Yesterday morning I went over to my OLD doctor’s office and picked up my medical forms.  I sat in the car and looked through the documents and found exactly what I was hoping for!  There was plenty of documentation on my obesity along with weight loss attempts and my depression issues, and even my acid reflux.  I haven’t been on medication for the depression or acid reflux for a couple years now, but this shows that I’ve had these issues and have been treated for it over the past ten years!

After leaving that doctor’s office I drove over to my current doctor’s office to pick up my lab order and some more medical records.  I needed a coy of the sleep study that I had done in March along with some of the notes that were forwarded to him from my OBGYN’s office.  I got everything that I needed and the sleep study states that I DO have sleep apnea and the OBGYN’s notes document high blood pressure along with my attempts at weight loss (South Beach Diet) with very little success, the metformin (meds for Type II Diabetes) and other items.

I also have my psychiatric evaluation on Monday morning…so I should be pretty prepared by next Wednesday when I have my surgical consultation.  I’ve copied all of the necessary documents and am feeling a bit better about my situation with this documentation.  According to what criteria has been set before me to meet on this by the insurance company, I now feel that I have MORE than enough documentation to show that I not only meet that criteria but surpass it.

Well, after having my blood drawn for tons of tests required by the surgeon, I went home to change my clothes and get Jason so that we could go see:

 It was AMAZING!!  We had a wonderful time.  This was my Mother’s Day gift from my wonderful hubby and I thank him very much because I loved it!  We aslo had dinner at an old haunt…well, we haven’t been there in a couple of years and the last time we were there was when we went with Daffo and Jen. Ahh…good times!

Anyway, it was nice to get lost in a story other than the one I’ve been living lately. 

Thanks hun…I needed that!

This weekend we’re taking the boys to a Rockies game…and tonight Jason and I are double dating with our daughter and her boyfriend (a bit strange I must say) and going to see An American Haunting (about the Bell Witch).  Should be fun!

Have a great weekend everyone!

I don’t have much time but I wanted to let you all know that I got my psych consult scheduled for Monday morning at 11am!! A really nice doctor was able to get me in quickly AND he’s covered by my insurance! YAY!!

Also, I was able to schedule my pulmonary consult for 2 weeks from today on the 17th…so things are coming together now.

I have to go get my car from the dealership…and pay $340 to do so.  Oh well, at least it’s fixed…’cuz it’s raining here and not having a window in the door would bring a whole new meaning to the word soaked!

Okay…gotta go…ttys!

So I spent yesterday morning calling every doctor that I’ve seen in the past 10 years asking for a copy of my medical records.  Some were more accommodating than others.

Anyway, I had to have some of the records sent to my PCP’s office because the other offices weren’t willing to send the records directly to me without charging a fee…but they were willing to mail it to my doctor’s office as a “professional courtesy”.  Whatever!  I just called my PCP’s office and told them what was going on and they said that they’d call me once the records arrived there.  I have a wonderful doctor!

This morning I spent calling physicians to set up appointments for the “consults” that are required for this surgery.  The surgeon highly recommends having these consults done prior to the initial consult with him.  He says that it speeds up the process.  Well I’m all for speeding things up!

I was able to schedule the pulmonary consult pretty much with no problem and with a doctor covered by my insurance.  However, I can’t get in until May 17th…a week after my surgical consult.  Oh well…so much for getting it done beforehand.  I’m just glad that I didn’t have to wait until June to get in.

I tried calling the psychiatrists on the list he gave us…but the only one I was able to get a hold of doesn’t take insurance at all and demands payment up front…for a consult it is $250!  Well..needless to say I called a different office.  Most of the other doctors on that list were out of town on vacation and were “now scheduling 4 to 5 weeks” in advance…umm…no.

So finally, after going through the list provided to me, I decided to look up a list from my insurance website.  I found one not far from my house and called.  I asked if he has ever given a consult on a bariatric patient before…and the lady didn’t know.  She said that she would talk to him and get back to me today.  So I’m waiting…

THEN…while I was out grabbing some lunch, I went to roll up my driver’s side window…and it fell into my door!!  It figures doesn’t it?  I mean, my warranty on my car just ran out.   Anyway, I now have to go drop it off to get it fixed…which I won’t know how much it will be until they’ve charged me $90 to take off my door panel and look to see what caused it.  I know what caused it…it came off track.  But what do I know…I’m a girl right?  Yeah…well I’ve only worked on cars for over 15 yrs with my dad who was a mechanic…but like I said…what do I know.

Thanks for all of the support btw…I DO appreciate it and I wanted to do what many of you suggested…but it’s just not worth it right now.  I’m focused on one thing at the moment…getting in for this surgery as soon as possible!

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.