And on it goes...still in limbo
I am struggling greatly with waiting for insurance approval...
My consult at Barix was in Dec. 07.
I was told in March 08 that Capital Blue Cross required 6 mos. of medically supervised weight loss efforts.
Since then, I've participated in a hospital based dietitian led program with only minimal weight loss...seeing my doc every 4-6 weeks. I've done the sleep study, extra blood work, and a regimen of antibiotics to knock out a stomach virus that was discovered along the way.
I got the requisite letter from my doc (took 2 tries to get it to say what seemed to be the right thing)...faxed the letter with 16 pages of added documentation to Barix on Dec. 31. I'd been to the pre-op support group at Barix in December and dared to get a little fired up about it all. Then I got a call last week...asking how I was coming with my documentation.
WHAT???
They never got the fax. I verified the number...but for whatever reason, my medical "life" is lost somewhere on the phone lines. As I'm preparing to resend it, the representative just happened to mention that Capital Blue Cross now requires a psych. eval. This was the first I'd ever heard of this requirement, and it just about pushed me over the edge. (Ironic isn't it? They drive you crazy and then make you go to a shrink!) I was surprised, and I don't like surprises. I especially wonder how long it would have been before I was told of this requirement. So I"ve spent time trying to get an appointment, finally settling on a place in Pottstown that was recommended by someone on the Barix message board. My appt. is next week...plus more time to get the letters....but what the hell, I already wasted 3 more weeks on the "non fax" issue, even though I was quite sure I had covered the bases. In the meantime I am more deperessed about this than I have been about anything in recent memory, and trust me I am generally the most optimistic person on the block. I feel like I can't get excited about it all - because it may be turned down. Even if I'm approved, it's a nerve wracking process to realize I am going to change my body's internal workings! On the other hand, I see what Oprah is going through, even with all the resources she has. And I saw her show a couple of weeks ago, when a Biggest Loser winner was on, having regained half of his weight lost. Even in those extremely successful attempts, I think Dr. P. was right in saying that this is the only truly permanent prospect for weight loss. And THAT's a double edged sword, because if I am not approved, it means that my only real and permanent option is closed down. Honestly, I feel as if I should call Barix again and set up another consult. My last one was almost 14 months ago. I was excited then, but the reality is that I'm not amazingly confident about the process pieces right now. It's not the surgery or their reputation or anything else...just that this insurance game is fraught with unexpected turns and not a glimmer of certainty. I'm depressed about my weight, try to watch it every day, and feel like the process is sucking the energy out of me.
OK, I've vented. Thanks for listening - I'm not usually like this but today I'm at the proverbial end of my rope. I hate uncertainty!
Lynn
My consult at Barix was in Dec. 07.
I was told in March 08 that Capital Blue Cross required 6 mos. of medically supervised weight loss efforts.
Since then, I've participated in a hospital based dietitian led program with only minimal weight loss...seeing my doc every 4-6 weeks. I've done the sleep study, extra blood work, and a regimen of antibiotics to knock out a stomach virus that was discovered along the way.
I got the requisite letter from my doc (took 2 tries to get it to say what seemed to be the right thing)...faxed the letter with 16 pages of added documentation to Barix on Dec. 31. I'd been to the pre-op support group at Barix in December and dared to get a little fired up about it all. Then I got a call last week...asking how I was coming with my documentation.
WHAT???
They never got the fax. I verified the number...but for whatever reason, my medical "life" is lost somewhere on the phone lines. As I'm preparing to resend it, the representative just happened to mention that Capital Blue Cross now requires a psych. eval. This was the first I'd ever heard of this requirement, and it just about pushed me over the edge. (Ironic isn't it? They drive you crazy and then make you go to a shrink!) I was surprised, and I don't like surprises. I especially wonder how long it would have been before I was told of this requirement. So I"ve spent time trying to get an appointment, finally settling on a place in Pottstown that was recommended by someone on the Barix message board. My appt. is next week...plus more time to get the letters....but what the hell, I already wasted 3 more weeks on the "non fax" issue, even though I was quite sure I had covered the bases. In the meantime I am more deperessed about this than I have been about anything in recent memory, and trust me I am generally the most optimistic person on the block. I feel like I can't get excited about it all - because it may be turned down. Even if I'm approved, it's a nerve wracking process to realize I am going to change my body's internal workings! On the other hand, I see what Oprah is going through, even with all the resources she has. And I saw her show a couple of weeks ago, when a Biggest Loser winner was on, having regained half of his weight lost. Even in those extremely successful attempts, I think Dr. P. was right in saying that this is the only truly permanent prospect for weight loss. And THAT's a double edged sword, because if I am not approved, it means that my only real and permanent option is closed down. Honestly, I feel as if I should call Barix again and set up another consult. My last one was almost 14 months ago. I was excited then, but the reality is that I'm not amazingly confident about the process pieces right now. It's not the surgery or their reputation or anything else...just that this insurance game is fraught with unexpected turns and not a glimmer of certainty. I'm depressed about my weight, try to watch it every day, and feel like the process is sucking the energy out of me.
OK, I've vented. Thanks for listening - I'm not usually like this but today I'm at the proverbial end of my rope. I hate uncertainty!
Lynn
Lynn I can certainly understand your frustration - you've been going through the process a very long time. I love Barix, but they're not the greatest when it comes to receiving faxes - I know they 'lost' my paperwork once and every time I fax bloodwork they say they never get - so don't despair - you're not alone in that regard.
Dr Boe required a psych eval for me, and even if he hadn't my insurance would have, so that's pretty much standard operating procedure and pretty painless once you find someone to give you the eval. I only had to see the shrink once and that was enough for her to write up a good eval for me to turn in.
You probably have a very valid point about scheduling another consult at Barix - I don't see why they wouldn't do another once since its been so long and they know what you've gone through - it might be the extra boost of motivation you need to get you through all this.
I think we all go in with expectations of 'gee, I made the decision so let's get going!' but I know for me I had my initial consult in June 2007 and didn't have my surgery til Feb 2008, and most of us are like that, so hang in there.
It isn't an easy process to go through but it certainly is worth the effort - I have never been able to lose a significant amount of weight in the 30+ years I dieted - 60 or 70 lbs at one time was the most I lost, but as soon as I started 'eating' again it all came back and then some. This is a big lifestyle change but the tool is fantastic and all you have to do is work it.
Best of luck to you - it will get better - you will get your surgery - and you will be on your way to a happier, healthier life.
Kathy
Dr Boe required a psych eval for me, and even if he hadn't my insurance would have, so that's pretty much standard operating procedure and pretty painless once you find someone to give you the eval. I only had to see the shrink once and that was enough for her to write up a good eval for me to turn in.
You probably have a very valid point about scheduling another consult at Barix - I don't see why they wouldn't do another once since its been so long and they know what you've gone through - it might be the extra boost of motivation you need to get you through all this.
I think we all go in with expectations of 'gee, I made the decision so let's get going!' but I know for me I had my initial consult in June 2007 and didn't have my surgery til Feb 2008, and most of us are like that, so hang in there.
It isn't an easy process to go through but it certainly is worth the effort - I have never been able to lose a significant amount of weight in the 30+ years I dieted - 60 or 70 lbs at one time was the most I lost, but as soon as I started 'eating' again it all came back and then some. This is a big lifestyle change but the tool is fantastic and all you have to do is work it.
Best of luck to you - it will get better - you will get your surgery - and you will be on your way to a happier, healthier life.
Kathy
'One shoe can change your life'...Cinderella
Hi Lynn
I also had to jump thru some hoops to get done BUT IT WAS ALL WORTH it in the end, I also needed a psych eval.
if you can't make it to the Saturday pre-op metings we also have a pre-op meeting the second Tuesday of the month at 7 pm in the lobby at Barix, this month it is Feb. 10th
hope to see you there.
Susan
I also had to jump thru some hoops to get done BUT IT WAS ALL WORTH it in the end, I also needed a psych eval.
if you can't make it to the Saturday pre-op metings we also have a pre-op meeting the second Tuesday of the month at 7 pm in the lobby at Barix, this month it is Feb. 10th
hope to see you there.
Susan
Lynn,
I can certainly understand your frustration and you came to the right place with it. It's just one more in the series of hurdles you go through to get to the Loser's Bench.
Unfortunately, early on I had some of my own experiences in the process with Barix, so what I was told and learned, was that we have to be very proactive in making sure that Barix receives all paperwork and what I did to accomplish that was, always asked for the doctor doing the clearance, Heart, gastro-intestinal, labs, primary, all of them for a copy of all test results, I then made sure to follow-up with Barix on each step of the process and in a couple of instances, my having the copies probably saved me having to be in a similar set of cir****tances. So, be sure to follow-up, ask the person who does your evaluation, to please send you a copy and give you a date as to when he/she will be faxing/mailing to Barix/Insurance carrier and from that date, start calling Barix to find out if they have said paperwork and find out what the next step is in the process as you want to get moving in a forward direction. It's the old addage, about the squeaky wheel getting the oil. . . be real squeaky and we'll be welcoming you to the Loser's Bench!
Hugs and best wishes, Laureen
I can certainly understand your frustration and you came to the right place with it. It's just one more in the series of hurdles you go through to get to the Loser's Bench.
Unfortunately, early on I had some of my own experiences in the process with Barix, so what I was told and learned, was that we have to be very proactive in making sure that Barix receives all paperwork and what I did to accomplish that was, always asked for the doctor doing the clearance, Heart, gastro-intestinal, labs, primary, all of them for a copy of all test results, I then made sure to follow-up with Barix on each step of the process and in a couple of instances, my having the copies probably saved me having to be in a similar set of cir****tances. So, be sure to follow-up, ask the person who does your evaluation, to please send you a copy and give you a date as to when he/she will be faxing/mailing to Barix/Insurance carrier and from that date, start calling Barix to find out if they have said paperwork and find out what the next step is in the process as you want to get moving in a forward direction. It's the old addage, about the squeaky wheel getting the oil. . . be real squeaky and we'll be welcoming you to the Loser's Bench!
Hugs and best wishes, Laureen
My Mantra is that I do not determine my success by the number hanging in my closet, nor will I let the scale determine that success either. . . It is through trial and error I will continue to grow and succeed. . . Laureen
"Success is a journey, not a destination." Ben Sweetland
Lynn,
You certainly aren't alone in this. Keep perservering...it is well worth it! My initial consult was April 07. In Dec. 07, my insurance company required me to have a 6 mo. diet. So needless to say, I was experiencing every emotion under the sun. After I finished my 6 mo. diet, my blood sugars were not under control, so that put another delay in the mix. I finally had my surgery Nov. 08! Let me tell you, jumping through those high hoops I think made me stronger in the long run...it wasn't easy by a long shot experiencing all those set backs, but I think I am more grateful for having my surgery now and I am more focused at following the rules because I had to wait so long for this life changing event! So, I guess what I am trying to say is be patient, keep focused on what is needed next, and before you know it your surgery will be here. In the meantime, keep venting here, we are all good listeners!
Dee
You certainly aren't alone in this. Keep perservering...it is well worth it! My initial consult was April 07. In Dec. 07, my insurance company required me to have a 6 mo. diet. So needless to say, I was experiencing every emotion under the sun. After I finished my 6 mo. diet, my blood sugars were not under control, so that put another delay in the mix. I finally had my surgery Nov. 08! Let me tell you, jumping through those high hoops I think made me stronger in the long run...it wasn't easy by a long shot experiencing all those set backs, but I think I am more grateful for having my surgery now and I am more focused at following the rules because I had to wait so long for this life changing event! So, I guess what I am trying to say is be patient, keep focused on what is needed next, and before you know it your surgery will be here. In the meantime, keep venting here, we are all good listeners!
Dee
This is not the first time stuff like this has happened at Barix.
Their medical staff, Dr. Pupkova, nurses, aide's, you name it as far as patient care goes is by far the best I have ever ever EVER seen. By far a top notch facility.
Their staff as far as all the issues you have voiced - eh.....not the best. You need to keep on top of them like buzzards on an animal. Sorry to be so crude here. And whenever you fax them ANYTHING you call them before you do it to let them know you are and then about 10 mins later to make sure they got it ALL and have them stay on the phone with you and tell you how many pages of each thing they got. End of story. It's a pain in the A$$ but it certainly beats waiting 3 weeks to find out they got none of it.
And just as an aside...although this is a great way to help solve the weight loss issue - And I love dr. pupkova and agree with her on almost everything...the ONLY way any of this works is if you stick to the program for life. There are countless stories of this surgery "not working" and really - it's not that the surgery didn't work in most cases, it's that the patient did work the surgery.
OK...that's my little soap box now on that.
Hang in there, I don't blame you for feeling the way you do. And I wouldn't see the problem in a second consult with Dr. Pupkova and what not just to touch base, get more info, and possibly "rekindle" the flame that has been dampered on.
Good luck!
Pam
Their medical staff, Dr. Pupkova, nurses, aide's, you name it as far as patient care goes is by far the best I have ever ever EVER seen. By far a top notch facility.
Their staff as far as all the issues you have voiced - eh.....not the best. You need to keep on top of them like buzzards on an animal. Sorry to be so crude here. And whenever you fax them ANYTHING you call them before you do it to let them know you are and then about 10 mins later to make sure they got it ALL and have them stay on the phone with you and tell you how many pages of each thing they got. End of story. It's a pain in the A$$ but it certainly beats waiting 3 weeks to find out they got none of it.
And just as an aside...although this is a great way to help solve the weight loss issue - And I love dr. pupkova and agree with her on almost everything...the ONLY way any of this works is if you stick to the program for life. There are countless stories of this surgery "not working" and really - it's not that the surgery didn't work in most cases, it's that the patient did work the surgery.
OK...that's my little soap box now on that.
Hang in there, I don't blame you for feeling the way you do. And I wouldn't see the problem in a second consult with Dr. Pupkova and what not just to touch base, get more info, and possibly "rekindle" the flame that has been dampered on.
Good luck!
Pam
Instead of complaining that the rosebush has thorns, be happy that the thorn bush has roses. 
I really appreciate all the encouragement here.
I refaxed everything (and called to be sure it was logged in), made my psych. appointment for Wednesday (worth a little drive to get an appointment fairly soon), and have settled down a little.
The waiting is stressful. It was great to have some good listeners out there!
Now - another question for you...
Let's just say I get approved. Did any of you face scheduling issues because of work commitments? I hate to wait till everything is "clear" on the work calendar...that would be about May! In fact, taking care of everthing else before myself is one of the problems that has led to the weight issues...just wondering here how you all scheduled your surgery into your life!
Lynn
I refaxed everything (and called to be sure it was logged in), made my psych. appointment for Wednesday (worth a little drive to get an appointment fairly soon), and have settled down a little.
The waiting is stressful. It was great to have some good listeners out there!
Now - another question for you...
Let's just say I get approved. Did any of you face scheduling issues because of work commitments? I hate to wait till everything is "clear" on the work calendar...that would be about May! In fact, taking care of everthing else before myself is one of the problems that has led to the weight issues...just wondering here how you all scheduled your surgery into your life!
Lynn
So here's the latest.
I had the psychological, and everything was submitted to Capital BC last week.
Yesterday I got a call from Barix. Now they want...
a pulmonary eval.
a cardiac eval.
verification of surgical consult
verification of attending 2 support groups (which I have done)
bloodwork for thyroid and h. pylori (which I have done, but it's been a year - they may want a redo)
Amazing. I think I will call Blue Cross today.
I had the psychological, and everything was submitted to Capital BC last week.
Yesterday I got a call from Barix. Now they want...
a pulmonary eval.
a cardiac eval.
verification of surgical consult
verification of attending 2 support groups (which I have done)
bloodwork for thyroid and h. pylori (which I have done, but it's been a year - they may want a redo)
Amazing. I think I will call Blue Cross today.
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