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06-24-2009, 03:51 PM
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#1 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |  buzzing about aproval process!
I need to vent and hear back from others that have been threw the approval process. I was told that I would get a call from the WLS office letting me know they were submitting the paper work 10 days ago. I gave it 10 days extra then I started calling around...First I called the WLS office and they said they were waiting on the psych report. They are all in the same team so there shouldn’t be a delay? I just called the psychologist office and told them on a voicemail that I needed a call back either way letting me know the status of the report that was supposed to be done 1 week ago and that I was actually seen 3 weeks ago with a promice of 2 weeks max for the report. Any way the office girl called back and confirmed that Nichole is the assistant that will be writing up the report and that she is teaching a class today but will be i there in the morning. The lady also told me that ironically when I called she was on another line with my insurance company dealing with them because they don’t want to pay for my psych evals! OH HECK NO!! Don’t even try this garbage now! The didn’t want to pay for a Cpap machine either and then they approved it after an appeal with the stipulation that I would only be approved for 10 months with the intent of not needing it after adequate weight loss was achieved threw weight loss surgery. (As it turned out the Dr said I could go with out it but that’s a long story in its self.) My thinking is that if they approved the cpap then they should approve the psych stuff since they are well aware of my intentions giving the 10 month cpap deal!. OOOOOOOOOOOOOOOO I am buzzing! The lady on the phone said that the insurance company had nothing to do with my report! I was supper nice about it and said well I look forward to hearing from Nichole in the morning about what I can do to help with any info that she might need to get the report finished. I am think that maybe I should just forget about them saying August and figure on late October. At least that way I won’t be disappointed! I have also been seeing my PCP for the last 6 months and have seen my WLS Dr for weight loss. Gee I guess I must be screwing around and they shouldn’t take me serious  Well I guess I just do what I can and keep working my program.... that’s the one thing that I can do! I did tell the lady that even , that that was my plan and I also said that I would continue to push stuff on this side of the process until we get the paperwork to go up for approval! I laughed when I said it but what I really meant was I will be calling you back in the near future if we don’t get this moving. DO you think I should just expect that they will shoot down the request for the gastric by pass the first time and figure on an appeal?
The good news in all this is that I have my weight down to where it needs to be and am pushing further 
I should add to this that part of tje reason why I waited 10 days was because I was on vactaion, but I checked my machine every day!
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Last edited by 4Kate; 06-24-2009 at 04:17 PM.
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06-24-2009, 04:09 PM
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#2 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: Tampa, FL
Posts: 3,605
Weight Statistics July 10, 2007 Surgery Date:
5' 6"
Height:
271 lb Start Weight:
175 lb Current Weight:
182 lb Goal Weight:
96 lb Weight Loss:
-7 lb Lb Left to Lose:
35.4243542435 % % Lost:
Body Mass Index43.7357667585 BMI Start:
28.2426538108 BMI Current:
29.3723599633 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Well, you're def motivated  I find a polite but assertive method works well and making sure you politely hold them to their word ~ kind of a thin line between being a pest and making sure they do their job efficiently ~ you could always get them on your side with donuts ~ LOL! Actually, a fruit tray might be better.......
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06-24-2009, 04:16 PM
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#3 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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The really rotten thing is that the girl that is suspposed to be writting the report is leaving the program! I am worried that I will get lost in the shuffle! I feel guilty getting all upset about this but I have done everything any one asked me to do and I have forked out so much already in medical bill co pays. I am continueing with the medically suppervised diet untill I have a date. I refuse to give them any leverage! I have never wanted any thing more in my life. Having this WLS is rite up there with the birth of my children. I am working so hard to do it rite.
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06-24-2009, 04:20 PM
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#4 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: Tampa, FL
Posts: 3,605
Weight Statistics July 10, 2007 Surgery Date:
5' 6"
Height:
271 lb Start Weight:
175 lb Current Weight:
182 lb Goal Weight:
96 lb Weight Loss:
-7 lb Lb Left to Lose:
35.4243542435 % % Lost:
Body Mass Index43.7357667585 BMI Start:
28.2426538108 BMI Current:
29.3723599633 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Hugs ~ it will pay off ~ hang in there. I had Humana and once the WLS surg had all the paperwork and submitted it I had approval in less than a week. If you have the CPAP that's a huge point for your having the surgery ~ I believe it will happen for you and your staying vigilant will pay off.
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06-24-2009, 04:32 PM
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#5 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Quote:
Originally Posted by clancythecamper  Hugs ~ it will pay off ~ hang in there. I had Humana and once the WLS surg had all the paperwork and submitted it I had approval in less than a week. If you have the CPAP that's a huge point for your having the surgery ~ I believe it will happen for you and your staying vigilant will pay off. |
I have the ok for the Cpap but they decided I could go with out it. I dont fully understand it but I only have sleep ap when I am on my back. I sleep on my side and during surgery they said I will be with the anestoligst care and be ok... They said if I need it while in recovery they can get one for me there at the hospital. I sometimes think I should have had them just give the machine. I hated it though so when he said I could go with out I jumped on it. It was only mild anyway....
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06-24-2009, 05:28 PM
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#6 (permalink)
| | Seasoned Veteran
Join Date: May 2008 Location: Just north of Iowa, not far from I-35. 2nd star on the right and straight on 'til morning!
Posts: 8,214
Weight Statistics December 13, 2007 (pre-op liquid diet started) Start Date:
December 27, 2007 Surgery Date:
5' 9"
Height:
280 lb Start Weight:
172 lb Current Weight:
184 lb Goal Weight:
108 lb Weight Loss:
-12 lb Lb Left to Lose:
38.5714285714 % % Lost:
Originally - 12/08. Actually - 8/08. Goal Date:
Body Mass Index41.3442554085 BMI Start:
25.3971854652 BMI Current:
27.1690821256 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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One lady on this list recently told of how she sent the doc's office a nice bouquet of flowers with a note politely reminding them that she was still waiting. She said it got almost immediate results. Something about catching more flies with honey ...
As always, your mileage may vary ... 
CT
__________________ da perfesser
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Dare to live your dream!!
If you want to be healthy for life, do for life the things that get you healthy!! Living healthy takes work. Dying fat is easy!! "That which we persist in doing becomes easier, not that the nature of the task has changed, but that our capacity to do has increased." - HJ Grant
"Do, or do not. There is no try!" - Yoda
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06-24-2009, 06:58 PM
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#7 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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wow you guys are serious about the flowers/ fruit deal? I though you guys were kidding! hmmmmmm!
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06-25-2009, 02:24 AM
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#8 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 23,801
5' 5"
Height:
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Hang in there, be patient but persistent. Hope all goes well soon.
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06-25-2009, 04:17 PM
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#9 (permalink)
| | WLS Master Guru
Join Date: Jan 2009 Location: ohio
Posts: 826
Weight Statistics January 5th,09 Start Date:
September 23rd Surgery Date:
5' 7"
Height:
289 lb Start Weight:
160 lb Current Weight:
150 lb Goal Weight:
129 lb Weight Loss:
10 lb Lb Left to Lose:
44.6366782007 % % Lost:
1-2 years Goal Date:
Body Mass Index45.2588549788 BMI Start:
25.0568055246 BMI Current:
23.4907551793 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Buzzzzzzzzzzing again! The lady that told me yesterday that that she would be sure to let the psychs assistant know that I am waiting for my my letter of aproval from them and that its the last thing I need, called today to appolize to me because she realized that she was the one at fault! She had the file on her desk the entire time fighting with the ins company to pay it! Grrrrrr! Ok , well atleast from what I undertand she gave the ins company a firm ride and filled in any missing gaps to get the ins co approval. They have paid for the visit and the test now. I will keep my fingers crossed that when the WLS office submits there part it will go threw on the first try. I guess as it turned out they didnt refuse my first psych claim but rather need more info on why I was there. Now they have it!
One other good thing is that I am so driven to be sure that I dont gain back any of what I have lost for apporval that I am still dropping each day! Wahoooooo. My legs are getting so firm from all the walking and biking. I think I will need PT on my shulder before I can do too much with my arms but its one day at a time for now.
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06-25-2009, 04:38 PM
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#10 (permalink)
| | Seasoned Veteran
Join Date: May 2008 Location: Just north of Iowa, not far from I-35. 2nd star on the right and straight on 'til morning!
Posts: 8,214
Weight Statistics December 13, 2007 (pre-op liquid diet started) Start Date:
December 27, 2007 Surgery Date:
5' 9"
Height:
280 lb Start Weight:
172 lb Current Weight:
184 lb Goal Weight:
108 lb Weight Loss:
-12 lb Lb Left to Lose:
38.5714285714 % % Lost:
Originally - 12/08. Actually - 8/08. Goal Date:
Body Mass Index41.3442554085 BMI Start:
25.3971854652 BMI Current:
27.1690821256 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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You know, this pit bull attitude of yours is a really good indicator of future success! You obviously want it bad enough to overcome any obstacle. After the surgery, the challenges will be of a different nature, but they will require no less from you than those you have now. If you hit them full-bore like you have these, I can't imagine too much standing up against you and surviving!!
This is the type of aggressiveness that will carry you a long ways down the road to your goal. Keep up the good work!! 
CT
__________________ da perfesser
*******************
Dare to live your dream!!
If you want to be healthy for life, do for life the things that get you healthy!! Living healthy takes work. Dying fat is easy!! "That which we persist in doing becomes easier, not that the nature of the task has changed, but that our capacity to do has increased." - HJ Grant
"Do, or do not. There is no try!" - Yoda
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