2nd attempt, Jax,FL, Been 2 years since last try.. Need emotional support

I attempted to have the surgery 2 years ago, went to Dr. Michael Butler in Alt. Springs, FL. I got the letters from my PCP and OBGYN documenting my weight loss attempts for the past 2 years. I want and had the sike evulation. Did all the leg work for Dr. Butler's office. They gave me a list of things I had to do and I did them all, except the blood work. Dr. Butler's office said to wait on this until about 1 week before surgery. The doctor's office submitted my request to BC/BSFL Health Options who promptly denied me. Reason: no blood work. I was mortified that this was the reason. I had since moved to Jax, FL and was traveling back and forth to Alt. Springs for all the appointments. I litterly sat on my floor and cried. I so desperatly wanted this surgery and not it was shot to hell. It has been 2 years since that attempt. I spoke with my PCP Dr. Zoller and he said he would be happy to give me a referral for the surgery. They gave me the list of hospitals and NFRMC in Gainesville was where they suggested I go as BC/BSFL accepts them. I contacted Dr. Butler's office for copies of my letters from my doctors documenting my 2 years on med. supervised diets as well as a copy of my sike evulation. I sent off the packet NFRMC gave me just this last week with copies of all I had. My doctor's office said they will give me the referral this next week. I'm so scared right now, and fear rejection again. Especially after BC/BSFL has said they are not going to cover these operations after 12/31/04. I need help. What can I do to help with obtaining an approval? What do I need to do? Would sitting down and writting a letter help me? I have high cholorestol, had my gallbladder removed because of the cholerstol, my leggs, knees and feet hurt from the weight. My lower back hurts all the time especially @ night when I sleep. My sleep problems come and go, I have heartburn (acid reflux) which I do take the medication for (nexium) otherwise I don't like to take medication. I know I'm suppose to but don't like to. I need a guardian angel. Some one to talk with, someone to help me remain positive. Can any of you help? My e-mail address is [email protected] and I welcome your advise, suggestions and your support. Thank you, Marilyn Jacksonville, FL

hay.. im so sorry about all they drama you have been threw with this process... i hope it works out this time... if you need to ventyou can e-mail me at [email protected] xoxo lexa

Marilyn, I have to ask... why oh why, didn't you appeal when they denied you for just bloodwork? Keep in mind, the ins companies deny for anything possible, such as not all records submitted and they hope we wont appeal, but the "squeaky wheel gets the oil" in that industry. Contact BC/BS and find out how far back they will accept your psych eval and supervised diet info. Two years is a long time, they may want more recent info. I would contact them ASAP so you know exactly what they expect before you see the surgeon. I would hate for you to experience disappointment again. In the meantime, research the doctors in G-ville and Jax, there are some very reputable up in that area now. Good luck, Amy

I didn't know you could object to a decision made by an insurance company. Dr. Butler's office never told me that was an option so tears were the only option I felt I had. I have done the research on the doctors in Gainesville and feel very comfortable with Dr. Thoburn. And I have done nothing but read everything everyone has wrote in this message fourm. It has been a wealth of information especially about BC/BSFL HMO. I will call first thing in the am to see if any of my now outdated information is still good. I don't mind doing the sike evulation again but another year of supervised diets will do me in. Especially since BC/BSFL plans on dissallowing any WLS surgeries after 12/31/04. **If anyone has contacted BC/BSFL recently to find out what the limitations are please share that with me. Thank you for your support. Marilyn

Hi Marylin, So sorry about all your difficulties. I would start seeing a doctor this week for a medically supervised weight loss program. Keep each appointment no longer than 30 days apart. Start now, and by October you will be finished...Just in case you have to start this process over. I would suggest you also contact BC BS of FL ask them what they require, tell them what information you have see what if any of your previous information can be used. It is my understanding as long as your paper work is in to BC BS by Jan 05 they will honor it. I asked them this, if they would drag out my approval just to keep things in the air until after Jan 05 so they wouldn't have to cover the cost of the surgery and their answer was as long as your paper work is in it will be considered. You go girl! Molly

I will contact them first thing this morning as well as my PCP to begin a monitored weight loss program. I didn't get an approval the last time because my blood work was not submitted. (previous doctor told me not to do this until a week before the surgery). Do you think they will fax me what is required for this surgery? So that way I know what I'm looking for in ways of approval? Thank everyone so much for all your support. It makes all the ups/downs in my mind a little easier to cope with. My father just passed away a few weeks ago, and I learned he told no one he had any family. I'm so angry with him for this. It appears that now I find myself having to contest a will on top of the stress of getting an approval. Boy I was never depressed before, it's finally starting to set in. God is really testing me to see how strong I am. I pray he has his arms open for when I fall so to catch me. Again thank you for your ideas. I will keep you posted on what I find out from BC/BSFL. Thanks again. Marilyn

I'm happy to say that today was a good day. When I went to bed I didn't think things could possibly get better but than GOD I was wrong. I started my day out by calling BC/BSFL and asking if they could please pull my medical request form. I spoke with a nice lady who told me it was in the vault (dead file room) and it would take 24 hours or more to retrive the information. I explained that when Dr. Butler had sent in my paperwork for an approval he didn't send it in complete (lacking blood work) and that I was going on 04/27 to have blood work done, I also explained I had switched surgens to Dr. Thoburn. I was very firm, I pretty much demanded a copy of my medical request form and told her I wanted to know if the information submitted previously would still be good or if I would have to beging my process again. I also asked her to fax me what BC/BSFL deems as medically necessary. She promptly faxed it to me. I qualify under all medically necessary areas. About 2 hours she called me back to say since Dr. Butler never requested a surgery date my request could be resubmitted again by Dr. Thoburn and all my documentation would still be valid. Thank you GOD and you Amy for making me call BC/BSFL. I might have never done it if not for your advise. I then called NFRMC and spoke with Shirley who scheduled 1st appts and does all the leg work. I told her I sent my paperwork last week and know it was received on 04/23 as I sent it certified. I went to my PCP today and picked up a copy of the referral sent to Dr. Thoburn as well. I told Shirley I included the sike evulation & 2 letters written by my physicans (PCP & OBGYN) who had me on a weight supervised. She said hmmmm, usally that comes later but give me a few days to look it over and I will call you back and we will go from there. THANK YOU Amy, and everyone else who has given me such wonderful advise and help. I'm still sad about my dad's passing and not being able to attend the funeral but I'm not totally stressed to the point I want to cry every second. And this is only because it looks like I'm begining to see a light. Thank you and God Bless all of your for your help. Marilyn

Hey Marilyn, I just wanted to say good luck! I am almost three weeks out of my surgery with THE best surgeon in Jax (my own opinion of course) His name is Dr. Sheriat. I know he accepts BCBS just not sure if hmo or not....anyway...I just wanted you to know that you have many on your side hoping and praying for you and if you need anything, please don't hesitate to call on any of us. My profile page has all my contact info. Take care and keep us updated. Susan post op 20 days -19

Marilyn, I am 5 months post-op and have lost 91 pounds. My surgeon is Dr. Wm Todd Overcash in Ocala. We have a support group that meets monthly on Wells Road in Orange Park (was at library on 103rd before they closed for remodeling). Our next group is on Saturday May 8th at 10 AM. It is open to pre-ops and post-ops or just anyone wanting info. We have patients of doctors in Jax, Ocala and Gainesville. I am one of just a few guys, it is mostly women. If you are interested and would like the address let me know and I'll send it to you. Gary

Thank you Gary, yes I would like the information on where the group meeting is I would very much like to attend. Thank you for thinking about me. Again thank you, Marilyn