Ready for the Next Steps

I began my journey to get surgery back in October of 2003. After 9 months of doctor visits, doctor visits and even more doctor visits and after three (3) appeals to my insurance company (Aetna EPO) has finally sent my surgeons office a letter and decided to reverse thier original decision and they will now provide benefits for my surgery. OH MY GOD I still can't believe it, I've been saying it every day since I found out last Friday but when you write it, it seems even more awesome. My doctor is Dr. Kane from Arlington Heights and my angel is Karen. She is the gal from the doctors office who has been handling my insurance - She is the best thing in the whole world. I gave up on Aetna after my second appeal was denied - I even went out and spent $150.00 on the Optifast diet- sounds desperate huh? Well thank God that Karen did not give up on me, she went ahead and spent another two hours on the phone with Aetna and submitted our 3rd and final appeal (I call this my "Hail Mary") she called me at work informed me of what she did and I kind of laughed and said "OK" I will be looking for the denail in the mail. Two days later I received a letter from Aetna appeals department infoming me that they were "reviewing the appeal" and would have a answer in 15 days. Four days later I get a call from Karen at Dr. Kane's office - she told me she heard from Aetna and was able to get me approved - I started crting and crying and crying - everyone in my office thought I was crazy!!!!! She let me have my fifteen minutes of babbling and praising and then I said I can't believe it, she said she had the actual approveal letter from Aetna in her hand and that I would receive one in the mail also - HOLD UP _ NO WAY I made her fax me a copy of that letter to me immediately and as soon as I read it myself I cried again. I can not express the feelings I have - for all of you who have gone before me you know exactly what I mean. For the first time in my life I can taste being thin. It's so overwhelming. I never posted on these boards since I didn't think I would ever get approved, BUT HERE I AM!!!! My name is Sherri, I'm 33 years old, I currently weigh 323 lbs and I just finalized my divorce two weeks ago. I have three beautiful children Jaide (she is 8) Jordan (He is 7) Jessica Faith (She is 3 1/2 going on 15). I can't think of a better gift than the gift of life and that is indeed what God is giving me with this surgery. I welcome all of your thoughts, guidance, prayers, motivation, critisism and whatever else you can give me. I have one last appt before my surgery date can be given, I see the Pulmonologist on 9/7/04 and then Dr. Kanes office told me to call and they will then give me my surgery date. Karen said it should be about 3-4 weeks out. I still can't believe this is really happening. I'm counting on you guys to help me with the do's and dont's before and after surgery, also - if anyone has younger children - how did you explain to them what you are about to do - My oldest is having a hard time with my decision.

Congrats!!!!!!! Amanda

Am I doing something wrong? I also have Karen doing my Ins stuff and she refuses to help me...she says there is NO Way I'll get approved because I have no co-morbs and my BMI is only 44...I got the policy from my ins co. and it says that anything over 40BMI will be approved but she argues with me everytime..I have requested that someone else helps me with my third appeal....once I get ready. We'll see....Congrats on your approval!!

Hi there Feedle: Not sure why you are having such problems with Karen, she has been so good to me. I will admit in the beginning of my process I could not find a sole at Dr. Kane's office to work with me, they kept on loosing my chart and everything. I came to them when they were ending their contract with Weight for Life and they decided to handle all insurance in-house. I think I got lost in the shuffle, finally got Karen to step in and she has been great. I have no co-morbs either, my BMI was 48 when I started this process a year ago and now it is 51. have you met with a doctor yet-insurance can not tell you that they won't submit your file, they have to do it regardless. If your private doctor is behind you and recommended you to go to Kane's office I would probably go over someones head. Has she even contacted the insurace company yet??? Let me know if there is anything I can do to help. Sherri *Nice to put a face with the name, pic looks good!!!!!!! - I should have mine posted on Monday - I'm having a guy from work help me.

I am one year post op and doing great. If you have any questions and would like to e-mail I would be happy to answer. I have a 8 year old and a 17 year old son. My 17 year old was okay with the surgery he was worried since I was so ill pre-op but he knew I had to do this. Him and my husband was the only way I could get around they had to assist me with mobility at home and at church. My 8 year old was another story he is a mommas boy and he was so scared and missed me the three days I was in the hospital. We talked about what was going to happen and how much better I would feel and that If mommy didn't have this surgery he would lose me sooner. We talked about it alot, he saw me crying when they sat down to eat and here i was post-op and couldn't eat with them for a while. Alot of changes... Last month while my 8 yr old and I was on a bike ride. He said Mommy I know when you had your surgery I was really really scared, for you and for me....but now I am so happy because you can do things with me you never have done before. His favorite is for me to jump on the trampoline with him. Just on Sunday he was being naughty and he took off running, boy you should have seen his eyes when I took off after him and caught him!!! We had to laugh because mommy had never done that before, How could I be mad at him than huh? I will be happy to share as much information as you would like.. I am one year post op with a loss of 171 lbs. 346-175. Take Care Ramona