Controlled Excitement!..for now

Hey Everybody! Went to the surgeons office today for my wife's two week postop visit and for my history and physical.  The doc checked me over and we talked about everything up to this point (preop tests,etc.).  He told me I was a good candidate for the surgery!  I went to the business office to schedule and was pleasantly surprised that I would only have to come up with a small amount more out of pocket.  So...(drumroll) I'm on the books for March 7 2008!   It's seems like forever away but I'm sure it will be here before I know it.  I want to make doubly sure that my wife is "over the hump" (we've got two little monsters!), and I have committments at work through February.   Now the controlled part:  I only have documented weights from 2004,2005,2006,2007, and will have one from 2008 when I see my PCP in January.  BCBS says they need 5 years, but I just don't have it.  The nurse says I "shouldn't have a problem".  They are a center of excellence and don't have to submit records to insurance until after the surgery so maybe she's right.  I just don't want to get struck down this late in the game.   Thanks to everyone here for the huge amount of knowlege that I have gained.  I'll keep everyone posted!

Whoa, your nurse said you don't have to submit insurance until after surgery????  Believe me, it doesn't matter if PCMH is a center of excellence in getting your approval.   I know the practice you are dealing with and you have to get preapproval for this surgery.  Please go back and talk to them or at least call your insurance company to verify that information.  I don't kow of any insurance company that doesn't require pre-approval (not to say that there aren't any), but I would hate you to find out that she is wrong and you are paying for this out of pocket.  It will be too late after.....

It sounded a little out there to me also, but my wife got her "approval" letter the day she got home from the hospital.  It was mailed on her surgery date!  I'm not really worried about it now since I'm so far out.  But I will double check before the time comes.  Thanks for the info.

Tina will take care of you at SS.  She will be your friend and knows the ropes inside out with BCBS.  She's always returned my calls promptly whenever I left a message too... so don't hesitate to ask her ANYTHING.  I was originally going to have lap band until the 11th hour and she said all she had to do was call them to switch everything (approval) over to GB, which is what she did.  But I got my original letter of approval from BCBS well in advance of surgery.  And then a 2nd letter after things changed from Lap to GB.  If she's already got you scheduled, I'm sure you'll be getting your letter well in advance as well.  Your surgery is almost 3 months away and mine was just in a couple of weeks. She's not going to schedule you w/out approval or telling you that you've become a self-pay because insurance was denied.  THAT isn't in their best interest to take a chance you can't pay them out of pocket... nor waste doc and OR time either. She probably already has some sort of verbal commitment from BCBS for approval with some code or something since you're schedule and since they are a Center of Excellence, I do believe things work differently with BCBS since they only approve surgeries at COE. Keep us posted...

I'd double check on the not needing approval comment ... but I wanted to congratulate you on getting your date. That is truly exciting.

My husband has recently decided to pursue WLS. I have been getting a number of lovely holiday cards from many of the friends I've made here on OH and my daughter commented that there didn't seem to be to many fella's on OH. I agreed and mentioned that there were a few brave souls. You came to mind. I'm sure that you and my DH will both have a great deal of success with your WLS ... It seems that you fella's always seem to strip weight off like crazy ... It's a good thing I did it first, now I won't have to get mad at him when he's losing like crazy ;-)

Wishing you all the best in your journey to a healthier you.

Barb

Thanks everyone for your kind words.  I believe what Wendy said above is more accurate than what I originally said.  I know that almost ALL elective proceudres have to be preapproved, but it's more very much abbreviated in my situation...I think.   Barb, I agree about men and WLS.  The estimate I seem to keep hearing is about 15-20% of WLS patients are men.  There is a Men's Forum on OH.com that I frequent and really enjoy.  We usually do drop the weight faster than women, as I can...but the issue with me is keeping it off.  I bet I have lost 1,000 pounds in my life, unfortunately I've gained about 1,200+!  I want something for a long term solution.  When I diet/excersise properly, I can drop about half of what I need to pretty quickly.  Then I plateau and get frustrated and usually gain 110% of what I lost.  I've done this over and over and over.  I'm also pretty miserable on a diet.  I am simply hungry all the time! 

March will be here before you know it!!!  Hope everything goes well for you!!  Good luck!! Donna

Yay!  Sounds like things are working out the way they should.  By March, maybe you can take a break from work and you wife will be 100% recooperated (sp).  You will have wonderful support, right at home with you!  Good luck!

Congratulations on your surgery date!!! Dr. Mac was my surgeon and he is wonderful! You'll love the way they handle things although I'msure you already know since your wife just had it done!  My husband wants to pursue it too, but his insurance has an exclusion policy. :( We have discussed adding him to my insurance, but we haven't completely decided yet.  Like you, he can lose weight easily, but always seems to gain it back. it is a never ending struggle!!!

Have you thought about attending the support groups on the first Wednesday of the month at SS? I think you live a little bit away from Greenville, but it would be worth your drive. We have several men that attend frequently that have gone through WLS and can share their experiences.  It's a really great group of people!   Anyway, good luck with everything and tell your wife to hang in there... It does get better! :)

Glad to hear that you have a date!  I would think that your PCP visit from 2008 would certainly count as your 5th year.. if not, did you not have any medical visit in 2003?  I got records from all doctors I had visited, not just my PCP.  And BCBS took it because I have had my surgery (and they approved me in 1 day)..   I sent in records from a surgeon, my OB/GYN and my PCP.  Double check and make sure that there is not somewhere you can get those records from...  Good luck!!