happy1957

Maine Native

My journey began in February of 2011. It has been an up hill climb and emotional roller coaster since day one. The first snafu was my primary care office who had not followed through and forwarded my records to the bariactric center as I had requested. After three requests that was resolved in March, as most of you have experienced I had all the hurdles of the insurance company and bariactric center requirements to meet, dietician visits, nutritionist visits, egd, physical therapy and psychiatric evaluation along with some weight loss and exercise requirements. Many trips to the bariactric site which were 120 miles round trip. Finally all requirements were sent in and my paperwork was sent in for approval.

Unlike many people here my answer did not come back in a couple days, it was nearly three weeks, and WHAM!!! Insurance denial for a low BMI in 2009 due to a period of diet and weight loss. This was yet another failed attempt to do this on my own. I was devastated, as my sister and I had started this together and she was approved and forged ahead. I was never upset with her journey and success, but disappointed in my inability to continue.

My Dr immediately appealed and we waited the 30 days in hopes the insurance company would overturn their decision and 37 days later we received yet another painful answer, unfortunately they stuck to their decision.

I was depressed, discouraged and actually just wanted to throw in the towel, but since I am doing this to better my health, to rid myself of prescription drugs and hopefully have a healthier future without the high cost of medical expenses when I retire one day, I decided to use my last appeal available and wrote a letter on my behalf and asked the Dr to write another. We resubmitted it and on Tuesday the 13th I had a level II appeal scheduled at 4:00. Unfortunately my Dr was in surgery and I was left alone to join in on this via telephone conference all by my lil ole self. I was scared and somewhat intimidated and the only information I had to offer about that low BMI was the truth. I have never kept records for past diets because I've never thought I had to prove to anyone. This one time I had documented my weight and eating habits on an on line site and was able to print out the weight chart, although the food listing had disappeared. I'm proud I even remembered my password, my memory isn't what it used to be. :-) I had also submitted that with my letter.

When going into the phone conference, I felt like I was on trial, but it was not meant to be that way. Everyone was introduced , there was a Dr, two nurses and narrator and myself. They just asked why I thought I should have them change their minds. I began my story, told the truth as that was all I had to offer. The Dr asked a few questions, then the asked if I had any and I was told that they would continue their discussion after I hung up and a decision would be made by majority vote that day. I would hear in a few days.

I called them yesterday, was on hold forever, the lady finally came back on the phone and in a sober tone told me that "we have decided to overturn the original decision and you are approved as of Dec 14th." I think she was trying to sort of surprise me. APPROVED???????????????????????? I can not tell you the feeling. I immediately sobbed.

It is the best Christmas present ever. I immediately called the Bariactric center who said if I got approved this year, would squeeze me in this year and my surgery is scheduled for the 28th of Dec.

So, NEVER, EVER give up... your life is worth saving..