Day: June 20, 2007

My Journey Toward A New Life

So, after I got the all clear from my breast surgeon, I waited to hear from my doctors office to let let me know when I should start my pre-op diet and when I would have my surgery.  So, I waited…and waited…and waited.  It was now mid February so I called the doctors office to make sure they got the information from my breast surgeon and you can imagine my shock when they said, yes, we got the information but you are not scheduled for surgery, your insurance company has denied your coverage.  What?? There must be some misunderstanding, I have already been pre-approved, I personally spoke with the insurance company back in November 2006, and your office also got pre-approval!!  I was told to call my insurance to see if I could clear things up, which I figured would be smooth sailing – – -WRONG!!!  I cannot begin to tell you how incompetant, unprofessional, misinformed, argumentative, inconsiderate, uncaring, untruthful and ignorant the people I spoke with were.  I got a different answer, or should I say excuse every time I spoke with someone.  I got the run around every time I called, I was put on hold, hung up on and promised returned phone calls that never came.  Over the next 4 months I was told, they did not have a request from the doctors office, then they said I did not use a referral, then I was declined because I had an HMO, then I was told HMO was okay but the doctor was not participating, then it was the doctor was participating but the hospital he operated was not and then it went back to your policy does not cover this procedure, then they finally said they would approve it once they reviewed the medical necessity so they requested my records from Dr. Dallal.  Whew, I knew once they reviewed my medical files it would be a no brainer especially since my family doctor had been recommending the surgery for years and my surgeon felt I was an excellent candidate for the surgery.  Imagine how I felt when I opened my mail 2 days later to find I was rejected because my BMI was 60.  They stated that there was no evidence that operating on someone my size would be beneficial to  my health.  What??  If I was 1″ taller or 15 pounds lighter it would be okay because my BMI would be 59, but since it was 60, rejected!  I sunk into such a deep depression it worried my friends and family.  I lost all hope and thought God was telling me not to have the surgery.  My doctor called one day to tell me that there was no reason for them to deny me coverage and he recommended Obesity Law, a firm in California that helps people in my situation fight the insurance companies, so I began to check them out.  The manager of employee benefits at my husbands job also called to say that she was requesting an independant consultant to review my case and I should hear something within a few weeks.  As far as I was concerned, I didn’t have a few weeks, I needed an answer now, I needed something to bring me closure one way or the other.  I went to and checked out their site and filled in the request to have them represent me.  It would cost me between $400 and $800 depending on how fast I wanted them to procede and they were fairly sure they could get the denial overturned.  I was literally about to press “enter” on my computer when I got a phone call from the insurance company stating they reversed their decision and my surgery would be scheduled for June 28th and I needed to have pre-admission testing done on June 4th.  WHat???? Was I dreaming, did I hear correctly??  No I was not dreaming and yes I heard right.  They never admitted they were wrong, they simply said they reconsidered their decision and approved my surgery.  WOW!!!!!!  I began to get everything I needed for my 2 week pre-op diet and had it all planned out and then the phone rang again.  It was my doctors office asking if I would like to push up my surgery date – – uh – – yeah!!  So, I’ve been on my pre-op diet for 10 days (short notice) and I followed the plan with only some minor oopsies. Today, the day before my surgery is all clear liquids and I really thought I would not make it, but oddly enough I did.  Lenore, a new buddy from the doctors office told me to stay busy and she was right.  When I kept busy, I forgot about food, except for when my stomach would tell me to put something in it.  I put a few things in an overnight bag and my daughter came over to help shave my legs and paint my toenails; can’t go on the table with funky feet ya know!  So, now I am going to get ready for bed, I have to be on the road by 630am to be in Elkins Park by 730am.  I’m nervous and a bit scared.  I haven’t slept well the past couple of nights but I made up for it by sleeping most of the day.  I’m going to miss my doggie Biskit and my family and my computer and my own bed but God willing I will be home by Friday night.  The next time I post I will give more details about the pre-op diet and I’ll have a true “before” picture.  My goal is to post an update to the picture every month and to list my weight.  Well, gonna go for now, God bless you all and please lift me up in prayer.  ^i^