My appeal letter was answered...but now I have questions...

As some of you know I sent an appeal letter to tenncare, because I was denied a referral to even go see a surgeon. Well I received my decision, and it said that I had not been denied bariatric surgery. I was like "wait a minute, I haven't even sent everything in for approval for surgery, or even SEEN a surgeon for that matter." I explained this to a woman who called me today from tenncare. She said that more than likely the reason my referral was denied was that I hadn't done the weigh****chers program yet with a tenncare weigh****chers doctor. That a lot of people were getting snagged up because of the whole weigh****chers thing. So I was sent a loooong list of things that I need to do before getting a consultation to go see a surgeon. One of them being the weigh****chers thing. Which is fine. Like I told them before I will totally cooperate with whatever procedures that had to take place. So I made an appt for friday with my PCP, to talk about weigh****chers, get some bloodwork done and, talk to her about getting a sleep study done (because I'm so exhausted all the time and I wake up with a splitting headache most days). I told her that I wanted to be tested for high cholesterol (I bet it's awful ) and all of that mess. I would have done it sooner, but with these couple of classes I'm taking in the summer are kicking my you know what... So now to the questions: 1. For those of you that have done the weigh****chers program through tenncare, how long does the program last? 2. Should I get a copy of everything?? Including records from my PCP and anything that happens at weigh****chers?? 3. What is a sleep study like? Do they have to stick stuff up your nose to see how you sleep at nite?? And should I get a copy of everything there too?? 4. It says I'm supposed to have medical records for FIVE years, but I've only been on tenncare since 2002. Will that be long enough for them to determine if I'm eligible for this surgery? 5. I am also supposed to go see a psychologist/psychiatrist..I dunno which one paper is downstairs...how does that usually go? 6. (LAST ONE I PROMISE :D ) I am supposed to prove that I am unable to do certain things?? Like what?? Would getting short of breath upon going up the stairs count? Not being able to play with my son without having to rest often? Barely being able to walk around the block without feeling like I'm gonna pass out?? Would that count?? I'm unsure as to how to prove that... Sorry for the novel...but thanks for the help. You guys are so great and supportive. Jess

Hey Jess, It sounds like you got a positive response from Tenncare but you've got some hoops to jump through! Other than that I hear its fairly easy to get approved through Tenncare. Now in regards to your questions: 1.) I haven't done the weigh****chers thing, but my insurance required 6 month dr. supervised diet. I kept a daily food log and exercise log. I suggest you do the same thing with your weigh****chers program. Send this along with all the other paperwork that needs to be sent to tenncare. 2.) Make copies of EVERYTHING including your food and exercise logs. 3.) I haven't had a sleep study done but I wish you the best of luck! 4.) Get as much medical related information you can get your hands on regardless if it was before your were on Tenncare. They need these records to show that you've been obese for 5 consecutive years. 5.) They probably want you to see a psychiatrist to determine if you're mentally stable to undergo the procedure. Not only does your body undergo changes..so does your state of mind. Also, they want to make sure you understand the procedure and that you will adhere to what is required of you after surgery. 6.) Tell your PCP everything that you can't do because of your weight. He/She will note these things in your record. That is what mine did at least. Also, it wouldn't hurt to write a personal letter to add to the other paperwork the insurance company requires. Be sure to have a full check-up while you're there (blood work, blood pressure, etc.) For insurance purposes, it is a "good" thing if you have co-morbidities. Good luck Jess! If you need anything let us know. Everyone is super supportive here. April

Jessica, I have TNCare/ medicade. I didn't have to do the W.W thing. I am glad to. As for your records, I would get everything I could for as long back as I could. I have never had a sleep study, But I know some people on here has & I bet they would be glad to share their experiences w/ you. Do you remember who your DR. was prior to being on TNCare? If you do, I would ask them to fax copies to the insurance co. I had to have a psych. eval. It wasn't bad at all. I even ask about counseling AFTER surgery & they said sure. I am a stress eater but have done excellent so far. Now, for your last question, I agree w/ April. Tell your PCP & let them document it. You will alway's have a record when they do that. Sit down w/ him/her & tell them what happens when you do these thing's. I hope I have helped in some small way. I am so happy w/ my surgery, I want everyone to be this happy. Best of luck to you. Sara.

See the thing is, I didn't have a doctor at all before I got on tenncare. I either used the emergency room or one of those minor emergency centers if I had a cold or whatever. The only time I did see a doc that I can remember was when I dislocated my knee cap back 5 years ago. So really my records start at about october 2002, when I was pregnant. But I had a lot of issues during my pregnancy due to my weight, and even ended up on bed rest because of my blood pressure. So maybe that will be enough for them, because it's all I have. But I do have the whole phenfen records and all of that from back when I was 17-18. So we'll see..my records kind of skip years. Sigh I hope that is good enough. Jess