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A New Day

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Roo101769

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Yesterday I sailed through my psych evaluation. The doctor said the fact I have already been making changes and trying to create new, lifelong habits will increase my odds of success. He said he has no problems supporting me because he knows I have researched this a great deal and I know the risks/benefits. I'm not the internet diva for nothing!!! LOL So his report will be turned in today and I am that much closer. I got my "check list" from Dayton Bariatrics yesterday. Many of the to do items are things that are out of my hands ( like requesting 2 yrs medical records and my PCP letter of recommendation) Considering my PCP is the one who referred me to Dr.Bruce I am not very concerned he will provide the items requested. I have my NUT appointment today. Not exactly sure how many of those I do, but I will do them. I also have to have a pulmonary check since I had the two pulmonary embolism. I'm not worried about that though, my lungs are fine. The only thing that "may" hold me up is the misinformation about a required 6 mos. medically supervised diet. Dayton Bariatrics stated that my insurance listed it as a pre qualification. Yet I have now verified TWICE with Anthem that it is NOT required by my plan. The rep I spoke with Monday said he would contact the office and let them know it is incorrect information. I have no doubt Anthem screwed up. Considering they initially told them I was excluded from coverage for the surgery when it is covered!!! But even if this miscommunication fails to be cleared up I am still sitting in a pretty good place. I actually started a "medically supervised diet" in March. My old insurance required 12 mos. of it. So, before my leg took a turn for the worse, I had started taking the steps I needed to qualify. Granted there has not been much dieting going on these past 5+months, and little exercise. But I have been under constant medical supervision, thanks to my leg. And it is on record I started in March, therefore September will be 6 mos.!! So to avoid another 6 months of waiting, I am sure my PCP will state I completed the required 6 months if they fail to clear it up.

Wait...I just got a call back from the Anthem rep!!! Wow, ok he earns a gold star in my book. He did research things further and found the only thing the plan requires is you receive the nutritional counseling and must follow their advice. So if they want you to do counseling for a few months you have to. But heck, your bariatric doctor would require you to also. But there is NO, I repeat NO, required medically supervised diet time frame. The guy had actually already tried to call the office but the girl who does insurance was not in yet, so he will be calling them back this afternoon. I thanked him very much for his help. As I told him, I have no issue at all if I am required to do nutritional counseling. It is part of the process. But I do not want to be held back from surgery just because my doctor believes there is a requirement of my insurance that there is not. He agreed fully and said he had no problem at all making sure they understand. So now I am STOKED!!! Not sure how it will go with the NUT today. I am hoping that they will be like the psychologist and see I am already working to change so I can succeed. I have done a LOT of research about what to eat, nutritional needs post surgery. So I won't be walking in there clueless. Just have to wait and see what they think....

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NUT evaluation / counseling done. Apparently I AM doing something right! I have nothing further to do before surgery, just check ups after!!! The research I have done along with the changes I have already made has gone a long way in this process. So now it is the pulmonary exam, wait for records & letter from PCP to be received and they will send in to insurance!!!! Which also means the 6 mos. has officially been cleared up. I received a call from the office on my way to the NUT appt. to tell me they have it straight now. The girl I spoke with ( handles insurance for Dr. Bruce) said Anthem is one of the worst insurers for getting information right. So she was not surprised it happened. But now it is cleared up so we just keep moving ahead. I know this is what I need. Yes, I have my doubts. But I also have my certainties and I understand for certain this is the path I need to be on..

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