That new beginning...now, just days away!

Well, here it is. There's no turning back now ( I could, but I won't---LOL). Wednesday, January 19, 2011 is the day I reclaim my health. My GOOD health. I begin the journey of a "new" life after bariatric surgery and capturing a quality of life that I could and should have had all along. This so-called "weight loss surgery" is not about cosmetics. It's not about vanity. It's about life. It's about a more reasonable portion of good health. It's about living without Diabetes and other co-morbidities.


I want to advise, that if you are considering gastric bypass or lap-band surgery---be mindful of the business side of the medical procedure. Attending a seminar or two is just the first step. Contact your insurance company. Find out about what they pay; how much they pay; what is your payment responsibility (deductible, out of pocket expenses). Above all, understand that the surgeon's office maybe separate from the hospital where the procedure is being performed. 　


I have learned so much over the past few weeks. Especially about the money side of the surgery. At my surgeon's seminar, we were told that we could, make payment arrangements with the hospital if we needed. However, after my pre-op testing, I was ushered to the hospital's financial services office. The counselor went over my surgery, insurance and all those numbers. But then, went on to ask me for my ENTIRE maximum out of pocket expenses allowed under my health insurance plan--$1,750.00.Needless to say, that request was a shock. 　


And of course, I strongly disagreed. This set off a trip back to the surgeon's office, a call to the insurance company, and the surgeon's office staff trying to intervene. The insurance company couldn't understand why the hospital was asking for the entire $1750 when they don't know what the actual out of pocket expenses would be. Anyway, the hospital came down to $1312---a 25% discount.


More phone calls, and meetings were held. In the end, the surgeon's office struck a deal with the hospital's business office allowing me to pay half of the $1750, and make payment arrangements on the balance. What about the $1312? That was only if I was going to pay that in full.

Anyway, we made the deal and all systems are GO! Now --back to the pre-op diet ( the cream of chicken soup tastes like flavored liquid chalk! LOL)


Love, peace and Protein (no more chicken grease! :o)

It's On! A final answer with a date (on the same day!)

Well, after three weeks of wrangling with my former primary care physician over a medical record the insurance company was demanding...I have finally been approved for bariatric (weight loss) surgery! Also, on the same day---a date has been set! YAAAAY!

The insurance had all of my medical records---or so I thought. They didn't have a medical record for me from 2008. I was under the impression that when I requested copies of my entire record from my former doctor. Turns ot, I was wrong. I'm telling you, there was a great deal of wrangling with the doctor's staff over this one record.  It slowed down the entire approval process I actually received a letter from the the insuranc company saying I had been denied for bariatric surgery. Part of the reason? Because they didn't have that one record from 2008. Tuesday, I received a called from the surgeon's office saying the insurance company called and had reversed the denial. Ain't God good?!?

My surgery is in mid-January. Hallelujah! Again, never be afraid to advocate for yourself!

To be or not to be...approved for weight loss surgery. Toiling with the Health Insurance puzzle

Paraphrasing former U.S. Secretary of  Defense Donald Rumsfeld, "there are known unknowns that we know about" when it comes to securing approval for bariatric surgery. It's those unknown surprises that get 'cha. Health insurance companies have so many hurdles for persons seeking "weight loss surgery" to jump over.  Some may require a 7 month, doctor supervised, diet and exercise plan, or scaled down 3-4 month version with the candidate being part of a weight loss program (ex., like the national groups that singer Jennifer Hudson reps now), a body mass index of at least 35 with two co-morbidities such as type 2 diabetes, high blood pressure, and proof of a prolonged history of obesity with negative results of anti-obesity treatments.

That is where I find myself now. Stuck in the red tape hassle. Before one embarks on the bariatric surgery journey, there is homework to do. First, you must decide how you will pay for your surgery. Whether your (private) insurance will pay for the surgery and of course, how much the insurance will pay. My insurance company will pay 90% of the surgery, leaving the remaining 10% and whatever is left of my deductible to pay.  If you are without health insurance and it's deemed medically necessary for you to have the bariatric surgery, the self- pay option is available. Check with the hospital and surgeon's office about payment arrangements. 

Also, there are some instances I've heard about in which the surgeon is able to get insurance companies to sidestep the rigorous rules of weight loss surgery because of the candidate has a BMI of 47 or over, or the candidate has other dire medical needs directly related to their obesity (I can't prove it, just heard about it).

So, I've paid out of pocket for tests my health insurance does not pay for ---h. pylori bacteria biopsi, EKG. The EKG came back abnormal, so I had to have a nuclear stress to make sure my heart, lungs, blood pressure were healthy enough for me to have the surgery. I'm glad to say I cleared those tests. I was especially glad/relieved to know that my heart health is good. By the way, my health insurance did have to kick in for the nuclear stress test.

But now, I'm in a holding pattern. After all the tests, mental evaluations, nutrition and physical fitness consultations went by swimmingly, the insurance company is stuck on medical records from 2008. Out nearly 10 years of records, they have, the stickler is on 2008. My surgeon's coordinator requested my medical records from my former primary care physician for that year, but was told they didn't have any records for me from 2008. Not true, after I pressed the issue. I even contacted the doctor in Montgomery who diagnosed me with sleep apnea to send records to the surgeon's office.

Bottom line...be proactive in all that you do. Don't be afraid to advocate for yourself when it comes to your health. For that matter, don't be afraid to advocate for your friends and family's healthcare. Stay tuned for the next episode!

Take a look at this...share your thoughts afterwards

http://www.google.com/url?sa=t&source=web&cd=12&ved=0CCQQFjABOAo&url=http%3A%2F%2Fwww.cdc.gov%2Fmen%2Flcod.htm&ei=wi7jTNrzMIT6lwex9Pm3Dg&usg=AFQjCNHJEUqclxnpOOIgXQM_7CnTpHTKvQ&sig2=l06eccZwEl9NOsr4r87Tog

A NEW ERA

At 41 years old, I have made an executive decision regarding my health. I am having bariatric (weight loss) surgery. My type surgery will be the gastric bypass. I decided to have the gastric bypass because of my type 2 diabetes. After 6 years of dealing with this disease and years of obesity, maxed out on my current meds and facing insulin, this surgery is my answer to a better quality of life. Over the years, I have tried several attempts to lose weight---appetite suppressants, fad diets, weight watchers,  bariatric diets (twice), gym memberships. Lacking in all of those, will power, frustration, weight loss plateau, stress and anything else that would contribute to failure.

Over the past ten years, three doctors, at three separate hospitals, in two different cities have suggested that I have weight loss surgery. Each time, I balked. "I would NEVER have the surgery unless something is threatening my life," I said. Well, now, something is threatening my life. My diabetes doctor (endocrinologist) says that I am maxed out on my current oral medications, has prescribed an injectable medcation (non-insulin) and that If I don't have the surgery, my next order of treatment to control my diabetes would be insulin. My fear is---if I get on insulin, I will never get off.

At 5' 11 1/2", and 336 lbs., I have a BMI (Body Mass Index) of 47, which puts me in the morbidly obese category. Think about that for a minute. Not just fat, overweight or portly---but MORBIDLY obese! I know that we are born to die, but I am not trying to give an unnecessary assist.  I want a better quality of life. I want control over my life. This is for my health  and well being, not cosmetics.

There are several tests and criteria that must be met before onbe is given the green light for bariatric surgery.
Doctors determine whether you are a candidate for the surgery, you decide on what you think is best for you (lap band, gastric bypass, gastric sleeve). There's the EKG, the H. Pylori Bacteria biopsy, the psychological evaluation and if necessary as was in my case--a nuclear stress test. The nuclear stress is given if your EKG report comes back abnormal and your surgeon wants to make sure your heart is healthy enough for the surgery

So far, I have cleared all of my tests. Now, it's up to the insurance company to decide if I have me their criteria to go under the knife. I have been to the doctor this year, probably more than most men have in their entire life. I have had a prostate exam, regular visits with my primary care physician , endocrinologist and of course the nuclear stress test. But the point is, I go to the doctor. I learned this year that my vitamin D level was almost non-existent and no take 2000 units a day of the supplement. As men, we don't go to the doctor as we need to. As a result, men die too young and un-necessarily so because of false bravado; believing we are invincible. Tragic, poor decision making.  We leave our families to grieve for a loss that could have been prevented or treated.  We will talk about all of this on this blog. Please feel free to share your stories, comments here. I feel if we talk more, honestly and openly, we can do a lot of good. I look forward to sharing my journey with you.