Thank God for Small Favors...

"Have faith in God," Jesus answered. "I tell you the truth, if anyone says to this mountain, 'Go, throw yourself into the sea,' and does not doubt in his heart but believes that what he says will happen, it will be done for him. Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours."
- Mark 11:22-24

After writing yesterday, I logged on to my insurance company's website and started looking through all of the claims that have been filed on our behalf by the different doctor's offices. I was really praying as I looked through the claims that I would be able to see back far enough, because they only archive the last 150 claims online. After that I would have to call the insurance company and ask them to look into it. I would be at their mercy as to when I would get the information that I needed.

Thankfully, on the very last page I found what I was looking for. I don't think I've been that excited over a doctor appointment in a long time. I knew that printing out the claim from online would do me no good, because the insurance company does not record anything other than the diagnosis and itemized billing, so I called the doctor's office. The nurse that answered the phone was great. I told her that I needed to place a request for a copy of my medical records dating back to 2005, and she initially told me that there would be a 24-48 hour turn around before I could pick them up. That was fine with me- it's better than waiting on the insurance company to get the records. However, as she was looking me up in the system, she surprised me by saying that she would just print them out while she had me on the phone.

I silently rejoiced, and quickly got ready to go and get my medical records. When I got to the office, they were waiting on me at the front desk. The nurse was so sweet that she even offered to make another copy of the records if I need them for another doctor. I thanked her and left, resisting the urge to speed all the way home so that I could look at the records and verify that my weights had been recorded by my doctor. I saw my weights and put them in to the BMI calculator to make sure that my BMI was high enough in 2005 to classify me as morbidly obese. As per my insurance company's guidelines, I have to be able to prove with medical documents that I have been morbidly obese for at least the last three years. When the calculator was done, I said a final prayer and then scrolled down to look at the calculation. I barely made it. My BMI from 2005 was 40.1 - a far cry from what I am at now. I've gained over 50 pounds in the last three years.

I was rather certain that I was morbidly obese in 2005, but I was also very concerned that I wouldn't be able to prove it with medical documentation as required. It just reaffirms my belief that if God brings you to it, God will see you through it. Thank God for small favors- he gives them to us each and every day. Sometimes I get so caught up worrying about every little detail that I can't see the forest for the trees. I just need to stop and realize each of the miracles and favors that he gives me and those around me each day.

Next on the agenda- quitting smoking. I know that I have quite some time (at least seven months) before I'll be having surgery, but I want to quit as soon as possible. The sooner I quit , the healthier I'll be. Also, quitting now as opposed to the required two months before the surgery will reduce my chance of complications even more than if I were to quit two months before the surgery. My quit date is Sunday, April 20th, 2008

Setback So Early in the Process...

If you want to get somewhere you have to know where you want to go and how to get there. Then never, never, never give up. -Norman Vincent Peale

When I called my insurance company a couple of days ago to inquire about their criteria for bariatric surgery for the morbidly obese, the customer service representative wasn't very helpful. She kept telling me to look on the insurance company's website for a document called "Surgical Management for the Treatment of Morbid Obesity". I looked and looked and wasn't able find any such document, but I did find an FAQ about their criteria for the procedure. I was browsing the website again this morning, and I was able to find the document that I had been referred to a couple of days ago.

I started reading through it, and I got to a certain part that made my heart nearly stop. (Not literally) In order to be approved for the surgery, you have to have medical documentation that shows that you have had a BMI (Body Mass Index) of at least 40 (35 if you have one or more co-morbid conditions) for the last three years. My husband and I have been married for three years and twenty three days as of today. I didn't have insurance before we were married, so I didn't go to the doctor often- if at all. I know that I have been morbidly obese for more than three years, but I am not sure that I have the medical documentation to prove it.

I'm pretty sure that by the time I complete the required six month (actually seven, as the first month doesn't count) physician supervised diet and exercise program I will be able to obtain medical documents showing morbid obesity, but I can't be sure. If I complete the six month physician supervised diet and exercise program, I have to have the surgery within the following six months according the my insurance company's website. (It says that the diet and exercise program must be completed within a year of the surgery). Patients that are trying to have WLS have to jump through hoops to gain approval from insurance companies as it is, and for me to complete the hardest and most time consuming step toward approval, only to have to do it over again would be devastating.

As I've mentioned before, I've been looking into this for well over a year, and have only made the decision to proceed in the last couple of months. To have this type of setback so early in the process is seriously discouraging. When I read that I felt like crying. I know that they are asking for the documentation that they ask for because of the need to demonstrate medical necessity. I get that. On the other hand, who in the world would go through something as life-altering and as painful as having WLS if it wasn't absolutely necessary? Who would put themselves through this?

Instead of crying, I am going to call the doctor that I saw before the one that I am seeing now and ask for a copy of my medical records. I don't think that they can keep them from me, and if they try I will do more research as to my rights as a patient regarding my records and proceed as necessary. Please, pray for me. I need all of the help that I can get right now.

It Begins...

A journey of a thousand miles begins with a single step. -Confucious

My name is Angelica, but most people call me "Angel" for short. I am twenty seven years old, and morbidly obese. In addition, I have several co-morbid conditions (diabetes, obstructive sleep apnea, polycystic ovary syndrome, and high blood pressure). I've been looking into gastric bypass surgery for over a year, mainly gathering information about the surgery, the benefits, the risks, and possible complications. I'm scared about the prospect of the risks and complications, but at the same time, I'm more afraid of what will happen to me if I do not lose weight. While I realize that nothing associated with this procedure will be easy, I feel that I am ready to do whatever it takes to lose this weight, once and for all.

To start the process, I called my insurance company to see what was covered with respect to bariatric surgery. According to my insurance company, in order to qualify for a covered bariatric weight loss procedure I have to meet several conditions. For starters, my BMI, or Body Mass Index, must be 40 or higher, or over 35 with other co-morbid conditions. A co-morbid condition is a medical condition in a patient that causes, is caused by, or is otherwise related to another condition in the same patient. Well, I meet this condition for sure. I currently have a BMI of 45.3, in addition to several comorbid conditions. Next, I have to complete six months of a physician supervised diet and exercise program. It's actually seven months because the first visit doesn't count. During this time, I have to be sure to see the doctor every thirty days. I cannot miss an appointment, or I'll have to start over again. Over the six month period the doctor must record the diet and my progress or lack of progress. When that period is over, all of the information will be sent to the insurance company with a request for approval for the surgery.

I wanted to ask if they also cover a procedure for the removal of excess skin after the weight loss, but the customer service rep. that I got on the line seemed rather rude and kept referring me to to look online at the Blue Cross website. I tried to explain to her that I had done that, but that our benefits booklet had not yet been uploaded and therefore was not available to me, but she kept insisting that I look online. I decided that I was most likely not going to get anywhere by talking to her, so I hung up the phone and found an F.A.Q. at the Blue Cross website about the gastric bypass surgery requirements, but that is all that I've found so far. If I cannot find anything else tonight, I'll call back tomorrow, and hopefully get a different CSR.

I did call and make an appointment for a surgery consult last week, and today I called and made an appointment with my primary care physician so that I can speak to him about getting started on this six month diet and exercise program. My surgery consult is on April 28, and my appointment with my PCP (Primary Care Physician) is on April 23. I have a list of questions that I saw here and decided to print out to ask the surgeon. In addition, I want him to explain everything to me, from start to finish. I'm excited, and can hardly wait to get started.