Jump to content
×
Are you looking for the BariatricPal Store? Go now!

Recommended Posts

Hi Revision buddies!

Just a bit of backstory: I had a lapband placed back in fall of 2007, so almost 12 years ago. Unfortunately, I have always struggled with my band when it had Fluid in it (vomited frequently, inability to eat most Proteins, GERD, could not drink anything that wasn't warm or at minimum room temperature.) My band and I officially "broke up" in 2015. All of the difficulties I had been struggling with had gotten so bad that I had developed acute gastritis, and esophageal spasms due to the GERD and persistent vomiting, which resulted in me having to have all of the fluid removed. While the vomiting every time I ate and esophageal spams stopped, the GERD remained and the last 60 pounds I had managed to keep off after my initial loss, rapidly returned.

So here we are in 2019, through an unfortunate incident my husband had earlier in the year, our deductible and out of pocket maximum have been met for the year. The window of opportunity for me to finally end 12 years of GERD and struggle with this band is finally open. I found a surgeon I really am confident in and have had an EGD to check for Barret's and see what kind of shape my stomach was in. I was lucky in that my hernia had not returned and I didn't have any ulcers, but he did notice that even with no fluid in my band, that it seems tight, I'm not really sure what that means, but it would explain why I still struggle with most proteins. At my last appointment, we reviewed my EGD and he was sending the letter to the insurance company. Because my revision would be due to band complications, my insurance doesn't require the 6 months of dieting, psyh visit, etc, just a letter from the surgeon showing medical necessity for the revision. Since I have a history of GERD, we have decided that RnY is the best option. The paperwork was probably sent in sometime after July 3rd, my appointment was late afternoon on the 2nd and I can't imagine that they would be able to get the letter done and submitted the same day. And now I wait. UGH! It's the worst. I don't have any idea how long it should take. I've read the boards and for some people, it's taken as little as a single day for approval. and some waited for weeks only to be denied. It's maddening!!

Thanks for the vent!

TX2NC

Share this post


Link to post
Share on other sites
Have you considered calling your insurance company to ask the status? That would be perfectly acceptable to do and you may at least be able to find out how long it should take.

Share this post


Link to post
Share on other sites

We have met our deductibles for the year as well. I wasn't planning on getting surgery but when they told me I could fix my issues with a revision I am all for it. The waiting is impossible! Good luck to you!!

Share this post


Link to post
Share on other sites

Totally check in with the insurance company and the patient coordinator/office manager at the Surgeon's office too.

My insurance approved it in 2 days but i got the notice in the mail a long while after.

Share this post


Link to post
Share on other sites

Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? 😠

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Share this post


Link to post
Share on other sites
Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? [emoji34]

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Yep, I understand the waiting part plus a fighting component! I am on the first day of the fifth round for this revision. I might have to go through abratration in away.

The hardest part? Why do I have insurance if it doesn't pay for what is necessary?

It should be "optional" for me to have a higher quality of life? I don't think so!

Sent from my SAMSUNG-SM-G935A using BariatricPal mobile app

Share this post


Link to post
Share on other sites
On 7/25/2019 at 12:37 PM, TX2NC said:

Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? 😠

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Sorry 💜

This is not meant to be a part of the journey.

It is not too much to ask that the job is done correctly and efficiently. Stay on top of everyone in every step of the process since you now know they are making mistakes. Don't let anyone's error cost you extra time

Good Luck 💜

Share this post


Link to post
Share on other sites
You’re right SeattleLady! It’s amazing to me that insurance companies basically bet that we’ll give up. That we won’t continue to fight for our health. I think that’s why I get so peeved when they try to push their “healthy lifestyle alternatives,” plans. They don’t care if we’re healthy, they just want us to pay our premiums and not file claims!
Thanks GreenTealael! I have tendencies to have very high expectations of my self regarding follow through. I can be a little hard line with it. Because I can be so stringent with myself, I somehow manage to convince myself that my expectations are probably too high when it comes to others. But you’re absolutely right. I feel like the lack of follow through has wasted the whole month of July.

It’s been a week since she called me to get the phone number. I haven’t heard anything, but again I’m worried about calling because in theory they are waiting in the insurance company. Maybe I’ll call the insurance company to make sure they’ve received the prior authorization request.

Ahhh! It’s also that whole thing of not wanting to bother people if I’m honest. It’s hard to explain. It’s like as a plus size woman, it’s been sort of constantly in my face that my size is a bother to everyone, airplanes, small office chairs, attribution of every medical problem I’ve had for 25 years being because of my weight, even if it’s completely not related. Almost like because I’m big, I should just stay happy and not raise a fuss because everyone is already being accommodating about my size. Fortunately, I have a therapist to help me work on reprogramming myself and learning to find my healthy voice.

In the meantime though, I can at least make a phone call.

I know this will all be worth it!

Share this post


Link to post
Share on other sites

I completely agree with GreenTealael, I have had to call my surgeons office several times. Every time I do, things are suddenly farther along. Sometimes I feel like a pest, but I am betting if I didn't call them I might not even get my surgery this year.

Share this post


Link to post
Share on other sites
So I just got off the phone with Anthem. They did receive the prior-authorization request on 7/25 and they have something like 14 days to review. So it looks like they have until about 8/13 to decide.
But at least I know where I am in the process.

Share this post


Link to post
Share on other sites

Approved! I go in next Thursday to get my official pre/post diet instructions and schedule surgery. We are aiming for the 1st week of September if we can't squeeze me in the last week of August. My DH is going with me to the appointment since he'll be the one helping me post-op. He's excellent at being a caregiver, so I'm not terribly worried on that end. So here we go.😁

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

  • Recent Topics

  • Most popular:

  • Recent Status Updates

    • veisor  »  Panda333

      Hi!
      Thank you for replying.   It means the world to me.  It also confirmed what I been feeling about which procedure to choose.   I fall into the category as you do and elected the sleeve as it seemed to be less invasive and recovery would be better and faster,  however I am so afraid to regain the weight back since I rarely eat and obesity runs in my family.   I have two siblings that had the bypass and they have been successful.  My sister was in the high 400's and is about 140 now and has been for several years since her procedure.  I guess I felt that the sleeve would allow me to have more control, however I realized that I can't control my genetics and that is one of the biggest reasons that I am here.  Yes, I have not always made the best choices but trust me when I say that I have been on the loss and regain + more rollercoaster weight ride for yrs! I have spent so much money as I am sure you have as well as many others who are going through this.  It is not easy and anyone who thinks this is a copout is crazy!!! This has been harder than anything I have done including hiring a personal trainer to kick my butt in the gym! And still with all the gym hours, clean eating "not to mention the clean eating cost" I knew it was time that I moved to the next step to finally be who I know in my head and heart cause when I see myself in the mirror,  well let's just say is not the girl I see in my mind. 
      So thanks again for your reply and I hope that we can keep in touch through our journey. 
      😊
      · 0 replies
      1. This update has no replies.
    • AggiG

      · 0 replies
      1. This update has no replies.
    • Pookeyism

      I'm going in for a sleeve revision October 4th. It worked well for me, and I am not back to my starting weight. However, a revision is strongly encouraged at this time (there are additional medical issues). I have decided to forgo the insurance process, even though I know I would eventually be approved. "Eventually" is the key issue here. I have a small window to create this to where it will not impact my work or home life as much, and waiting for the insurance approval would take over a year.
      · 0 replies
      1. This update has no replies.
    • ms.sss

      I just read @BoredCW's status post and also want to lament the loss of my butt.  Looking at me the side, my back is basically flat from my neck to my knees.  My jeans have lovely fabric folds draping from my backside from lack of filling.
      Two days ago, I was sitting on a worn couch at the gym and I could feel the springs and count how many I was sitting on.  Told the Kid and she said she wants to find her childhood alphabet fridge magnets in the basement to spell out words and have me sit on them and do some "butt-braille-reading" 😂
      · 5 replies
      1. FluffyChix

        HI-LAR-ious! I love your kid!!!

        Yeah, we all suffer from noassatall syndrome. :(

      2. 2Bsmaller18

        Yes. I think the spandex in jeans is the only thing that helps keep the sag below the pockets form looking ridiculous. Even leggings wrinkle there.

      3. ms.sss

        Ah, our disappearing collective butts.

        I am seriously considering changing my plastics plan. I am booked for an arm lift in December, but my summer obsession with arm exercises has improved the look of them quite a bit to the point that I think I may hate my butt more than my arms. Should I do a butt lift instead?!?! In conjunction with?!?!?

        I am trying to cultivate an obsession with butt exercises but its not working so far...

      4. 2Bsmaller18

        I don't think you could do both at the same time. For me personally it's arms. I have granny wrinkles down to my elbows. I can always dover my body with tshirts, pants, etc but unless I wear long sleeves my arms are an issue. I also can't wear a small enough jacket since it fits everywhere but too tight in the arms. They measure around 13.5 inches. Can you compromise and get the smaller arm lift. I don't know if that saves much $ or recovery but if your arms improved that much maybe just a tweek will work?

      5. ms.sss

        The difference in price for a mini arm lift and the full arm lift at my surgeon is less thank 2K and probably not worth the savings. May as well pay the extra bit and get the full arm lift as my sag also reaches my elbows. You are right though, my arms see the light of day way more than my butt does...I'll have to see if the continued butt exercises will change my mind down the road (but it's looking more and more that a butt lift is in my future)

        P.S. At the beginning of my 2 week pre-op diet, my upper right arm measured 17.75 inches in circumference. Now its 10. And that is with the extra skin still.

    • BoredCW

      On the 3 week plateau from hell.. It seems like an endless desert with sand dunes that represent the 1-2 pounds gain then dropped from day to day. Met with my weight loss group tonight and was told its normal. That this is sometimes like a step, plateau then drop, plateau then drop. Only for the plateau's to go on longer the farther away from the surgery date I get. Much like EDM, I can't wait for the drop. 
      On top of it all, I lost my ass. Seriously.. its gone. All that cushion that I enjoyed lounging on eating what ever I ate, watching what ever was on the computer or tv... is gone. That glorious support system is vamoosed. I know this because my ass (tailbone) hurts all the time. I'm sitting on bone now and its sore. I am my own literal Pain in the Ass! (My family would say whats new, but who cares about them.. my butt hurts.) I have yet to bring a pillow with me everywhere I go to sit on, but I'm getting ready to as I sit for my job working on computers. So far losing the weight is a Pain. I hope it gets better. 
      · 2 replies
      1. ms.sss

        Hang in there, the plateau will end eventually. Also I feel you on the butt thing.

      2. FluffyChix

        I have a butt pillow. I'm not proud. :D

        The plateaus suck!!!! Keep the faith and motor on!

  • Trending Topics

  • Together, we have lost...
      lbs
    ×