Another Small Step Forward - ThinnerTimes

OsoDelDesierto · 01-12-2007, 11:32 PM

I had my initial consult this morning with Karen Baumann, Dr. Schwartz's RN/Clinical Coordinator. I had read good things about her kindness and helpfulness on another WLS forum and had heard many more good things from Dr. Schwartz's patients at the WLS support group I attended last Saturday, so I had pretty high expectations. Karen lived up to the hype - she was great! Plus, she's an inspiration - she herself had a gastric bypass in 2000 and has lost and kept off 150 pounds!

We took a baseline weight (485 = BMI 59.0) and reviewed my medical history, particularly my co-morbidities. Karen quizzed me on what I knew about the RNY already and answed my other questions. We went through PacifiCare's requirements for WLS and discussed the delightfully ambiguous language that patients "may be required" to participate in a six-month medically supervised weight loss program before receiving approval for surgery. Karen will call PacifiCare to find out exactly what their guidelines are regarding who "may be required", but we both hope that someone with a BMI of 59 and multiple co-morbidities would not be required. I'll do the six-month program if I have to - I'll do whatever I have to, but it would be great not to have to jump through that series of hoops...

I definitely must undergo a three-part psychological assessment before Dr. Schwartz will even see me personally and submit my case for insurance approval. Karen gave me the instructions for setting up the first of the three appointments, and I was able to get approved by PacifiCare with no real difficulty.

The psychotherapist Karen recommended, who does the assessments for many of their patients, will see me on February 23 for about 45 minutes, then have me take two multiple choice tests, one approximately 500 questions in length, the other 150, that will last another two hours or so. I will schedule my second and third appointments with him when I complete the first one. PacifiCare will cover unlimited outpatient sessions with him (for a $30 copay), so I may continue to see him as a therapist for my eating disorder and other issues if we "click" during the evaluation process.

So, things are progressing slowly, but they are still progressing. This is a great opportunity for me to practice patience and tolerance, and also to start "training" for surgery and post-surgery by practicing good eating habits such as eating slowly, chewing my food (what a novel idea!), and making low-fat, low-carb, starch- and sugar-free choices, as well as getting back to walking and stretching every day. Thank you to everyone on this forum who has set such a great example for me to follow, especially the patience part!

AlabamaChick · 01-13-2007, 06:44 AM

Hey there Eric and welcome to our forum family! Stay with us and learn as much as you possibly can before your surgery so you will be well equipped with the knowledge needed out of the gate to use your tool to its highest potential. Can't wait til you are on the loser's bench with us. The weather it GREAT over here!

Bypassingme619 · 01-13-2007, 10:03 AM

Eric Welcome aboard. Eric it seems like a long process but it is so worth everything you go through. Good to see you have dropped a lot of weight from your hightest to your current weight. Congrats.

Gina in NY · 01-13-2007, 10:58 AM

Sounds like you have your ducks in a row. It can be quite a roller coaster, but we're here for you every step of the way! There is always room on the losers bench!

ceekerr · 01-13-2007, 12:25 PM

Hey, Eric and welcome to the forum! You'll find a lot of good information and support here - I have.

As for the 6 month diet that may be required - I just went through that - BCBS wanted "evidence of a failed diet" -

as if a life time of being overweight and a BMI of 47 is not evidence enough! It really gets me going - they wouldn't ask an alcoholic for "evidence" nor would they ask a narcotics adict for "evidence"!

How in the world do they justify requiring it of us? Do they think we Just haven't tried? Anger and frustration at the system aside, I have jumped throught their hoops and have (finally) been approved. Hopefully, your journey to approval won't take so long. Keep us informed of your progress!

kittens4 · 01-13-2007, 09:09 PM

Welcome to the forum! You will love it here! Lots of great info/advice. I don't think I would have come through it nearly as well without the help of these nice people! Good luck to you!

OsoDelDesierto · 01-13-2007, 09:15 PM

Thank you all for your kind words and encouragement! Although I don't post much yet, I am a regular "lurker". I have read lots of your comments, stories, and helpful hints and I am totally inspired - I can't wait to join you on the losers' bench!

MiladyB · 01-13-2007, 10:40 PM

Eric, welcome to the forum. It sounds like you had a really informative appointment. Some insurance companies require the 6 month program, some don't. For mine it wasn't required for a BMI over 50, which I was. But like you said, you do what you have to do. There are many hoops you will probably need to jump threw. I had several just to get approved to go to the surgeon's orientation! After that, insurance approved me quite quickly but it took awhile to get all of my lab work in order. I had several labs the surgeon didn't like the results of. I had to do some major work with my PCP before the surgeon would approve doing the surgery even thought the insurance company had approved it. Just keep plugging away. Yes, you will have to tap into that patience...now...and after surgery. Nothing comes easy with this surgery...before or after. Just know we are all here to answer your questions, encourage you and sometimes maybe even have to set you straight on a few things. Just remember it's because we care. We all travel this road together.

LyndasRoom · 01-14-2007, 09:53 AM

Eric,
Patience is a BIG part of the process, isn't it? I have Pacificare Signature Value HMO...I think the wording is put like that, so your primary doc can require that 6 month supervised program before referring you, if they wish, mine did, and held my referral hostage until I completed it, LOL. Pacificare has been great, approved me and I haven't even SEEN a bill. Love that! You're on your way, congratulations. I'm so proud of you for taking this time to learn skills that will serve you in your new life...you should be proud of you too!

MILA · 01-14-2007, 10:42 AM

Good for you Eric - don't let the pre-approval dance frustrate you too much - it can be a challenge at times ... but in the end it is worth it. You will be post-op before you know it. Good luck.