Monday, January 18, 2010

WLJ Update~

WLJ{Weight Loss Journey}
Well, I told you that last Monday Id be receiving a call from Dr. Wagner the surgeon who Id contacted for the LapBand.... I did indeed get a call from Brittany-who has been assigned to help me through this whole process. I cannot express how upset I was after the call. Angry, crying.. I had just received a LIST a mile long of things that I had to do if I wanted to continue with this journey. I have been struggling since with my decision and am still at a loss as to how to go forward.
First and foremost, if I do not plan on paying for this weight loss surgery on my own, in full .. I will have to wait NO less than 6 months to even start moving forward even a tiny bit.

Brittany told me that she had called my insurance company and was told that they do not cover any type of Bariatric surgery. Ok, so I knew that... but.. the insurance company did say that if the physicians involved in my care wanted to "fight" them, they would do a review... possibly several.. and I would either get the go ahead or not. And all of this AFTER my 6 months of a supervised physician diet and exercise program. It does not matter my past or what I have done.. it starts from the first time I see my physician and on. I am to see him once a month for talk, diet plans and exercises. He documents. He sends findings to the insurance company ALONG with LIST for review.
The list includes... 2 different physician letters supporting my need for said surgery. A Nutritionist eval, Psyciatric eval, Medical Records {lifetime}, series of blood work ups, TSH, current diet plan {the 6month ordeal}, diet history {past 10yrs}, Upper GI, full cardiac clearance {who knows what kind or how many of the cardiac tests are needed}and PFS. I think that is it.. I was trying not to cry and write all of this down.

So, I do all of this and it can be denied.. several times over, with more tests and more urgent letters from the docs.. and more diet plans and cost. {Just my copay is $20-$40 per visit}.. She also suggested joining either Jenny Craig or Weight Watchers and pay them to journal/keep my records for me as another form... alas costing even more moolah!

Im not opposed to doing all of these tests.. for real it could be very helpful. Butttt... the cost, the time consumption.. and all to hear a NO.. I just dont know if my heart/soul can handle that. I just dont know.

On the other hand.. if I had a cool $15K for the surgery.. Im looking at a letter from my physician, medical records {past 5 years} and a Psyche eval. .... thats it.. done... have it and in and out lickity split. Crazy.. pure crazy!

Im at a sheer loss. Ive missed the window to get in to see Dr. Wagner for a consult this month {and wouldnt you know his consult fee *cash only* is only $200 this month, rather than the usual $375}...I dont see my regular physician until the 5th of February. He will then set up yet another visit to talk to me about the 6 month diet thingie. YAY.. so many delays.. so many decisions. In the meantime.. Im going to start my own diet/exercise with Todd as planned before going to the seminar as it was one of our New Years Goals.. we'll see how that works for me... it certainly couldnt hurt!!!

Next time.. a peek at our 2010 New Years Goals and possibly a look back at some 2009 highlights!


Tam, I am said...

Angi, I am so sorry that this road block has cropped up in your weight loss path. I have no doubts that once you are able to process all of the information you have been given, the good and bad, and after having a good cry, (and what I usually do ---big temper tantrum), you will knock that road block out of your way. I have no doubts. In fact, you have already started knocking it down just by sheer will and the desire to continue with your goals. Don't focus on the negative, no matter how hard that is, focus on the goal, focus on that healthy, pain free and fit Angi!

Big Hugs my friend!

Jenn K said...

Oh sweetie I feel for you..I know that the Insurance companies are just CRAZY!! They want money, money, money but then when they need to pay they have an impossible list of things for the subscriber to do and then they still say no. How frustrating. Keep your head up though, you have a great support system in place and can do this! I am cheering you on all the way!! Hugs.

Kimmy said...

that price (15k) doesn't sound right. could you maybe inquire some more prices first? i mean you can get fake boobs for 7k and they can do lapbands through laproscopy right? That has to be way less price-wise. I believe in you though Ang, keep your head up. :)

Angie said...

I'm so sorry Ang, but I have faith that you can get through this rough spot. I know that right now your feeling discouraged. My SIL went through this samething and it all worked out alright in the end. BIG HUGS.

Gina said...

Angi, I'm so sorry about this . . . Insurance companies always seemed to think they know what's best for the people, but in the end it's only about money. Tam is absolutely right . . . don't let this little bump stop you. In the mean time don't give up, keep being strong and you'll start to see that it'll all pay off! HUGS!!!

Cat said...

That price seems really high. I'm sorry this is happening. Don't let it get you down!