Well I just spoke with my insurance company and was told that my file was in “medical review staffing” and to call back later today for a status update. A few moments later Jason told me that someone from Wausau had called the house looking for me and that he gave her my cell phone number. However no one had called my cell…so I called them back. I was then told that the surgery was listed as an “exclusion” on my insurance.

Well yeah, this is why my doctor sent in all of the documentation that he had and a letter of recommendation. She then told me that they could not approve it at this time because it was listed as an “exclusion”. I asked what I should do and she told me that I would need to contact my HR Dept. (of our parent company) and talk to them about this, that HR would be the only ones to change this because they are the ones who put it in the policy to begin with.

Okay…so I call HR and am told that it is true that this is an “exclusion” and that it must be “medically necessary” for someone to have this surgery. I said that I already knew that and that I have spoken with the insurance many times regarding this and that I even had a list of the criteria that must be met in order for it to be deemed as medically necessary faxed to me and gave it to my doctor in which he included with the letter of recommendation and notes that he sent to the insurance. I also told her that I meet that criteria and she told me…

“oh c’mon now Maria, you’re not morbidly obese and you’d have to be in order to meet criteria”

Oh yes…she did. I was FLOORED! I went on to state to her that,

“no…I’m not morbidly obese…I’m SUPER MORBIDLY OBESE and have a BMI over 50″

…but she interrupted me and went on and on about what is “classified as medical necessity”. I told her that I’ve been researching this for over 2 years now and have been conversing with the insurance on it for over 1 1/2 years and that I’m well aware of the criteria that must be met in order to qualify for this surgery…but she went on anyway. She then interrupted me and said, “Maria, are you going to let me finish or are you just going to keep talking?”

What I wanted to say was, “who in the f*** are you to tell me what I AM or am NOT??  Have you seen my medical history? Do you know what I currently have or even what a BMI is??”  I’m telling you that STUPIDITY SHOULD BE PAINFUL people!!!

I finally told her that I would just let the surgeon’s office fight it out with the insurance and that I’m done with this conversation. She said that she would “check on it” with the insurance and get back to me…I told her there’s no need for her to get involved after what she just stated.

Yeah…I pay for insurance and my own company is fighting me on this. This is completely ridiculous!

UPDATE!!

I just got off the phone with my insurance again (they called me this time).  They apologized…apparently I was “misinformed”.  Ya think??  They assured me that they “have not dropped the ball on this” and that “the surgery IS covered” under my insurance and that they will personally “review my case” and will contact me if “any further documentation is required”.  I thanked them for calling me and correcting the situation…but OMG!

Why must people torture me?  Like I need more stress!

At least I know that it’s not over yet.

Okay…so Jason and I are watching the Avalanche v Stars (round one) playoff game the other night and the Avs were just kicking ass the first period…and then the Stars came back the second period were up by one goal by the third period.  So we’re watching, hoping that the Avs pull one out, and around 17:35 into the third period…this comes onto our television screen…

…this is Kurt Sauer…

 what the hell was he possibly thinking??

Jason and I were laughing hysterically at this for several minutes…mainly because I kept on rewinding it and playing it OVER & OVER again!!!  I couldn’t help myself…

The commentators didn’t even acknowledge the fact that he was making these faces…they just acted as if this was normal and kept on with their conversation!

Jason turned to me and said, “this is just proof that hockey scrambles your brains”!!!

Jason, my mom and I went to the seminar last night for the “in network” surgeon (Dr. Snyder).  It was very informative and I’m glad that mom and Jason were able to attend it with me.  It was nice not to have to go to that by myself.  It was hard enough for me to attend the first seminar last Fall all alone…I’m just glad that I didn’t have to again.

Dr. Snyder is a very charismatic person and is extremely knowledgeable, which is VERY comforting to me.  His staff seemed very nice and eager to help people.  I called his office this morning and was able to schedule a consultation for May 10th!!  Only 2 1/2 weeks away! I was quite surprised and a bit relieved.

He stated last night that they usually schedule consultations within 3-4 weeks of inquiry…but I was able to get in faster than that.  He also told us that they normally schedule surgery 2-3 weeks after the consultation!  That’s a bit exciting! I’m hoping that it will be the case with me as well.  I’m SO ready to start this life over again as a happy healthy person. I’m tired of dealing with not being able to function and do what I want to do…especially with my family.  I hate that I’m not able to go to Six Flags with the kids because I can’t ride the rides…or go roller blading because it hurts my joints something horrible, or even ride a bike.  It sucks let me tell you….it SUCKS!

While listening to Dr. Snyder talk last night about how obesity effects a person’s life…it took almost everything I had not to break down and cry.  It hit home…HARD!  I’ve been this way SO long…I don’t remember ever NOT being this way.  I’m not going to know how to react to being “normal”…but I’m sure looking forward to the adjustment! 

Jason looked at me last night, while we were lying in bed, and asked “Are you scared?”.  I told him “no…not of the surgery…I’m scared of what would happen without having the surgery”.  I know this is the best option for me…of that I have doubt.

Anyway…that’s what’s new for now.  I’ll be around to visit you all soon!

PS ~ check this website out! It’s a movie about two people with Aperger’s Syndrome (starring Josh Hartnett)…it’s a romantic comedy coming out soon!

…to help spread the word about Autism Awareness!!

http://www.magnetamerica.com/

I would’ve posted yesterday but I was busy doing all of the cooking and such and well…my hubby was hogging the computer!  Anyway, I hope that you all had a

We had all of our kiddos home this weekend for Easter and had a blast!!  The kids and I baked cookies all day Saturday and then yesterday morning I set out their Easter baskets and Jason and hid the eggs in the front yard for them to have their egg hunt.  It was fun and they enjoyed themselves immensely!

After they were done with their egg hunt we all headed into the house for BIG breakfast of cheese, eggs and sausage, fresh fruit, croissants & bagels with cream cheese and orange juice.   It was good!

The kiddos went and played games for a bit after breakfast while consuming the candy from their Easter baskets.  They were some hyper kids throughout the day!!  So what did I do…I put out the cookies that we baked on Saturday so they could be pumped with more sugar! Yeah, I’m a glutten for punishment I guess.  

We played several games throughout the day including a couple of games of chess.  It was fun to hang out with the kids and have a good time as opposed to me asking them every night “do you have you homework done yet?”.  We had a late dinner but it was oh-so yummy!  I made homemade chicken parmesiana with fresh green beans with parmesian and walnuts, and a fruit salad for dessert.  The kids were pretty tired after that and went to bed without much fuss at all.

Good times though…good times.  I hope that you all had a wonderful Easter weekend as well!

Of course, today has been a completely different story all together. About an hour after I arrived to the office the electricity went out due to some idiot who was putting in a fence on the property severing the electrical lines with a backhoe…oy!  So we spent the next 4 hours without any power, which meant that we all sat around doing a whole bunch of NOTHING!! Did anyone offer to send us home you ask?  Umm…NO.  

Finally I just decided to call a friend and go to lunch.  At least that way I was doing something!

We finally got power back around 1:15pm or so…yeah, most of the day has been shot to hell.  Oh well, at least I’m getting paid right?

After reading through my subscriptions and coming across this idea on a friend’s blog…I thought it was a good idea to show Caleb Over the Years as a tribute to Autism Awareness Month as well!!

March 5, 2006 – 7th B-day

 

Study Denouncing Autism Epidemic Misses the Mark
ASA Calls for Studies Benefiting Families Now

On another note…

I visited my doctor yesterday and when I got to the office my blood pressure was 142/87!  He was NOT happy about this and honestly, neither was I.  I also was diagnosed with unrinary stress incontinence yesterday…just another co-morbidity to add to my list, but since this symptom is commonly associated with diabetes I am again being tested for that.  I typed up a request for pre-approval letter to my insurance today and after four pages of listings, I realized that on paper my conditions look even worse.   Anyway, if anything the more conditions listed will only just prove my case to the insurance and should help with getting approval.

Hey…I’m trying to look on the brighter side.  I have to go back to visit the doctor in two weeks to check on my blood pressure and follow up on the urine analysis that he did for diabetes.

Well…since I last posted about the WLS (weight loss surgery) I’ve contacted the surgeon’s office of which I was originally going to have do the surgery.  At the time that I attended the seminar put on by this surgeon last Fall he was “in network” for my insurance.  However, since that time he is now listed as “out of network”.

Why does everything have to be SO damn complicated??

Anyway, I didn’t find this out until I finally talked to someone from his office to schedule my consultation.  I went ahead and scheduled the consultation just in case I’m not able to get in with another surgeon who is “in network” beforehand.  My insurance covers 70% for “out of network” surgeons and I would have to pay the $500 deductible and possibly at least $1000 beyond that in charges.  Not too bad…but if I can get this done by an “in network” surgeon it would be covered 100%.

So I tried contacting the “in network” surgeon’s office and again got someone’s voicemail telling me that they would get back to me within 24 hours.  Well a person DID contact me the very next day and informed me that I couldn’t just schedule a consultation with this surgeon without attending HIS seminar.  I explained that I had already attended the seminar put on by his affiliate and she said that it wasn’t good enough, that I MUST attend HIS seminar in order to be registered to setup a consultation.  My heart sunk right then and there.  Usually these seminars are scheduled like every 3 months or so and I saw the schedule posted on the website and the next one listed was in July.

But I asked her anyway to go ahead and schedule me for the next seminar.  To my surprise she informed me that it’s next Thursday!  I asked her to repeat that…and again she tells me that it’s next Thursday at Rose Medical Center.  I told her what the website stated and that I was very concerned that I was going to have to wait a couple more months but was very happy to hear that the schedule listed was incorrect.  She said that they had a cancellation and that she could get me registered for that seminar.  So I did just that and now Jason and I are going to attend this seminar next Thursday.

I realize that not all surgeon’s do these procedures the exact same way and have different requirements and all, but good grief!!  On the other hand, I’m glad that Jason will be able to have the opportunity to join me for this seminar considering he wasn’t able to attend the last one.  I think it may help him fully understand exactly why I’m making this decision and what is going to happen and how.  My mom also mentioned that she would like to attend and that’s fine also.  I think this may be very informative for them both.

I just wish that this wasn’t such a mundane task and at the same time I understand that this is a life changing decision and that it’s definitely not something that anyone should take lightly but why do they have to make it so damn difficult to get it done once a doctor has recommended it and a patient has made the decision that it’s best for them?  It’s just…frustrating.

Anyway…enough bitching.

Thank you all for your comments and support and prayers and thoughts.  I appreciate it all SO very much.

**sorry that these didn’t show up yesterday…I’ve resubmitted the pics so hopefully you can see them now**

Okay…as I had promised here’s the pics that we took while in Vegas over St. Patty’s Day weekend!

We went to Madame Tussaud’s Wax Museum…

Jason w/ JLo…a sign beside her said “touch JLo’s most famous asset and make her blush”…so he did!

My favorite…I have TONS of pics of The Rock!!

Jason playing poker w/ Ben Affleck

Make it so…

Jason playing w/ the Blue Man Group

Anyone want to marry George Clooney?

Jason playing ball w/ Shaq

Jason flirting w/ Beyoncè

me hanging out on the American Idol set

Billy Idol doing his thing

even Frankenstein’s monter was there…

of course…Marilyn Monroe

and Judy Garland…

it wouldn’t be Vegas w/o the King!

Jason hanging out w/ the good old boys…

Princess Diana display…very touching

Jason w/ “dubya”

There are a ton more pics…but I don’t want to make this post SO big that it would take forever to load.  Anyway, I think that you get the idea!  It was a LOT of fun!!

Well…the letter of recommendation from my doctor was mailed today to my insurance.  So now I wait…wait to be approved…wait for denial…wait for someone else to make a decision that will affect the rest of my life.  I hate depending upon other people to decide my fate…but what choice do I have?

I called the surgeon’s office to schedule my consultation this morning but instead of speaking to a person I got voicemail.  I left a message with my information on it and why I was calling but the voicemail stated that it could be 48 hrs or more until they call me back.  OY!

Can you tell I’m not a very patient woman? Not when it comes to me anyway.  I’m much more patient with my children and others than I am with myself.

It was mentioned in my last post’s comments that I need to make sure that I’m well informed about the wls and how it will effect the rest of my life before making this decision.  I must let you all know that I’ve been researching this for the past 2 yrs now and that I’ve attended a seminar on it and have talked to several people who’ve had the surgery before I even decided that this is what I wanted to do.  I’m well aware of the drastic changes that this surgery will have on every aspect of my life and have met with doctors and dieticians regarding it all as well.

After my consultation with the surgeon (whenever that will be ) I will have to attend a nutritional class put on by an office appointed dietician informing me of exactly what the diet limitations will be after surgery and for the rest of my life.  I’m already aware of most of the limitations after being given the information from the surgeon’s office when I attended the seminar put on by him back in Sept. of 2005.  However, this is a required item by the surgeon’s office and also by the insurance company and I’m sure it will be helpful and very informative. 

I will also have to undergo a psych evaluation to make sure that I’m mentally stable enough to handle this life changing surgery.  I’m sure that this will be no problem.  I think that I’m quite stable mentally, it’s my emotions that I need to work on!  My doctor even wrote in his letter of recommendation that I’m an “intelligent and motivated” person.   Thanks doc!  (he gets paid to say this stuff…j/k)

I just want you all to know that this decision is definitely something that I have not taken lightly at ALL.  I’ve researched, ask questions, attended seminars, spoken with doctors, dieticians and insurance, and have talked to many people who’ve had the surgery themselves before coming to the decision that this is the best thing for me.  My doctor feels that it is and to be honest…I don’t feel as if I have any other options at this point.  I’ve done everything else that I could possibly do in order to lose the weight and live a healthy life.  However, my metabolism is not normal and my body chemistry is warped.   My body does not react the way it should to reduction in calories and exercise or the weight loss drugs the way that it should…in fact it reacts the opposite of how it should.  When put into ketosis my body goes into starvation mode instead of cleansing like it should.  Ketosis should force your body to expel toxins and drop weight more easily considering it’s a very low calorie diet and consists of very low carb intake. 

I have a severe metabolic disorder and it is genetic.  It’s not because of anything that I’ve done in my life or how I’ve lived my life or my diet.  I’ve been obese since I was 5 yrs old and am a pretty active person even today considering that I’m over 300 lbs.  People who reach the weight that I’m at and above are considered to be “Super Morbidly Obese” which means that the BMI is over 50 and mine is currently 54.6. 

Here is the BMI breakdown:

Range	Meaning
less than 18.5	Underweight
18.5 – 24.9	Normal
25.0 – 29.9	Overweight
30.0 – 39.9	Obese
40.0 – 50	Morbidly Obese
over 50	Super Morbidly Obese

Basically this is saying that if something isn’t done soon that I will die.  I have not been able to maintain or lose weight (significantly) in the last year and my weight has been consistently increasing for last 10 yrs.  Being that I’m only 30 yrs old and that at the age of 19 I was told by my cardiologist that I wouldn’t live to see 30 because of the strain that my weight has put on my heart and that I’m high risk for a coronary…isn’t exactly good odds if you ask me.

I’ve made the decision to have this surgery so that I can live.  I do feel this is my last resort and without this surgery I do not think that I will live many more years.  I know my body and my medical history and my family’s medical history and all of this states that I will not survive long without a drastic change.

So now…we wait and see.