New here & My Story -

My journey to Gastric Bypass Surgery, has been a long one to say the least. It started a year ago when my diabetes doctor suggest that I look into Surgery so that I can loose weight, and avoid having to go on insulin shots. The decision to call the Umass weight Center was a hard one. I am not HUGE by any sense of the word, but, I am considered Morbidly obese, weighing in at 230 lbs, at a height of 5’2”. I attended the informational sessions, like a good patient, and even attended the session that followed that, the intro to gastric surgery.

 

 

 

After completing the initial steps, I called my healthcare provider, to inquire about coverage. I was told that I was fully covered, and if I chose, I could go ahead and start the procedure to get into UMass’ program, which I had resolved myself to do. I attended appointments with a nutritionist, a behaviorist, and behavior modification and pre surgical skills classes. At the end of the classes, I had gained weight, through fault of my own, because I was eating as if I was having a “last supper”. So I had to book another nutrition appointment with the nutritionist. In the meantime, I became a regular staple at the gym, ate a lot less, and followed the slim-fast diet plan. After my appointment with nutrition, I was down to 224.5 lbs. and was now given a date to meet with my surgeon, Dr. C.

 

 

 

I was elated to say the least. So on March 12, I went to the appointment, taking time off from work. When the Nurse Practitioner came into the room, she sat down and said, “I have bad news for you.” My heart sank, as I was sure she was going to tell me that I had not lost enough weight, and was no longer a candidate for surgery. She then told me “I am really sorry to tell you this, but a few days ago your insurance decided to no longer cover this type of surgery.” I was hysterical, sobbing incessantly. Begging to find out what I could do. They told me to appeal the decision. I called my insurance, and was told that it had to be denied approval first before it went to appeal and grievances.

 

 

 

A month later, I was told approval was indeed denied, and I went to the insurances internal grievance dept, and filed an appeal. Again, I was denied, based on the fact that I had not completed THEIR program!!! I had already completed a program, I was supposed to get booked for surgery on the day I was to meet the surgeon, on the day I was told what the insurance company did 6 days earlier, without ever informing any of the people that they KNEW were in programs such as I was.

 

 

 

I again appealed the decision, this time to the state of MA, who sent it out to an outside, impartial agency. I was told not to expect a decision from them until August. Well, 2 weeks ago, I got the letter that they overturned the decision of my insurance, and that they would HAVE to cover the surgery!

 

 

 

So, now I have my date, and am working hard on getting the last few pounds off of me. I am very determined. I did not fight this so hard to fail. I will Prevail! Twinsmom

Well, Congratulations! to you.  You will be glad you went through all that trouble.  RNY was one of the best decisions I've ever made.  Good Luck and best wishes.  Nicole

It took me 18 months of fighting my insurance company after being denied twice by them to finally get approved.  I'm glad you fought for this as it's a life changing experience for your health.   So when's your surgery?

July 30th.  I go for a weight check on July 10th, and i am a tad nervous, as I have put some weight on. I need to lose by then about 6 lbs. I am walking daily, eating scarcely, and doing what I KNOW I need to do, and it is not going away. Depressing to say the least. I am also due for the monthly, so maybe that is what is doing it. Dawn

Dawn, you sound like me! Cept I've been diabetic (on shots) for 38 years now. I got denied the first time around too, and appealed and got approved! My date is set for August 1st and I can't wait! I'm still telling ppl this is my only option...I weigh about 224 now and need to lose more before I see my doc on July 9th for my final pre-op appointment. I just SO want this DONE!! :) Are you getting that too? People say "but you're not THAT heavy! WHY such a drastic thing"....(eyeroll)

The support groups are wonderful and most of the staff I've dealt with at hospitals and my insurance company have been great! I'm trying NOT to eat a path through Richmond but it's not easy. I hit that "last supper" groove too and now need to add in a shake or two a day to lose more. It's goign to help in the long run as I'll just be that much used to smaller portions...so I'll be living between shakesville and the Gerber aisle at the store! LOL... CONGRATULATIONS!! This is going to be one of the best things we've ever done for ourselves! Marie

Hi there!  Congradulations on finally getting your approval.  I had my surgery done on March 5th and have lost 65lbs in almost 4months..this was truly the best decission I have ever made and I dont regret it at all!  Like you I weighed 234 and I am 5'2 but my doctor didnt stress on my losing weight before hand BUT I started my process a year in advance and then stopped due to a new job and getting time off etc..and in that year I stayed pretty steady at my 234 weight.  The day after my surgery the announced that insurance companies were stopping these surgeries and making people go threw a program with the insurance company whch can take up to 1 year and I thought OMG I am glad I wasnt any later on my surgery...however a friend of  mine with the same insurance as me had to cancel her surgery and go threw the program...which bites! I still to this day have a very hard time looking at my self and seeing thin but I get more compliments and my clothes have gone from 18 to 10/12 so I know there is a change...lol   I wish you the best of luck!  dont get discouraged because in the beginning right after surgery you can get very emotional and say what did I do!  Take it slow and get lots of support and you wont regret it MA

I REFUSED to let Tufts do that to me,, I fought them, and won, took me 4 months to do it, but I did. What they did to people who were in my position was WRONG!!  Dawn

Congratulations to you!!!!  You are your best adviocate.   I had surgery 1 1/2 years ago and have lost 180 lbs.  It has proven to be the best thing that I have done for myself.  I wish that I had done it 10 years ago, but, you have to be in the right frame of mind and ready to make changes for the rest of your life.   My boyfriend was with me before the surgery and has stood myside the whole time.  He has been a huge inspiration to me.   My new goal is fighting with the insurance company to get my TT paid for.  I have to have a hernia repaired and don't see why they won't do them both at the same time.  But that is a battle that I am in the middle of and will not give up on. Good luck to you and keep us informed of how you are doing.

If you do not mind me asking,, what is TT?? and who is your insurance carrier??  Dawn