then, I shall keep on doing what I need to until I get the yes that I so well deserve!

Cheers to making new friends!! I haven't been a member on here for very long but I have already taken in so much information. It feels nice to have people who can relate and understand the battles of being over weight. I recently met someone on here who like me is fighting the Medicaid Maze. This site is the most amazing place to find comfort. I am so glad that I decided to join.

I am 28 years old and trying to have the sleeve surgery. I have Medicaid and so I know it is going to be a long road ahead. As of right now, I have an upper endoscope scheduled and several diet and exercise classes to finish. In late October we will be submitting for approval for the surgeon.  (which seems light years away from now)   

The insurance has not been helpful at all and I am currently doing the 6 month diet and we aren't even sure if they are going to require that. We went with what UHC normally requires (even tho medicaid is different). I am 5'2 and have a BMI over 40 and we are hoping that it will be enough to get the approval. I am not sure what I would do if I were denied. I want this so bad and am going to try like heck to do this. I want to live. I want to be healthy and happy.