Frustrated

I have been lurking in the background on OH for about 7 months now.  I have been diligently getting everything on a check-list for RNY completed.  I kept myself calm during the 6 month diet because I knew I couldn't ru**** and it would take me through Christmas and that worked for me.  I wanted surgery at the beginning of the year anyway. (I have Aetna) So, January came and I was finally finished except my sleep study and my cardiologist.  I had the sleep study, came back that I had sleep apnea, went and did the second one.  I am now an a cpap machine.  That's fine...everything is still going smoothly.  In the process of the 2 sleep studies, I got my cardiac clearance letter too.  I took all of this to my primary and she wrote me the final letters I needed.  I had EVERYTHING together.  I was so excited.  On Friday I hand delivered them to the surgeons office.   So, at this point I was on pins and needles.  I know it will take about a week for the surgical coordinator to put it together and then get the surgeon to look at it and then off to insurance it would go....Yeahhhhh...I finally can sit back, relax and start the waiting game for insurance. Well...my bubble was burst today. I got a call from the surgical coordinator and she told me I had to have a clearance letter from the pulmonary doctor since I have sleep apnea....Well, first of all I didn't know this or I would have done it.  But, I still thought, okay, no big deal.  I'll give them a call and surely they will just fax me one over.  I have had 2 sleep studies...they have me video taped and have hours of my breathing during sleep, what more could they need.  NOT SO EASY.  I have to actually come in for the doctor to SEE me to get my clearance letter.  Okay, so I'll go in.  Not a problem.  First available appointment is NEXT MONDAY.  A whole week away just for him to "SEE" me.  I realize it is only a week.  But it really isn't.  He then will send the letter to dictation.  Then after it is typed, I can get a copy of it.  SO sometime next week I will have the clearance letter.  Then the week with the surgeon's office starts over.  The surgical coordinator will put my file together and then the surgeon will look at it.  So it is actually 2 weeks.  Then if the surgeon finds something else he needs, I'll have to wait again.  I thought I was finished waiting for stuff like this. I know I'm sounding like a cry baby, I'm just frustrated.  I kept calm for 7 1/2 months getting this all together.  Once I thought I was finished I actually got so excited I couldn't stand it.  So, I just needed to vent to people who I knew would understand.  You are all so sweet and reassuring.  Thanks.  Cyndi

I am so sorry you are having to go through this. I would ask the insurance coordinator at Dr Duncans office to go ahead and send it in just to see if it came back denied for that one item or if it would be approved with your PCP letter. It makes you mad that you go through all the testing to get the approval and that should be documented why you came in that you are considering it and then you have to go back to get the approval letter. I am afraid I would have argued with them on that. Oh when you go in ..if he will just right out on a prescription pad that you have his approval for the surgery then that should work also.

Thanks for the suggestions.  I did write the surgical coordinator and ask her if she could still put the file together and give it to the surgeon to see if there is anything else missing while we wait for this letter.  I haven't heard from her.  That would definitely make things better, then it would just be a case of slipping the letter in.  But, knowing my luck, that can't be done either.  I don't really want a denial if I can help it.   I will definitely mention the prescription pad thing.  That would make things so much easier.  I'll have a copy of a sample letter with me from the surgeon where they say it can be on letterhead or prescription pad and then maybe he will just put it there.  Thanks for giving me that suggestion.   Congrats on your weight loss so far.  I can't wait to be on the losing side...sniffle sniffle.  I'm about to die.....I want it like yesterday!!!

Oh I remember the feeling well! It will happen just keep telling yourself that..and it will. My daughter in law grew up in Mcdonough/stockbridge area. It is a busy little place! Phyllis

Hi there Cyndi my friend,   I am so sorry you are going through this but I fully understand.  Between my appointments, clearances, and jumping through all the other hoops they wanted, it took me a full year to get my surgery.  I too had a problem with my pulmonologist getting the letter correct.  It said I was approved for surgery but didn't use the words "medically cleared" so I had to go back in to 'see' him and I let him know of my displeasure and I guess I made an impression because he dictated it to his receptionist and had her type it up right away for me.. while I waited.  Please trust that this is going to work out for you.  Be sure to use this extra time to attend support groups.  They are a very important part of this journey.  Remember there is one right here in Henry County every month too.

Thank you Pat for your encouraging words.  I do need to start the support groups.  I need to start marking my calender.  I get on here for a while DAILY and then I will not be on for a while.  I have been on the site constantly for the past week.  I know it is so close and now I am just absorbing all the information so that I know what to expect.  I realize support groups would be even better.  I know beyond a shadow of a doubt I'll be there after surgery...I guess I just would probably be depressed if I came before surgery.    But I definitely want to meet all of you and can't wait to be on the losing side with all of you.