My Gastric Bypass Story Pt. 2: Getting Insurance to Pay

September 11, 2013

three year weight documentation
The first thing I did was go back through all the doctors I've seen in the past three years and get ALL of their office notes.  Unfortunately, most of them did not have my weight documented.  I needed one from 2010, 2011, & 2012.  I was able to find weight documented office notes from 2009, 2011 and 2012, but not 2010.  Luckily, the insurance allows you to send in a full body picture for only one year instead of an office note.  I had a lot of panic and anxiety over finding all of this, but luckily it worked out.
seven month doctor supervised visits

I have blue cross insurance and they had SO many requirements to be approved. In January, I started the insurance required monthly appointments with my primary care physician, Dr. Han.  He was so supportive and always made sure that any issue I had was taken care of.  On my first visit with him for surgery, I also found out I had asthma.  Who knew?  A few visits later I found out I was clenching my jaw from stress.  He helped me through so much.  So towards the end of every month I would go see Dr. Han.  I couldn't miss an appointment or I had to start counting the months all over again.  Dr. Han would weigh me, check my blood pressure, make sure I was still following my chosen diet plan, calculate my BMI, and sign off on my progress. I had to do this for SEVEN months straight.  I'm not sure if the insurance is trying to trick you or not, but they will tell you it's a "6 month doctor supervised weight loss program."  Okay, well it is- BUT.  The first appointment only counts as a consultation.  So after the first visit, you have six more to go.  Tricky tricky! At the end of July, I was finally done with all my visits and had been given the clearance for surgery.  What I thought would be the longest seven months of my life turned out to be the quickest.  I can't even explain how fast it went by.

sleep study(ies)
Another crazy part of going through this process is having a sleep study.  I found a place close to my house that did these and luckily they did them on the weekend.  So I went sometime in June after work on a Friday and was put in a room that looked like a hotel room.  They hooked me up to what seemed like hundreds of cords and probes.  My legs, chest, face, neck and head were all covered in cords hooked to a machine that would read everything from my leg movements at night to when I stopped breathing and for how long.  Apparently, when you stop breathing due to sleep apnea,  you kick your legs like your struggling.  This scared me!  I was sure there was no way I did that in my sleep.  Wrong again.  I had mild sleep apnea, I did stop breathing a few times throughout the night and I did kick my legs while struggling for air.  I was shocked!  (I'm still not convinced this info is accurate, because how can you even sleep normally while hooked up to all those cords?!)  So I stayed until Saturday morning around 6:00 when they came in, unplugged me and told me I could go home.  They also gave me a special formula for getting the probe goop out of my hair when I got home, which was NO easy task.
A few weeks later is when I got the results about having the mild sleep apnea, kicking, etc... They told me I needed to come back in for a CPAP study.  Surely they were kidding... Nope, wrong again.  So I scheduled it for another Friday a couple of weeks out.  Same process-  cords and probes all over- with the added bonus of a CPAP mask.  Again, getting a good night's rest with all that is just about impossible.  But they said I slept much better and should feel much more energized from having a lot more oxygen during the night.  And I did.  I was advised to purchase and wear a CPAP until surgery, which I also did.  (Ben wears one, so you can imagine that we were like, the sexiest couple ever.  Getting into bed with our CPAP's on at night... totally hot.)  Before surgery, I had to let the doctor check my CPAP compliance to make sure I really was wearing it at night.  Once they approved my compliance, I checked the CPAP off my list.
psychiatric evaluation
A lot of my friends weren't sure I was going to make it through this portion... I mean, I CAN be kind of crazy.  When I called to set up the appointment with the recommended Psychiatrist, they told me to mark at least six hours off my day for the eval.  Um, seriously?  So I took a day off work (coordinated with the day my dad had knee replacement surgery, so it worked out) and tried to get as much crazy out of my system as possible.  When I arrived at the office, I did the usual paperwork & copay combination.  I was surprised at how quickly they took me back, but it wasn't to see the doctor.  They put me in a room full of cubicles & snacks.  (not sure if that was some sort of trick to see if I would be tempted to eat or if that really was just where they kept their food.  Again, tricky tricky.)  I sat down only to be handed a huge (no literally, huge) stack of papers.  There were about 16 tests (with about 200 questions each) I had to take- all asking the same thing but wanting different kinds of answers.  Like: true/false, scale of 1-10, very true-mostly true-not true-never true, etc... The questions mostly consisted of things like, "do you see people that others cannot see?"  or "do you often want to harm yourself or others around you?"  or  "do you feel as though you have no self worth because you are overweight?"  Etc...
After the 16 tests, I had to look at an ink blob (yes they really make you do those) and write down what I saw.  Then I was given three pictures:  a boy sitting in a doorway of what looked like an old schoolhouse, a shadow of a man looking out a white window, and a boy putting together a model airplane.  I then had to write three sentences about each picture:  what happened before the picture was taken, what was happening in the picture, and what happened after the picture.  Then I had about five or six more small tests to take, asking about my diet and what information I knew about the surgery I was having.  NO WONDER they ask you to take up to six hours out of your day!  Doing all of that took me almost three hours!
Finally after finishing all of that, I had to wait on the staff to "score" my tests, which took about another hour.  After almost four hours of being in the office, I finally met with the Psychiatrist.  He GRILLED ME on everything from surgery to my relationship with Ben.  45 minutes later, he said he saw no red flags and would send my approval letter for surgery.  The insurance definitely does NOT make it easy on you.
support group/nutrition education class
A month out from surgery, I had to attend a mandatory support group.  They hold them once a month so that other patient's can come and share their struggles and successes and future patient's can see what they are in store for.  My insurance didn't require this, but my surgeon did.  They would not request approval from my insurance until I did these two last things.  After going to the support group, I was so excited about surgery.  Seeing people's before and after photo's and how far they'd come was amazing.  Hearing that their diabetes went away literally over night and they were able to stop taking their 15-20 pills a day was so inspiring to me.  I knew this would be me in ten years if I didn't have this surgery.  So if there was ever a moment when I was nervous or hesitant before, it all went away after this class.  Ben, of course, was with me and he was excited for me as well.  We were in this together and ready to get it over with.
The last thing I had to do was go to a four hour nutrition class.  (For anyone thinking of having this surgery, it requires a LOT of time away from work.  I'm so thankful my job was understanding and supportive of everything I needed to do!)  They talked about everything you could eat after surgery and everything you'd never be able to eat again.  I learned that I would have to take multi-vitamins twice a day, a calcium chewable three times a day, and B12 twice a week- FOR THE REST OF MY LIFE.  I also learned that I would have to give myself blood thinner shots for 30 days after surgery to avoid getting a blood clot. (more on that debacle in Pt. 3)  I left the nutrition class, had all of my pre-surgery work up done, and went to play the waiting game with my insurance.  Those were also the slowest few days of my life.


6 comments:

  1. They really do put you through the ringer, don't they?! All of that just proves how strong of a person you are! I am sure not everyone can hang.

    ReplyDelete
  2. Holy cannoli! That's a lot of hoops to jump through. That's the stuff you don't hear about! Thanks for inside look... I'm sure the payoff is bigger than all of those annoying things though! :)

    ReplyDelete
  3. wow! what a lot of steps! glad insurance could cover it, but stinks you had to go through all that. insurance is tricky. funny how some insurance will not cover for you to go to weight loss classes, but it will cover for you to go and get surgery for it. strange!! i thought it was all about prevention here. glad it all worked out for you!

    ReplyDelete
  4. Wow I really had no idea what went into all of this! Sounds like you stayed pretty optimistic throughout everything though and that's great.. now look at you :)

    ReplyDelete
  5. Good grief woman! I had no idea that you had to do so much in order to be considered for this surgery. I'm proud of you for being strong and for making it all the way through, that shit ain't no joke! : ) When you say there are things you can't eat for the rest of your life...what things are on that list? No way I would even get one wink of sleep hooked up to those machines like that, they would have to keep me for 3 days if they wanted me to sleep. Now the psych eval? That's a different story. I would LOVE to go in and take those tests. I am so weird but I enjoy taking questionnaires like that and anything psychological!

    ReplyDelete
  6. Northern Sleep and CPAP is a company that provides effective treatment to patients with sleep disordered breathing such as sleep apnea.

    sleep Apnea Equipment

    ReplyDelete