Friday, June 18, 2010

Diabetes Free

Got the labs back.  I am not even prediabetic which I realize is a good thing but doesn't bode well for the insurance approval.  Also had my pain specialist appointment with Doogie Howser.  Seriously, this guy looks like he's about 12 years old.  According to him, my weight has nothing to do with my issue and losing weight won't help which means his report won't help me either.  Looks like the sleep study is my last hope.  It's schedule for June 23rd.  Things are looking pretty bleak.  I can tell when I'm talking to my surgeon's office that with each one of these tests, my chances of approval are slipping away.  Might be going camping this weekend.  I've never been before but my husband has been itching to go.  Northern AZ has a no-burn policy in place right now so we're going to see if there's anywhere else we can go that's not too far.  To me, it's just not camping without a campfire and smores.  Hope y'all have a great weekend. 

Tuesday, June 15, 2010

Diabetes Test

Hey all! I've got some stuff lined up.  I have my pain management appointment Wedsneday.  I'm going to try to get that doc to notate that my weight is causing the pain...we'll see how that goes.  Also, I'm supposed to go in for an Hemoglobin A1C test tomorrow as well.  They're hoping my levels will be high enough to make a case for diabetes.  Hoping to be diabetic?  Weird. anyone know how to "fudge" this kind of test?  Can I drink a milkshake or something before I go in to raise the levels?  My sleep study is scheduled for July 3rd but there's a possibility that will get moved up.  I told them if anyone cancels, let me know even if it's during the week.  Feels good to be taking some proactive steps and my surgeon's office really does want to get me approved.  They're working very hard at it.  I have a strong family history of diabetes and heart disease so we're hoping that will help as well.  That's all the news for now.  Any advice on that hemoglobin test will be greatly appreciated.  I's a blood test so not sure if there's much I can do about that.  Again, thank you all for your amazing support and well wishes.  I really I hope I'll be able to join you Bandland soon.

Monday, June 14, 2010

Back Pain/Sleep Study

Sorry I've been MIA with the comments.  I have been following but have been too depressed to say much about anything.  Just thought I'd post a little update.  The peer to peer never took place.  They're trying to build a case and are having a hard time.  I'm one of those healthy fat people that didn't feel the need to go to a doctor about my back or joint pain because I knew the doc would be like "'re fat...lose weight and the pain will go away."  I also never went for my..ahem...urinary issues as I blamed childbirth for those.  So documentation of problems is scarce.  So my surgeon is going to set up a sleep study to determine if I have sleep apnea which I doubt but some very helpful bloggers have advised of a way to make it more likely.  Also, remember that tailbone issue I had awhile back?  Well, it still comes and goes but I never went to the pain specialist because, well...the idea of pain meds or a shot in the rear didn't sound all that appealing to me.  And, again, based on what some others have experienced, I really believe it's partially weight related and that if I could get these extra lbs off, the situation would RECTify itself (bad pun...I know).  Turns out this tailbone thing might be a good way to get approved.  So I made an appointment with the pain specialist Wednesday to see what can be done.  We'll see when we can schedule to the sleep study.  I REALLY wish I could afford to self pay as these insurance companies are going to be the death of me.  To add insult to injury, a RN from the insurance company called last week to "check in."  Supposedly, they do this from "time to time to remind you of your benefits and answer any health related questions you might have."  Funny, the only time they've called was after my babies were born.  Seriously?  You deny my request and then you're going to call to see if I have health related issues?!?!  What a load!  So this was the conversation:

Her: “we like to check in from time to time to remind you of your benefits and answer any health related questions you might have. I see you’re trying to get a surgery approved.”

Me: “Yes..y’all told me no.”

Her: “Did you get a letter or something?”

Me: “No. My surgeon’s office informed me of the denial and my doctor is supposed to have a peer to peer call with the medical director to see what can be done.

Her: “yes..I see that was requested. A lot of these conversations can often clarify for your doctor what other documentation may be required or for our medical director why the surgery is necessary.”

Me: “OK”

Her: “Along with the denial, your surgeon should have also received instructions on how to appeal so that’s another avenue you could go down.”

Me: “OK”

Her: “So is the expectation that you’ll be in contact with your doctor next week?”

Me: “I was told I’d hear something after the conversation to see what the next steps are.”

Her: “Good. It’s good that you’re staying involved with your doctor. I’ll check in with you next Friday to see how I might be able to assist at that point. I can facilitate conference calls between your doctor and our staff if necessary and just help coordinate the communication between all parties.”

Me: “OK”

Her: “Do you have any other general health questions or anything I could maybe help you with?”

Me: “No”

What an utter waste of my time.  Yeah...I have a question:  "Are you aware that you work for the devil?  You love collecting our premiums every freakin' paycheck but don't want to pay when we actually need you to you-piece-of-poop-insurance lady?!?!?!"  So I'm hoping she doesn't call back Friday as I'm not sure I can be so nice then.  Otherwise, it's another manic monday...wish it were sunday...that's my fun day...  (sigh).  Hope y'all are all doing well.

Tuesday, June 8, 2010

No Title Today

I just wanted to thank you all for your comments yesterday.  It meant a lot to me to see so many people behind me.  Now that I've stopped crying...I'll answer some questions.

First, I don't want anyone to think...especially my hubby...that I'm not happy that Ron got approved.  I am because he needs this even more than me because he DOES have the health issues that come with being so heavy.  So...that being said, I'm just upset at my situation.  We knew my approval was a longshot but I guess I just got my hopes up.  I really felt like this was going to happen for me and now it just doesn't seem like it will. 

Anyway, there may be a glimmer of hope.  My surgeon has scheduled a "peer to peer" call with the medical director at the insurance company for Thursday.  I guess he'll try to make a case for me and have the decision reversed.  Greg (the guy from my surgeon's office) said that sometimes this is successful.  My husband spoke to Greg about this too because Greg had to call him to let him know he was approved.  Apparently, Greg told him that Dr. Simpson has been doing this a long time and is very optimistic that it'll work.  I'm not sure if any of this is true as my dear hubby may have just been trying to make me feel better.  So anyway...there's this conversation.  Depending on how it goes, Greg is going to get me signed up for a sleep study to see if they say I have sleep apnea (I really don't think I do).  And then we can file an official appeal if need be.  Also, this is all through my husband's insurance so if all of this fails, I may look into changing insurance companies to the one my company offers and see if they'd approve me.  So there you have it.  Those are the next steps.  Self pay is not an option.  I don't have that kind of money and my credit isn't good enough to get me that kind of money.  I'm not anti-Mexico...but even that is too expensive for me.  So this where everything stands. 

Again, I appreciate your support.  I'm not in a good place now.  I admit I've been eating my feelings the last two days and I just don't care.  Everything seems hopeless.  I have a tendency to snowball things in my mind so when one thing goes wrong, it's like the sky is falling.  I start thinking about all the other things in my life that are bothering me.  The fact that I can't self pay gets me thinking about my finances which SUCK which gets me thinking about my job which gets me thinking...blah, blah, blah.  Anyhoo...just wanted to check in so y'all knew I didn't go throw myself off a cliff or anything.

Monday, June 7, 2010


Received the call from the surgeon's office today.

I was declined because while my BMI is over 40, they require 1 comorbidity and I don't have one.

Ron was approved.


Thursday, June 3, 2010

Yes...I called again...

So I wasn't going to call the insurance company today.  My husband finally got his paperwork in order and the surgeon's office submitted it yesterday.  So my husband asked Greg (the main insurance guy) how long it takes to hear back (because he knows I'm DYING to hear something) and Greg said "I always tell patients it can take between 30 and 45 days (!!!).  Sometimes it's quicker...sometimes it's longer so I leave a lot of cushion."  Ugh.  So I started thinking.  Seriously...what's the point of calling?  It's not like it's going to make them look at my stuff any quicker or say yes as opposed to say no or anything else.  All calling will do is satisfy my sick need to feel in control of an uncontrollable situation.  How does that help anybody?  How does that help me?  It's just going to drive me crazy when they tell me it's still "pending" and don't give me any idea as to if anyone's even looked at the damn file yet!!!!

So as I was saying...I called the insurance company today.  I spoke to an awesome guy named Ruben who just rattled off what he was seeing in the computer as he was seeing it so I didn't even have to ask any questions.  The first thing that threw me was he said, " I see you're scheduled for surgery for morbid obesity (Am I the only one who hates that term?) on June 15th."  REALLY??? I AM?!?!?!  LOL.  I think it's just a dummy date that the surgeon is required to put on the form but still...I found that kinda shocking.  Then he goes on "Yeah...You're going to want to give us a little more time (because it's still pending, blah, blah, blah - eck!  Why did I bother?) because it still has to go to the medical director for final approval."  What's that?  Medical director?  So I ask "So the nurse has already looked at it?"  And dear, sweet, irresistible Ruben says "Yep.  The nurse has looked at it and it's been forwarded to the Medical Director who has final say." 

Seriously...I could've kissed Ruben! the nurse has passed it on.  I've got to think that if something was obviously amiss in my paperwork or my prerequisites (is that the right word?) she would have denied me right away.  Right??  To me, this is a sign of hope.  Who's with me?  I'm trying to stay cautiously optimistic because I don't want to get my hopes up but as far as I can tell, the signs so far are positive.

I wanted to send a special little shout out to Cara and Sarah.  Cara has some kind of cold/flu bug and isn't feeling so hot and Sarah is dealing with a loss of her beloved godfather.  If you get a chance, please send some good thoughts their way. 

Y'all have a GREAT Thursday!