So day 5 of low carb and you know what I noticed yesterday that my steering wheel didn't rub up against my stomach. I was like hey! That's a start. It is amazing the things skinny folks take for granted. I bet they never think about their stomach touching the steering wheel. I can't wait for all the other little victories to start happening. Today is day 3 of no diet coke, water only and today is.. drum roll please.......Day two of no cigarettes!!! I am really wanting a cigarette today though. I went and found me some quotes to remind myself that I am in control, not the junk food or the cigarettes. Here's my quotes:
I am the master of my fate; I am the captain of my soul.
William Ernest Henley
Knowing is not enough; we must apply. Willing is not enough; we must do!
Johann von Goethe
Fear not that life shall come to an end but rather fear that it never began.
John Henry Cardinal
What you do today determines where you'll be tomorrow.
A journey of a thousand miles begins with a single step.
I really like the first one and the last one.
I didn't think I had it in me to give up the cigarettes but I guess it is all mind over matter. I told myself that I only had to quit for 30 days, just til surgery. Oh yeah! I forgot to mention...THEY OVERTURNED THE DENIAL AND APPROVED ME FOR MY VSG SURGERY!!!!! WOOT WOOT! OH YEAH! LOL I called my daughter on Wed and was like did I get a letter and she was reading blah blah blah and then I heard: The external review board approved your request for benefits. I said whoa! Read that again....and as she did I just felt the lump in my throat and wanted to ball. I think I shed a tear or two but I was at work so I tried to compose myself. I just didn't think it was going to happen for me. Nothing ever goes my way so that night Jan 7 at 9pm I smoked my last cigarette. Miss pack and a half a day put them down, that's how bad I want this. I am tired of just existing, I am taking my life back.
Showing posts with label i. Show all posts
Showing posts with label i. Show all posts
Friday, January 9, 2009
Tuesday, December 2, 2008
Shot down again
Well BCBS didn't care for my appeal as I received my 2nd denial letter on Nov. 21st stating that there was not enough evidence to support the sleeve as being non investigational , therefore it is considered non-medically necessary and the denial will be upheld. Uggghhh!!! So what did I do? Went to bed, sulked, ate a whole bunch, then got mad at myself becuase that is why I am fat to begin with. Decided to do nothing for a few days, then I got busy on my 2nd level appeal letter and some more documentation. I planned on mailing it that Wed. before Thanksgiving but I forgot so I mailed it yesterday. It is posted below along with the research links. Keep your fingers crossed!
Speaking of Thanksgiving, it is my favorite time of the year because after spending time with family, my sister in law and I sit up all night going through papers and head out about 3am to go Black Friday shopping. I absolutely love doing this! But this year I was afraid because of the back pain I had been experiencing and I had every reason to be afraid come that morning. My back and feet ached so bad. At one point, I had to go sit in the van, I was so angry at myself and the fat and the Graves Disease for being this way. It was all so clear once again of why I need this surgery.
2nd level appeal letter
To Whom It May Concern:
This letter comes in response to my recent denial dated November 21, 2008 for Weight Loss Surgery (WLS). I am writing this letter to implore that you reverse the decision not to approve Vertical Sleeve Gastrectomy (VSG) surgery on the basis it is considered investigational, therefore not medically necessary. In this letter I will explain why VSG is the best surgery for me and dispute BCBSNC’s assessment that VSG is investigational by asking you to review my Level 1 Appeal packet documentation as well as offering additional facts to dispute this claim. I am confident that you will reverse denial upon reviewing this additional information.
It has been established that WLS is medically necessary per my doctors, surgeon and BCBSNC’s medical policy (Attached in Level 1 Appeal packet) and I am grateful WLS is an option for me. I am even more appreciative of the fact that there is more than one WLS to choose from to accommodate a person’s medical and psychological needs. I have spent years researching different types of WLS; the side effects, lifestyle changes, the risks, the pros and the cons. I have read story after story of Gastric Bypass (RNY) and Lap Band being the perfect surgery for one individual, but not the next. I have read how one person’s body adapts to the changes from RNY or Lap band and the next person is continually sick from throwing up, dehydration, diarrhea, malnutrition, band slippage, band erosion; as well as suffering embarrassing moments in public by an abrupt exit because they ate too fast or ate the wrong food and had to make it to a restroom quick.
This is one of the many reasons I feel VSG is the best option for me and my lifestyle. It is the one WLS available that offers the most normalcy post op. There is no re-routing of my intestines so there is less malnutrition risk and complications; the stomach stays in tact, it remains a fully functioning stomach so there is minimum chance of dumping and complications. If you take a look at the attached surgery comparison chart you will see that VSG is the optimum choice. I do realize it is still a tool and as with all other WLS, I have to do my part in order to succeed. As I stated in my initial appeal letter, I am a morbidly obese female weighing 379 lbs with a BMI of 61 with mostly obese related co-morbidities that will improve or go away completely with weight loss. This surgery will open the door for a new life for me. I will no longer feel like a kid being punished sitting at their bedroom window watching the other kids play outside.
Partial Gastrectomies have been done on patients suffering from stomach cancer and peptic ulcers for well over 100 years so we know a patient can live successfully with part of the stomach removed. The first gastrectomy was performed by Theodor Billroth in 1881 on a patient with antral carcinoma. The procedure itself has been of course modified and improved over the years just as the original Vertical Gastroplasty of the 1970’s and 1980’s has made the pathway for the significantly improved Vertical Sleeve Gastrectomy. VSG was first performed in 1993 by Dr. Jamieson in England and has since been refined and improved into the VSG we know today by Dr. Gagner in 2001. The VSG has been performed for 15 years and as we know it today for the last 7 years. This is a far cry from an investigational surgery. The results from the studies submitted in my initial appeal packet speak for themselves as well as the people I correspond with on a daily basis on Obesityhelp.com forum ( http://www.obesityhelp.com/forums/vsg/ ) that are real life examples of the success of the VSG with weight loss in excess of 100 lbs with no major complications post op. Laparoscopic Associates of San Francisco has a two year study that can be viewed at www.facs.org/education/gs2004/gs33lee.pdf as a slideshow. I am confident the information provided is significant enough to disprove VSG as an investigational surgery. More insurance companies including BCBS Carefirst and Federal BCBS are adapting VSG in with their policies; this is further clarification this surgery is no longer considered investigational.
Please take a closer look at my initial Appeal Packet as well as the additional documentation attached. I am excited to begin a new life with the surgery that will most benefit me. I look forward to hearing from you soon with good news of a reversal of the initial denial. Thank you for your time.
Sincerely,
http://www.obesityhelp.com/forums/vsg/cmsID,8874/mode,content/a,cms/
http://www.lapsf.com/vertical-gastrectomy-weight-loss-surgery.php
Speaking of Thanksgiving, it is my favorite time of the year because after spending time with family, my sister in law and I sit up all night going through papers and head out about 3am to go Black Friday shopping. I absolutely love doing this! But this year I was afraid because of the back pain I had been experiencing and I had every reason to be afraid come that morning. My back and feet ached so bad. At one point, I had to go sit in the van, I was so angry at myself and the fat and the Graves Disease for being this way. It was all so clear once again of why I need this surgery.
2nd level appeal letter
To Whom It May Concern:
This letter comes in response to my recent denial dated November 21, 2008 for Weight Loss Surgery (WLS). I am writing this letter to implore that you reverse the decision not to approve Vertical Sleeve Gastrectomy (VSG) surgery on the basis it is considered investigational, therefore not medically necessary. In this letter I will explain why VSG is the best surgery for me and dispute BCBSNC’s assessment that VSG is investigational by asking you to review my Level 1 Appeal packet documentation as well as offering additional facts to dispute this claim. I am confident that you will reverse denial upon reviewing this additional information.
It has been established that WLS is medically necessary per my doctors, surgeon and BCBSNC’s medical policy (Attached in Level 1 Appeal packet) and I am grateful WLS is an option for me. I am even more appreciative of the fact that there is more than one WLS to choose from to accommodate a person’s medical and psychological needs. I have spent years researching different types of WLS; the side effects, lifestyle changes, the risks, the pros and the cons. I have read story after story of Gastric Bypass (RNY) and Lap Band being the perfect surgery for one individual, but not the next. I have read how one person’s body adapts to the changes from RNY or Lap band and the next person is continually sick from throwing up, dehydration, diarrhea, malnutrition, band slippage, band erosion; as well as suffering embarrassing moments in public by an abrupt exit because they ate too fast or ate the wrong food and had to make it to a restroom quick.
This is one of the many reasons I feel VSG is the best option for me and my lifestyle. It is the one WLS available that offers the most normalcy post op. There is no re-routing of my intestines so there is less malnutrition risk and complications; the stomach stays in tact, it remains a fully functioning stomach so there is minimum chance of dumping and complications. If you take a look at the attached surgery comparison chart you will see that VSG is the optimum choice. I do realize it is still a tool and as with all other WLS, I have to do my part in order to succeed. As I stated in my initial appeal letter, I am a morbidly obese female weighing 379 lbs with a BMI of 61 with mostly obese related co-morbidities that will improve or go away completely with weight loss. This surgery will open the door for a new life for me. I will no longer feel like a kid being punished sitting at their bedroom window watching the other kids play outside.
Partial Gastrectomies have been done on patients suffering from stomach cancer and peptic ulcers for well over 100 years so we know a patient can live successfully with part of the stomach removed. The first gastrectomy was performed by Theodor Billroth in 1881 on a patient with antral carcinoma. The procedure itself has been of course modified and improved over the years just as the original Vertical Gastroplasty of the 1970’s and 1980’s has made the pathway for the significantly improved Vertical Sleeve Gastrectomy. VSG was first performed in 1993 by Dr. Jamieson in England and has since been refined and improved into the VSG we know today by Dr. Gagner in 2001. The VSG has been performed for 15 years and as we know it today for the last 7 years. This is a far cry from an investigational surgery. The results from the studies submitted in my initial appeal packet speak for themselves as well as the people I correspond with on a daily basis on Obesityhelp.com forum ( http://www.obesityhelp.com/forums/vsg/ ) that are real life examples of the success of the VSG with weight loss in excess of 100 lbs with no major complications post op. Laparoscopic Associates of San Francisco has a two year study that can be viewed at www.facs.org/education/gs2004/gs33lee.pdf as a slideshow. I am confident the information provided is significant enough to disprove VSG as an investigational surgery. More insurance companies including BCBS Carefirst and Federal BCBS are adapting VSG in with their policies; this is further clarification this surgery is no longer considered investigational.
Please take a closer look at my initial Appeal Packet as well as the additional documentation attached. I am excited to begin a new life with the surgery that will most benefit me. I look forward to hearing from you soon with good news of a reversal of the initial denial. Thank you for your time.
Sincerely,
Research links:
http://www.obesityhelp.com/forums/vsg/cmsID,8874/mode,content/a,cms/
http://www.lapsf.com/vertical-gastrectomy-weight-loss-surgery.php
Saturday, October 18, 2008
The Nut, The Surgeon and the Shrink
So I had the last of my pre op testing and consultation this week. I met with the nutritionist Monday. I expected a lot of talk about diets and food choices but she was more interested in talking about the surgery itself and why I was doing it, I thought I was at the phychiatrist. Lasted about 30 minutes, it was painless and my inurance didn't pay for it so out of pocket I paid 55.00. At least it wasn't hundreds.
I had my consultation Tuesday. I have heard so many good things about Dr. Enochs, I was excited and nervous. My mom and daughter went with me so we can all have as much information as possible. The receptionist took my 400.00 consult fee...ouch! and a 30.00 co pay. This surprised me because I thought the point of the consult fee was to cover their costs in case you ended up not having surgery and got no money from the insurance company, which is why I didn't mind paying the consult fee but if I had to pay a co pay, that means they billed my insurance too. So they do get paid. I guess I should have asked but I was just so excited to have come this far in the process. I guess in the end, it really is all about money. My appointment was at 3:00, we arrived at 2:45, we were finally called back at 3:45, then sat in the room until 4:45..2 hours! I was irritated! I kept saying I hope they are having an off day because I would hate for them to be the top bariatric office in our area and this is how they operate. The nurse came in to take blood pressure and stuff and ask me what surgery I was looking at and I said possibly lap band or...and she jumped in to say "Your insurance won't cover lap because your BMI is too high" What??? What if that was the ONLY surgery I was willing to have? That would have been a good thing to tell me BEFORE I paid 400.00!! I said or the sleeve...she said oh they might do that but usually they only cover RNY. Well I don't want RNY. Why does it matter, it is my body! This just infuriates me. WLS is a choice I feel for lower BMI's but I think oncve you surpass 50, WLS is a necessity and it bewilders me how the insurance companies can look at it any other way. So Dr. Enochs came in and he was warm and friendly, made me feel very comfortable. He wasn't rushed even though he had to be somewhere by 6:00 and we were pushing 5:30. He skimmed over my chart and said he would recommend the sleeve for me as a surgeon because I don't really have many co-morbidies..I am somewhat healthy for a fat person! I do have a slight hernia and slight acid reflux and a fatty liver. The hurdle will be the insurance company. I know if they deny it, I will appeal...beyond that..I might push for lap band. I don't know what I will do. Try on my own once again I suppose. I didn't get to ask him all my questions, since most of them were surgery related I decided to wait until I was definately going to have surgery, plus he had to be somewhere so I thought I would be nice and not hold him up even though I had to wait for 2 hours but whatever, I am not bitter. LOL Really I'm not. I was a little irritated that day but Dr. Enochs was so nice, I got over it pretty quickly.
I met with the psychiatrist yesterday and she was super nice as well. I might have to meet up with her again. She specializes in bariatrics so I might need her down the road. I had to do a questionaire that asked questions like do I binge, do I closet eat, make myself throw up. Then we talked about the different surgeries and she said she has a lot of patients that are disappointed in their bands because they can cheat it and a lot of RNY's losing hair because they are not following the rules so she emphasized the importance of protein and eating right, lifestyle change. I know all these things but I think it really hit me for the first time in her office. I have just been so excited about what could be. She also helped me confirm my thoughts about not telling anyone at work. She said she has a patient that did tell everyone at work and they are not losing weight and people keep asking why isn't it working or can you get a refund. I don't want to face that pressure. I won't be lieing if they ask how I have lost weight and I say I watch my portions and excercise. A lot of people have surgery or get on medications to help cure a medical problem and end up losing weight. She asked if I was scared and if I thought about the changes I was going to have to make and I said I know the changes but I really don't feel I have a choice, it is kind of like if I had stomach cancer and they had to remove the cancerous stomach. It's a have to for me so "just jump" and figure out the rest later. She wanted to make sure I wasn't obsessed with being skinny...what did I want to weigh? I don't really care what I weigh...I just want to be healthy, to feel good, to be able to walk without hurting, to be able to really clean my house without relying on others, to be able to go places and have fun with my children, go on vacations and not stay in the hotel room or sit on a bench while everyone else around me is living. I want to live!
I had my consultation Tuesday. I have heard so many good things about Dr. Enochs, I was excited and nervous. My mom and daughter went with me so we can all have as much information as possible. The receptionist took my 400.00 consult fee...ouch! and a 30.00 co pay. This surprised me because I thought the point of the consult fee was to cover their costs in case you ended up not having surgery and got no money from the insurance company, which is why I didn't mind paying the consult fee but if I had to pay a co pay, that means they billed my insurance too. So they do get paid. I guess I should have asked but I was just so excited to have come this far in the process. I guess in the end, it really is all about money. My appointment was at 3:00, we arrived at 2:45, we were finally called back at 3:45, then sat in the room until 4:45..2 hours! I was irritated! I kept saying I hope they are having an off day because I would hate for them to be the top bariatric office in our area and this is how they operate. The nurse came in to take blood pressure and stuff and ask me what surgery I was looking at and I said possibly lap band or...and she jumped in to say "Your insurance won't cover lap because your BMI is too high" What??? What if that was the ONLY surgery I was willing to have? That would have been a good thing to tell me BEFORE I paid 400.00!! I said or the sleeve...she said oh they might do that but usually they only cover RNY. Well I don't want RNY. Why does it matter, it is my body! This just infuriates me. WLS is a choice I feel for lower BMI's but I think oncve you surpass 50, WLS is a necessity and it bewilders me how the insurance companies can look at it any other way. So Dr. Enochs came in and he was warm and friendly, made me feel very comfortable. He wasn't rushed even though he had to be somewhere by 6:00 and we were pushing 5:30. He skimmed over my chart and said he would recommend the sleeve for me as a surgeon because I don't really have many co-morbidies..I am somewhat healthy for a fat person! I do have a slight hernia and slight acid reflux and a fatty liver. The hurdle will be the insurance company. I know if they deny it, I will appeal...beyond that..I might push for lap band. I don't know what I will do. Try on my own once again I suppose. I didn't get to ask him all my questions, since most of them were surgery related I decided to wait until I was definately going to have surgery, plus he had to be somewhere so I thought I would be nice and not hold him up even though I had to wait for 2 hours but whatever, I am not bitter. LOL Really I'm not. I was a little irritated that day but Dr. Enochs was so nice, I got over it pretty quickly.
I met with the psychiatrist yesterday and she was super nice as well. I might have to meet up with her again. She specializes in bariatrics so I might need her down the road. I had to do a questionaire that asked questions like do I binge, do I closet eat, make myself throw up. Then we talked about the different surgeries and she said she has a lot of patients that are disappointed in their bands because they can cheat it and a lot of RNY's losing hair because they are not following the rules so she emphasized the importance of protein and eating right, lifestyle change. I know all these things but I think it really hit me for the first time in her office. I have just been so excited about what could be. She also helped me confirm my thoughts about not telling anyone at work. She said she has a patient that did tell everyone at work and they are not losing weight and people keep asking why isn't it working or can you get a refund. I don't want to face that pressure. I won't be lieing if they ask how I have lost weight and I say I watch my portions and excercise. A lot of people have surgery or get on medications to help cure a medical problem and end up losing weight. She asked if I was scared and if I thought about the changes I was going to have to make and I said I know the changes but I really don't feel I have a choice, it is kind of like if I had stomach cancer and they had to remove the cancerous stomach. It's a have to for me so "just jump" and figure out the rest later. She wanted to make sure I wasn't obsessed with being skinny...what did I want to weigh? I don't really care what I weigh...I just want to be healthy, to feel good, to be able to walk without hurting, to be able to really clean my house without relying on others, to be able to go places and have fun with my children, go on vacations and not stay in the hotel room or sit on a bench while everyone else around me is living. I want to live!
Subscribe to:
Posts (Atom)