Yvonne
Well-Known Member
I sure hope you'll all bear with me. You need to hear the story in order to maybe/hopefully?? have some advice. I was invited by Lara to come over here from OH. She suggested that DianaCox would be able to help me or at least offer advice. So here's my story:
I started this in November of last year. I have PCOS and have tried about every diet known to man and really don’t lose well on anything. My insulin runs high all the time (around 19 – top of normal although my Endo told me she’d like to see it at 4). I had a lap band placed in July 2015 against my Endos’ advice. He (this was a different doctor a long time ago) said “I’ve seen you eat 800 calories a day and you didn’t lose weight. Until we can get your insulin down it won’t work”. I lost about 70lbs (I’m obsessively compliant – great for the DS), then I just stopped. My weight crept back up at 25lbs and then I just sat there for years.
Well, I’ve gotten older and the weight, plus the PCOS has just reared its ugly head and I started having trouble with my blood pressure. In January of 2013 I started going to a weight loss doctor (not surgeon) that worked with hormones. He was sure he could help with the insulin. Nope. After going to him until April 2015, I found a new GP and we started on new meds for blood pressure. One she put me on (which we didn’t know) shot my insulin through the roof. I was at 38 from April – November. I gained 5-7lbs a month every month with no change in diet. Then “I” figured it out by research and I went off of it (I discussed it with her of course). I stopped gaining but never lost any of that. I was devastated – 80 POUNDS heavier. I have Fibromyalgia and honestly, I function pretty well, until all the weight gain. I am in college at 49 years old and now I’m falling down because my leg goes numb from the extra weight and all these parts of my body that never hurt are hurting. I walk like an old woman and need help down stairs and forget walking upstairs. If there is no elevator I wait at the bottom. We tried everything (I’m on 3 pills and it’s only OK right now), but my blood pressure is still not normal.
That’s when we decided to do something more. I went to a new Endo (as mentioned above and she suggested a RNY). I didn’t’ really want that but I didn’t know of anything else. So that’s when I went to the bariatric doctor that she suggested here in town. He thought the RNY would not allow enough weight loss (I have a BMI of 56.9 and need to lose about 200lbs). He suggested the SADI. He also said that if he can’t get the Lapland out in enough time I’ll wake up with a SLEEVE. Which makes me about as excited as I am now about my Lapland. Now of course, I still had never heard about the DS, so I figured that would be great, after all it’s “just like the DS only improved”. I should have just gone to Dr. Inman at this point, but I was so excited to have a doctor so close so I could go to support meetings, etc. Well, he submitted it as band removal (no mention of me going to that weight loss doctor for 16 months straight – CASH $100-$200 an appointment), not much mention of problems with my band, other than a “little reflux” and then the SADII was coded as sleeve and also Misc. gastric procedure. Yeah, I know I know. I meanwhile started studying up and realized, maybe I should be going with the DS. But I pushed on. My insurance denied my band removal saying that even though I can't tolerate it, it is functionally fine. They see no reason for additional bariatric procedures for my obesity. He immediately did a peer to peer and THAT was denied. It was done by a Gastro doctor at the insurance company that said “I’m not sure why they’re having me do this, it’s not my field. But I’ll pass it on to appeals”. THAT was denied. I have NO fluid in my band and I choke on food daily, have severe reflux that IS controlled by Prilosec, but the 10 years of Prilosec, has caused my stomach to be full of polyps. But because it's not "broken" they won't pay for its removal. Even though my BMI is 56.9, they said there is no need for Bariatric surgery.
I picked up the phone and called Lindstrom and have paid them the $800 of the $900 (I have one more installment payment). I started with them at the end of June and I have yet to have an appeal sent in. It’s is not entirely their fault (not that I’m blaming them), but it took my SURGEON’S office 3+ weeks to send my files to them. Now we can only do a “telephone testimonial”, which is finally scheduled for September 8th.
I have literally been jerked around for MONTHS (from everyone). I jumped through everyone's hoops (all my psych stuff and dietetics are done) and whatever else they asked for. I started this process in November 2014 and was hoping for surgery in May or at least early summer as I'm a full-time student. So here it is, school just started this week, and no surgery. I also have an $8000 deductible that I have all but met due to all the preliminary stuff. In fact I'm almost to my stop-loss and at least part if not most of my surgery will be covered at 100%. That gives you an idea of how much I've spent trying to have this surgery. Now I find out my surgeon hurt his wrist on vacation last week and will need surgery to fix it. They not only don't know/or won't tell anyone WHEN he's having it, but can't give us an idea of when he'll be back to surgery. I can NOT have this go into next year. It will bankrupt us (new $8000 deductible starts again
I had my lap band at this hospital where Dr. Inman is at and LOVED it there (the one that is so far away). I have a whole lot of friends that are happy to drive to appointments with me (my husband was having to take off all kinds of work to go with me - he would still go to important ones, just not every single one).
OK, so if you made it to the end, boy do I appreciate your continued interest. Here are the questions. I know some of you have used attorneys and I believe someone told me that they used Lindstrom before. Did it take as long as this to get things going? What do you suggest I do about the attorney/new surgery submission? The new surgery will be coded completely different. Should I have the new surgeon submit a new surgery precertification request and I tell the attorney to sit on hold in case I need them (I am happy to finish paying them as that is what I promised to do. OK, not happy, but understand my responsibility). Do you think they’ll say “too bad so sad, new surgery, new $900”? Keeping in mind they have not submitted anything for me yet. As far as I know the appeal hasn’t even been finished as I’m supposed to get a copy of it when he’s done with it before the phone testimonial. I have my consultation appointment with Dr. Inman on September 17th. Should I call the attorney now and tell them what’s going on? Any suggestions? Honestly, I can’t wait around for the other surgeon to ‘get better’ especially having NO idea how long that will even be, oh and every person approved before me goes on a list before me, oh and I DON’T want the SADI now. One quick note. I had a regular doctor’s appointment yesterday and she said “Perhaps the whole reason this has taken so long and nothing has gone through is because you aren’t supposed to have it locally and should be having it with this other surgeon 2 hrs away.” Help?
I started this in November of last year. I have PCOS and have tried about every diet known to man and really don’t lose well on anything. My insulin runs high all the time (around 19 – top of normal although my Endo told me she’d like to see it at 4). I had a lap band placed in July 2015 against my Endos’ advice. He (this was a different doctor a long time ago) said “I’ve seen you eat 800 calories a day and you didn’t lose weight. Until we can get your insulin down it won’t work”. I lost about 70lbs (I’m obsessively compliant – great for the DS), then I just stopped. My weight crept back up at 25lbs and then I just sat there for years.
Well, I’ve gotten older and the weight, plus the PCOS has just reared its ugly head and I started having trouble with my blood pressure. In January of 2013 I started going to a weight loss doctor (not surgeon) that worked with hormones. He was sure he could help with the insulin. Nope. After going to him until April 2015, I found a new GP and we started on new meds for blood pressure. One she put me on (which we didn’t know) shot my insulin through the roof. I was at 38 from April – November. I gained 5-7lbs a month every month with no change in diet. Then “I” figured it out by research and I went off of it (I discussed it with her of course). I stopped gaining but never lost any of that. I was devastated – 80 POUNDS heavier. I have Fibromyalgia and honestly, I function pretty well, until all the weight gain. I am in college at 49 years old and now I’m falling down because my leg goes numb from the extra weight and all these parts of my body that never hurt are hurting. I walk like an old woman and need help down stairs and forget walking upstairs. If there is no elevator I wait at the bottom. We tried everything (I’m on 3 pills and it’s only OK right now), but my blood pressure is still not normal.
That’s when we decided to do something more. I went to a new Endo (as mentioned above and she suggested a RNY). I didn’t’ really want that but I didn’t know of anything else. So that’s when I went to the bariatric doctor that she suggested here in town. He thought the RNY would not allow enough weight loss (I have a BMI of 56.9 and need to lose about 200lbs). He suggested the SADI. He also said that if he can’t get the Lapland out in enough time I’ll wake up with a SLEEVE. Which makes me about as excited as I am now about my Lapland. Now of course, I still had never heard about the DS, so I figured that would be great, after all it’s “just like the DS only improved”. I should have just gone to Dr. Inman at this point, but I was so excited to have a doctor so close so I could go to support meetings, etc. Well, he submitted it as band removal (no mention of me going to that weight loss doctor for 16 months straight – CASH $100-$200 an appointment), not much mention of problems with my band, other than a “little reflux” and then the SADII was coded as sleeve and also Misc. gastric procedure. Yeah, I know I know. I meanwhile started studying up and realized, maybe I should be going with the DS. But I pushed on. My insurance denied my band removal saying that even though I can't tolerate it, it is functionally fine. They see no reason for additional bariatric procedures for my obesity. He immediately did a peer to peer and THAT was denied. It was done by a Gastro doctor at the insurance company that said “I’m not sure why they’re having me do this, it’s not my field. But I’ll pass it on to appeals”. THAT was denied. I have NO fluid in my band and I choke on food daily, have severe reflux that IS controlled by Prilosec, but the 10 years of Prilosec, has caused my stomach to be full of polyps. But because it's not "broken" they won't pay for its removal. Even though my BMI is 56.9, they said there is no need for Bariatric surgery.
I picked up the phone and called Lindstrom and have paid them the $800 of the $900 (I have one more installment payment). I started with them at the end of June and I have yet to have an appeal sent in. It’s is not entirely their fault (not that I’m blaming them), but it took my SURGEON’S office 3+ weeks to send my files to them. Now we can only do a “telephone testimonial”, which is finally scheduled for September 8th.
I have literally been jerked around for MONTHS (from everyone). I jumped through everyone's hoops (all my psych stuff and dietetics are done) and whatever else they asked for. I started this process in November 2014 and was hoping for surgery in May or at least early summer as I'm a full-time student. So here it is, school just started this week, and no surgery. I also have an $8000 deductible that I have all but met due to all the preliminary stuff. In fact I'm almost to my stop-loss and at least part if not most of my surgery will be covered at 100%. That gives you an idea of how much I've spent trying to have this surgery. Now I find out my surgeon hurt his wrist on vacation last week and will need surgery to fix it. They not only don't know/or won't tell anyone WHEN he's having it, but can't give us an idea of when he'll be back to surgery. I can NOT have this go into next year. It will bankrupt us (new $8000 deductible starts again
I had my lap band at this hospital where Dr. Inman is at and LOVED it there (the one that is so far away). I have a whole lot of friends that are happy to drive to appointments with me (my husband was having to take off all kinds of work to go with me - he would still go to important ones, just not every single one).
OK, so if you made it to the end, boy do I appreciate your continued interest. Here are the questions. I know some of you have used attorneys and I believe someone told me that they used Lindstrom before. Did it take as long as this to get things going? What do you suggest I do about the attorney/new surgery submission? The new surgery will be coded completely different. Should I have the new surgeon submit a new surgery precertification request and I tell the attorney to sit on hold in case I need them (I am happy to finish paying them as that is what I promised to do. OK, not happy, but understand my responsibility). Do you think they’ll say “too bad so sad, new surgery, new $900”? Keeping in mind they have not submitted anything for me yet. As far as I know the appeal hasn’t even been finished as I’m supposed to get a copy of it when he’s done with it before the phone testimonial. I have my consultation appointment with Dr. Inman on September 17th. Should I call the attorney now and tell them what’s going on? Any suggestions? Honestly, I can’t wait around for the other surgeon to ‘get better’ especially having NO idea how long that will even be, oh and every person approved before me goes on a list before me, oh and I DON’T want the SADI now. One quick note. I had a regular doctor’s appointment yesterday and she said “Perhaps the whole reason this has taken so long and nothing has gone through is because you aren’t supposed to have it locally and should be having it with this other surgeon 2 hrs away.” Help?
I'm pretty persistent. I'm in school to be a Social Worker to work with teens and I plan to go before Congress if I have to in order to protect them and their rights when it comes to anti-bullying laws etc. I had it out the other night with one of our state Representatives. In the nicest and firmest way. I'm pretty tenacious when something is important. I told my husband, I really believe if I don't have this surgery I will die young and I have far too much to do and way to many kids to help before I'm gone. I do have a way of charming people to do what I want, so I'm sure I'll have a copy soon enough. I'd really rather not have any contact with the other surgeon if I can avoid it. I live in a pretty small town and it's possible I'll work at that hospital at some time. I'm almost positive that the attorney has a copy of the EOC and I'd bet she'd be happy to send me a copy via email. I just remember it's really long.
