Insurance issues - probably not having surgery on Monday

Well, it looks like there's not much chance of my having surgery on Monday. Misty from Dr. Wynn's office called this afternoon looking for documentation from my PCP regarding medically supervised weight loss attempts, and guess what, I don't have any! I discussed that very thing with Dr Wynn during my consultation, and she said she didn't feel it would be a problem with my insurance company. I have Aetna Choice POS II. So now I either have to go through a 6 month supervised diet and exercise program with my PCP, or a 3 month multi-disciplinary surgical prep program which is basically a nutritionist, psychologist and exercise therapist. The thing that frustrates me the most is I've been doing everything for the past 3 months that these specialist would have me do, I've even lost 30 lbs, but because I was not supervised by a physician, it doesn't count. I've been in tears since I got the call from Misty. I blame Dr Wynn, because I specifically asked her about this. I blame my PCP, Cydney Teal, because I discussed this with her as well and she did nothing. I blame myself because I had lingering doubts that the advice I got from those doctors was right, and I didn't continue to push the issue. I'm at my limit, and have nothing left to give. This surgery date was timed so that I could be back to work in time for a critical project at work, and now I probably wouldn't be able to take the time off until August at the earliest. I want to give up, say that it's not meant to be, and have a vodka martini...there's a part of me that still holds out some hope, but it's a small part.

Girl!!!!!!!! I do not even know what to say. I know it is going to be very hard, but keep your chin up and push this issue hard. I know that we did not get to know one another to well in class, but I could at least tell that you are a person of determination. I will certainly keep my fingers crossed for you and keep you in my prayers. Congratulations on the 30 pound weight loss too. That is wonderful. Julie

Thanks Julie, I appreciate that.

WOW! I'm not even sure what to say... Could you check with PMRI & see if there docs would 'sign off' on a medically supervised diet, since you did loose 30 lbs since being under the CHRIAS/PMRI umbrella? Just a thought, not sure if it will work. I'm feeling very bummed for you, but want you to stay positive (if at all possible!). Remember, everything happens for a reason. Best of luck, keep us up to date, Valerie

Thanks Val. I plan on calling PMRI tomorrow. Unfortunately this came about at the end of the business day and I couldn't get ahold of anyone. I'm hoping PMRI can work something out with me, and if they can, I'll take the time off regardless of the project...I'm not the only director in our department that can handle it. I'll post as soon as I talk to the folks at PMRI.

I am sooooooooooooo sorry that this is happening to you. I hope it all will work out for you. Talking to PRMI might be the smart way to work it. What more can your insurance company want. You did everything that you needed to. Maybe someone can call them and speed the process along for you. Please come to lunch on Sunday at Ruby Tuesday's with us. It will do you good to have someone to talk to. Ellen

Thanks Ellen, Jenn and I still plan on being there on Sunday!

I am so sorry this is happening to you, please don't give up!!!!! The same thing happened to me, I fought and fought and then decided the only way I was going to get approved is to do what they want, yes it did put it off for six months, but I kept busy and kept getting support from the wonderful people on this board and I made it through. I do agree with Val, that PMRI might be able to help, it won't hurt to ask. Just keep plugging away, and don't give up. It will happen. Take care, Dana

Thanks Dana

Hi Joni, Same thing happened to me the Friday before my surgery. I called the insurance company and gave them an ear full. I informed them that they paid for: Gym membership Phen-Phen Heart check up from Phen-Phen and other medical issues related to me gaining weight. I did have 6 months from LA Weigh Loss. I also let them know that if they did not paid for the surgery that I would need pills for depression, high blood pressure, and a psychologist. I also told them that I did Weigh****chers online. I asked them to provide me with the name of the doctor that was reviewing MY case. Well, there is no doctor! Just a person paid to say no. Well, needless to say, I got approved for the surgery that same day however they did get me back! I was only approved for open surgery! All is fine and I am feeling good! Best of luck! I will keep you in my prayers! Don't give up! Fight and refuse to hear the word "no". Jen