Surgery June 25, 2013
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Now that I am "approved" for surgery and this is becoming a reality, I figured NOW is the time to post my story so far.
I am 49, 5'7 and 235 at my highest weight. (Can't believe I actually wrote that down for public consumption!) That made me a BMI of 36.8.
I had considered weight loss surgery off and on throughout the years of yo-yo dieting. My last good weight loss was about 30 pounds back in 2009 and I was lighter then. So that means I have put on about 40 pounds in four years. (Less than a pound a month, not too bad, right??!! Ha!)
I have some lung problems, high blood pressure (if you would only lose weight, you wouldn't have to take these pills anymore....) and hypothyroidism. Too much for someone my age I decided and started considering the lap-band. I am a nurse and considered that to be "least invasive" and "easiest" to have done surgically.
On November 28, 2012, I signed the hubby and I up for an informational seminar. While hubby wasn't interested (I'm hoping to change that), I listened to the doctor present the band, sleeve and RNY options. To his credit, he didn't try to sway anyone to any one procedure, but I had changed my thinking from lap-band to sleeve. I submitted my "insurance verification" form and left.
In lateDecember/early January, I was contacted by the doctor's office and told that my insurance (CIGNA) did provide WLS benefits. I had started a post-holiday "kind of" diet about mid-January with Weight Watchers. I saw my surgeon for the first time on January 28, 2013. We discussed all the usual things and agreed that the sleeve was a good procedure for me.
My only beef with the process was that the coordinator told me "All your insurance needs is the evaluation and 3 months of diet history. Just print out Weight Watchers and it will be ok." More on that in a minute....
From there, I had:
EGD (endoscopy) on 2-4 and found to have a small hiatal hernia.
Psych eval and nutrition eval on 2-13.
In the mean time, I had researched CIGNA's bariatric policy and found out that I needed a lot more than "Just 3 months of Weight Watcher history." Rather than chance it, I went and got clearance from my PMD and met with a nutritionist for 3 months of a supervised diet. (2-20, 3-16 and 4-20...boy am I glad I started that "kind of diet" back in January!) Am now at 222 (fluctuating pounds.)
My coordinator submitted my packet on about May 10th with a comment of "everything looks great...should be no problem."
On May 17th, I was notified of denial...based on two points. My physician had failed to state that he BOTH recommended me for the surgery AND cleared me (he only recommended me....despite the fact I had asked him to do both.) The nutritionist did a summary report that detailed all three visits, with all of the components required, but CIGNA wanted it in three separate notes. At least it wasnt because of medical criteria!
So...my coordinator got all that together and on May 21st, she submitted again, stating it could take up to 90 days, but probably not that long. The waiting is the hardest part!!!
Well, today I got the news I was waiting for...APPROVED! It took 7 business days for the appeal.
Now we are in fast-forward mode:
6-10: Pre-op meeting with surgeon to sign consents, etc...
6-15: Start of pre-op diet! (Not looking forward to it....)
6-17: Pre-op lab/x-ray work at hospital
6-25: Surgery
I travel for my work (I am a healthcare consultant) and will be out of town three weeks between now and then, so it will fly by! I am so excited. I think now that it's a reality, my husband is concerned. I got the "If it makes you happy, it makes me happy" but I am not convinced. I know he is supportive of my decisions, but probably a bit insecure at the same time. food has always been a big part of our life and I have been slowly withdrawing from that over the last few months.
Thanks for listening! I am so darn excited I just needed to share it with someone. I have told very few people.
I will update after the surgery.