Anyone unable to get approval? What are you doing? Dieting? Giving up? etc etc

I'm hoping there are more people out there like me. After 40 years of dieting and up and down weight, I reached my all time high weight and my all time low self esteem at the beginning of this year. After much homework I decided that WLS was my last resort. I found St Vincent's Bariatric Center and Dr. Evanson and new I had made the right choice. My husband attended the surgeon consult with me and is 100% behind my decision. I had the pysch consult and was told I was an excellent candidate. Now for the brick wall.... Insurance company declined coverage. Called them to get the particulars on what I needed to do to appeal. Jumped through every hoop. Drs. office sent in the papers for appeal along with an excellent letter written by my PCP and a letter from me. Appeal was denied. No 18 months of continuous physican supervised weight loss. I'm 56 years old and 18 months feels like a long time to me. Now I find myself eating everything that isn't tied down! I've gained 8 pounds since April when I saw the surgeon. Depressed and frustrated over this whole procedure. I don't know whether to forget the surgery. Start my 1,000,000 th diet. Anyone have any advice? How do I get motivated for another diet? I'm ashamed that I'm in this position. I'm ashamed I don't have more self control. I just wanted help and feel like I can't get it from the insurance company. Since the battle with approval began, I don't seem to be able to make any positive move towards a healthier me. I'm hoping someone else has gone through this and can help.

Vicki, Do NOT give up! You would be giving up on yourself if you did! First, start a physician supervised diet plan. See your pcp once a month for the purpose of weight loss. Get weighed, get your BP taken, and discuss how your weight loss is going at every visit and be sure it is documented by your pcp. Second, contact the insurance and find out when their contract is up for renewal. Indiana state law was changed in July so that it is now a 6 month MAXIMUM supervised diet that can be required, however, insurance companies do not have to abide by that until after they renew their contract with the employer. So...without the state law, your 18 months wouldn't be up until Feb. 2008. With the state law, IF the insurance renews their contract every January, you would be elgible June 2007. Third, while you have the insurance on the phone, discuss what all of their requirements are: do you need to submit a food/exercise journal? do you need x amount of visits to a dietician? to a psychiatrist? In the meantime, to go along with your physician's supervised plan, buy a pedometer and start walking. You will need to walk as soon as you get out of surgery anyway so might as well start now. Whatever you do, do NOT give up on yourself! Sherri

Sherri, Thank you soooo much for your comments! I think you offer good advice. Haven't been thinking very clearly with all the frustration. You have given me a concrete plan of attack. I have an appointment with the PCP the end of July. I'll call the insurance company before that appointment and use your letter as a guide for questions to ask. I read your profile. You look beautiful! Sounds like you had a real time of it with the complications. I hope all is going well for you now. Thank you for your kindness. Vicki

Vicki, Eh? Complications happen. If they didn't, the surgeons wouldn't know what to tell people are the risks involved. At no time however did I ever regret having the surgery. I can't say it 'gave me my life back'...as, I was always so overweight that I feel like it gave me life for the first time ever. And yes, I was denied at first too....so I say 'FIGHT!' with personal conviction from my own experiences. You can't let the insurance company negatively affect your health. Remember, you want to convince them that you WILL use this tool as it is meant to be used. You do that by showing them that if they want you to jump, you ask how high. You do what you need to do, FOR YOU. Some of us are going to the Speedrome Race Track Saturday night. We're meeting at the International Buffet on east Washington at 5 beforehand. You (and your dh) are welcome to join us. Drop me an email if you're interested. It'd give you a chance to meet some post-ops...and if you're married, it'll give your dh a chance to ask our spouses questions about the surgery as well. RNY-wise, I feel fine now. My intestines have been doing a few loop-de-loops like they did when they first kinked up & gave me hernias, but other than that, tummy is fine. I'm just keeping a watch on that. If I do get another hernia, they can fix it when they do my plastics this time. I'm ~13 lbs from being able to have my plastic surgery(s) done. I'm about to have surgery in August for bunions..which isn't RNY related at all but will be keeping me from walking...which those who knows me knows that not allowing me to walk is ALMOST as bad as saying I can't talk or post on OH! I do appreciate your asking. Sherri