My Surgery/Insurance Woes

My original date was 3/22/04, but that was setback due to the gb lifeskills course. Then I was given 5/4/04 which was less than a week after I passed the lifeskills class. On the night before, it was postponed as insurance was still pending. Given another date of 5/19/04, then that was taken away due to insurance (Mid-Atlantic) issues. The problem was that the director at Mid Atlantic wouldn't pass me. Dr Baag, Ellen Clevenger-Firley (nutritionist) and Dr Keenan (psych) all passed me and gave the reccommendation that I was an excellent candidate for surgery. Dr Baag states the reason was because although they passed me on the lifeskills class, that I didn't lose 3% of my body weight that they had asked from each of us. All along I was telling them that I wasn't sure I would as I was stopping smoking right in that time frame as well. They all agreed that stopping smoking was more important. At the last class where they weigh you and give you a test, I had gained one pound. Dr Baag felt that was reasonable. I also had stopped taking lasix (fluid pill) in that week as reccomended by my PCP to prepare for surgery. Dr Baag felt that if I see him on a monthly basis so he can document weight loss, that he can present my case to Dr Walter at Mid-Atlantic and get an approval. I saw Dr Baag on Fri (Hi, Ken) and I had lost 10 lbs since they last weighed me. I see him again 6/14/04 and hope that I can lose more weight by then, too. Also, I spoke to Misty at Dr Irgau's office about this and when she explained my situation to Dr Irgau, he put a call in to Dr Walter at Mid-Atlantic. I am anxious to hear what he finds out. Bottom line, gb lifeskills members, lose that 3% they want. I sincerely tried, but I know that when you stop smoking it automatically puts weight on you. I'm frustrated with myself for not doing better the first time. Sorry so lengthy, Dianne

Hi Dianne, You sure have been put through the paces on this whole thing. I just hate when redtape gets in the way of progress. I must say that the patience you have shown through this ordeal will serve you WELL after you do get the surgery. Wow, you have some impressive team going to bat for you with the insurance company! I am so glad they are all there to help you get what you need. Congratulations on the weight loss! It's so hard to feel like your life is on hold while suspended in insurance limbo. I have faith that all your dreams will come true and you will be a loser before you know it! Here's a big hug for you (((Dianne))) Linda

Dianne, You sure are a trooper. It is soooo stressful dealing with the insurance companies. I had to do a documented weight loss program for 3 months. I went to weigh****chers and had it documented through my PCP and then had a fitness director work with me also. I have Aetna and it was a requirement. They finally approved me. It was very frustrating. Fortunately for me I did not have to loose a percentage of weight. That always irritates me that someone wants us to loose a percentage. Of course we are going to loose regardless when we have the surgery. Its awhile later that we have to REALLY watch what we eat. I wish you the best of luck with everything and hope it all works out for you soon! blessings and best wishes! and a big congrats to breaking the smoking habit!!! Elizabeth M -49lbs

Hi Dianne, I am sorry you are having such a hard time with your insurance company makes you just want to them. I know what you are going through I am in the same boat I finally gave in to my insurance company and I am doing the 6month doctor supervised diet. That puts me into November, it makes me so mad the lack of communication I had with them, had I known it was a requirement I would have been just finishing up my 6months instead of just starting. Oh well, I believe that everything happens for a reason, and you will have your surgery when the time is right. Hang in there, you are my hero when it comes to patience. And best of luck on the quitting smoking!!! Dana