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I have decided that I am NOT going to give up on getting preferred benefit approval for the surgeon or the hospital I want.  Starting today and through the weekend I will be completing the most impassioned, factually based and comprehensive appeal I can muster and will send it in for "urgent action" on Monday.  It would be easy to just throw in the towel and say, "OK, you win.  I won't go to the doctor I want or have the after care I feel I need." But I have decided that I AM WORTH THE EFFORT to get my case reconsidered and so help me God, if I have to go there and talk to these people in person, that is what I will do!

Monday came and went and all it did was confuse me worse.  My PCP did consult with the director at the insurance company but it is starting to sound like my plan will not allow them to approve an out of network provider in non emergent cases at all, but no one seems to be quite sure.  Everyone I talk to has a different answer, and no one sounds 100% sure.  I am so frustrated!  I will call again after work today and see if I can't get someone to walk me through the out of pocket expenses and see from there.  Meanwhile, the hours tick by, and the days become weeks.    Easy to be discouraged...

Just returned home from a 2 day field trip with a group of my students and found a message from my PCP that she has an appointment for a phone conference scheduled with my insurance company on Monday.  We are hoping that she will be able to get them to reconsider and ultimately approve my out of network doctor and hospital request in that call.  One way or the other she'll call Monday and let me know how it goes.  Please keep your fingers crossed for me!

Well, I should have known better, I guess.  After getting the phone call that I was approved and posting all about it on Thursday, Friday came with a letter from the insurance company and that letter told a different tale than the phone call did.  They have approved my surgery, but not the hospital and doctor I want to use because they are out of my network.  GRRRRR.

I've been told by my PCP that a simple phone call from her to the insurance company should be enough to change the status, but it sure knocked the wind out of my sails to go from the happy high of Thursday's news to the reality of Friday's mail.  I think I jinxed myself by writing and telling about it so soon.

Anyway, once again I have to play the waiting game since no phone calls asking for reconsideration can happen until Monday.  Feeling a bit blue about it all tonight...is that normal?? 

Just found out that I have been approved for both my surgery and the out of network provider and hospital I wanted!  And it only took TWO DAYS!! YIPPEE!!  Finally it feels like this is really starting to happen.  I'm not just thinking about it or talking about it anymore, I am actually going to do it!

It was DEFINITELY worth the time to go through my medical records and charts with my PCP, and do a thorough job preparing the materials to send in to support my request.  I would recommend that course of action to anyone.

Is that great news, or WHAT?

Tomorrow I will call and schedule my initial intake appointments.  Here we go...

Submitted everything to the PCP yesterday with faxing to the insurance company expected to happen today.  And now the waiting begins.    I suppose it woud be too much to hope I might be one of the ones approved within minutes of the first letter!  Any idea how long I can reasonably expect a response to take?  Thanks!

I spent an hour with my primary care doctor yesterday pouring through my charts and gathering documented evidence to support my request for WLS.  We have everything we need (we think anyway!) as well as a clear record of weight gain through the years. Wish I had a dollar for every time the word "obese" was written in the chart!  Anyway, we also were able to document at least 4 different types of prior weight loss attempts so I should be all set there too.

Monday we will fax it to the insurance company and see if we can get this show on the road.  I finally feel like I am really getting started, not just thinking about doing this, and am still hopeful that if they approve both the surgery and the out of network hospital, that I can still look toward getting this done this summer.

It sure was eye opening to look back at all those years though...Most of the weights would be TRIUMPHS now!  No sense looking back though.  Rip off the rear view mirror and look for what's ahead.

Hope you all are having a good day.

Best to all,
Lois

I am planning to have the RNY.  I have found a great doctor and hospital in Hartford, CT and what I really feel best about with this program is that the surgeon is involved with each patient right from the very beginning of the process and through the first year and a half of follow up.  I did not like the idea of not meeting with a surgeon until 2 weeks before surgery and then only seeing him or her once afterward and then being handed off to never see the surgeon again.  I felt a little invisible with that idea and found it to be the case with three of the four programs I investigated.

This doctor also has an incredible record, including no deaths and not having to do an open procedure since 2003!  I never thought that with someone with my BMI that I'd be able to even consider laproscopic RNY but I see now that it is not only possible, but probable.

I'm starting the insurance paperwork now and hoping to schedule my first appointments soon so as to begin this journey to the rest of my life.

Thanks for your interest, guys!

Hi everyone!  Just got back from attending my second information session, (coupled with an extended weekend to be with family,) and I am pleased to say that I THINK I HAVE FOUND THE RIGHT PROGRAM FOR ME!!! I was VERY impressed with the surgeon. He spoke for more than an hour, and then also stayed afterward for any individual questions people had, to speak with him one on one for a minute.  He believes very much that the surgeon should be involved with the patient right from the start and all through after care and that is what I have been waiting to hear. Now, I start the insurance abyss of paperwork and hoops to jump through...  

It's 250 miles away, but it looks and sounds like an excellent program with a top notch surgeon and very thorough aftercare program.  I am looking forward to hearing what they have to say in person.  Wish me luck!