Freaking out - please advise

Good afternoon All,
I had lap ryn April 2006 and went fron 370lbs to 215lbs and then had a hysterectomy.  I started to slowly gain weight and while I do take accontability for grazing and not being as good as I used to , I am not pigging out!   I sought out some help and after and upper GI , endoscopy and a month of iron infusions and B12 shots was cleared and approved (deemed medically necassary) for revision lap ryn.  The pouch is not stretched but the opening below the pouch is way too large and the Dr. found other issues with the path that was taken by the original surgeons.   I was excicted at a second chance to learn to use my "tool" and finally get to onederland and be healthy.
I now suffer from lyphedema, high blood pressure (again), migraines and now a new diagnosis of vertigo.    My primary cleared me and I thought I was on my way UNTIL.... I found out that the authorization for surgery was put through on Septemeber 18th and now as of today its still open and pending. I have United Health Care Choice Plus PPO.. I was told that it due to the nature of the surgery it sometimes takes up to 3 people to review. I also know an insurance company has up to 30 days to approve an authorization. I was told that only 1 person has reviewed and it will definately go to a 2nd review and possible 3rd. I am sooooooo terrified it will decline. I have gained 30lbs and am scared.
Does anyone know anything about this and has had success?  Am I being paranoid?   I did everything my primary and my Bariatric Dr wanted and now the insurance is just dragging.

Any advise and help would be soooo greatly treasured as i totally feel like a gastric bypass failure.
huggggggggggggggs and beauty to all xoxoxoxo

I think it is natural to be "paranoid" when waiting on insurance!  They sure do not make it easy for us revisioners!

You can always pull a "TEENA".  Read her post and I am sure you will understand what I am referring to....Teena if you are out there, I hope you don't mind me using you as a reference!  ;-)

Sorry I don't have much advise but do wish you well.  I can only suggest to keep bugging them daily!  They will want to get your nagging off their back!

Good luck. 

Mew,

Gotta love it!

I don't mind at all .

Thx.

Thank you Mew hugggggggggggs,
I decided to not make a follow up phone call until tomorrow but I am getting more and more frantic over this.
I plan to totally try to pull a "Teena" *playful smile*  as this is something that was proven medically and I will fight for myself but pray that I do get approved soon.
Thank you for your response hugggggggggggggggs

 Hi There - you know, I was starting to feel like no one understands what I am going through...  I too have UHC but haven't actually gone through the process as of yet because my surgeon and I are at odds.

I was a "light-weight" (250 lbs) at the time of surgery but with a multitude of co-morbidities.  I got down to 155 lbs (and fluctuated between that and 160) even after having a baby. I am 3 yrs out.   Due to really bad periods I opted to have a partial hysterectomy in April.  

I have gained 22lbs since then at a rate of 5 lbs a month.

I noticed (before the hysterectomy) that I wasn't feeling the "restriction" and "fullness" to the same extent but I wasn't gaining weight.  I was maintaining and to be honest I was happy at 160 lbs - my clothes fit good and I felt good.

Now... I have absolutely no feelings of fullness of restriction.  I am hungry all the time - not head hunger, trust me I know the difference.  I've become depressed and all but given up.  I've pushed away my husband, family, friends because I am ashamed and don't want them to see me.

I also had an upper GI and was told that my "anatomy" was fine - I want an endoscopy to prove that my stoma and pouch have stretched but am having a hard time getting my surgeon to order one.  I just want proof that it's not just me that is screwing up...  If it turns out that it is me - then I will deal with it, but I know in my heart of hearts that something is wrong.

He sent me to a "nutritionist" for a plateu-buster program but she wanted $90 a week - I told her to shove it up her a**.  The main reason I had RNY was that diets do not work for me - my metabolism is dead.

Anyway - I am sorry for my sob story...  I just wanted to offer my support and I hope that you get the approval you need.  Please do me a favor and let know how UHC responds and what "codes" were used..

Good Luck!

Vanessa

Hi Vanessa,
thank you for responding hugggggggggs.
While you are more on the "light weight" side for sure- it is a valid concern. The same thing happened to be and I was on the total heavy weight side lol.
The hysterectomy did effect me and I did gain weight and no longer feel the fullness as easily and in fact I also know it is not head hunger.
Please do not apologize for feeling bad, I feel horrible and embarrased about my weight gain but you look wonderful and we just have to realize that we never want to go back to where we were and fight hard if we do not get the approval we need.
I hope your surgeon does do an upper GI and endscope just to see because things can happen.
I will keep you posted and thank you again for the support hugggggggggggs

Sandy,

I am sorry to hear that you are having to be involved in the red tape that is insurance.

I knew my case was one where I could be approved with ease as I have a gastro gastric fistula confirmed by EGD and Upper GI, but insurance was just trying to stall as most of them do.

I cannot speak of your particular cir****tances, but I do know that you can't give up.

You have to be your own advocate and not let anyone or anything stand in your way.

I had to call United Health Care Choice Plus PPOand fax them daily to get what I needed accomplished.

The worse that could have happened is for them to tell me to stop calling and faxing.

I made it my mission to reach out and touch my Nurse Case Manager daily once I realized that she was dragging ass.

If I was not going to get their attention and make sure they understood the urgency in my case being approved no one else would.

What I did may not be for you or your situation may not warrant that level of contact, but mine did and it worked for me.

I wish you well on your journey and hopefully you will get approved soon.

Good luck.

Hey there Teena,
you are my hero!  I am so happy for you and hope and pray my day comes also.
I am going to call united tomorrow as today I found out that I am going for a sleep study for sleep apnea and now I am taking high blood pressure pills and meds for vertigo which is all following the weight gain. They did find the problem with the endoscope and I do trust in my new surgeon but gosh this waiting and waiting is so frustrating.
Good luck on your corrective revision and thank you for the encouragement.
warm hugggggggggs

Sandy,

Thx.

Make sure when you are calling them you document who you speak to every time (especially when they transfer you a lot), the date and time you called, and what was discussed.

When is your sleep study scheduled for?

I wish you well with that.

I also take high blood pressure meds daily.

I am happy that you have found a surgeon that you trust as that is part of the battle.

I know the waiting is frustrating.

It's like this" Sit somewhere and be real real still" or "Hurry up and wait"

LMAO.

It is the worst, but just like I did and everyone else did you will get through it.

"That which does not kill us makes us stronger." Friedrich Nietzsche

I will keep you in my thoughts and prayers.

NEVER GIVE UP!

Good luck.

Sending you warm hugs back.

Well I have somewhat of an update and not sure if I should breath now LOL I think its okay to breath but am almost afraid too.
I called on Friday and was told that there was 2 open authorizations for the revision (one under my maiden name/one under my married name) - I am going through a bad divorce due to abuse (another story) but due to low self esteem I settled :(   - Because my Bariatric Surgeon used my correct name but some of my other doctors had my maiden name , it caused some "red flags" so as of the 28th it was closed and reopened under the proper last name. I was told it was approved under the incorrect name and that its just the waiting game.
I hope I was given correct info because I did in fact call on the 28th and was never told any of that and in fact none of that makes sense because my insurance knew my name changed becauase they sent me new insurance cards when  my job informed them.

Please keep me in your thoughts and once I know more I will let everyone know if in face I have this 2nd chance!


Thank you again to all for the support.

BIg warm hugggggggggggggggggggggggggggggggggggggggs
I will never give up and TEENA you are still my HERO
huggggggs to all