nofearonlyheart

Any advice on my rejection?

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I got a letter from Cleveland clinic that stated I am not currently a candidate for wls because of my past history of psychiatric hospitalizations. They said try again in a year from now. It has already been a year since my last hospitalization. I am doing really good. My counselor is really proud of me. I just don't understand what their deal is.

Anyway I am going to try another center. St. Vincent's Charity Hospital. Hopefully I don't run into the same problem.

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Makes sense to check into another medical center, but don't just write off Cleveland Clinic. They are an excellent facility with top notch medical professionals affiliated with it. It may be possible to do an appeal, especially if you got a psych clearance and the psychologist does a peer-to-peer review of your case. It's also possible to have some type of mitigation plan in place, likely time doing monitored weight management along with counseling. They do truly have your best interests in mind, but reading a case file doesn't necessarily provide the full picture.

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I think I'm going to call Cleveland Clinic back Mon. and check into getting a psych clearance. If they say no I will try st. Vincent and if they say no then I will go back to Cleveland clinic to see the bariatrician dr. Cetan about the weight management. Thanks Wendy.

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Try another program.

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I was hospitalized because of being suicidal but it was because my son told me he was molested by his grandfather. I couldn't accept it. I thought it was my fault. I couldn't see that I was making everything a million times worse. I was very selfish. My son is doing good now. He is in kindergarten and doesn't really remember anything or bring it up. I'm super glad I went to the hospital and got help because they helped me cope and be there for my son. It seemed like the worst situation possible but we got through it. And we are both in counseling right now to make sure everything is good.

Time heals. I always remember now from experience this too truly will pass.

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I'm glad to hear you are in a better place but so sorry to hear about what happened to your son.

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Hang in there, there are insurance experts in every 1A bariatric center of excellence whose job it is to get approvals. Please stay with it, it's the best thing you can do for your life.

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I'm so sorry to hear this. I'm glad you felt No YOU KNOW you can come here to discuss this type of thing will all of us.

You sound like a wonderful mother if you ask me.

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I think you have a great plan.  Go to the psychiatrist affiliated with your current program requesting approval, go back to the insurance coordinator with your current program and get an appeal lined out.  And then submit your appeal to the insurance company.  Appeal their decision based on facts! 

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I was hospitalized because of being suicidal but it was because my son told me he was molested by his grandfather. I couldn't accept it. I thought it was my fault. I couldn't see that I was making everything a million times worse. I was very selfish. My son is doing good now. He is in kindergarten and doesn't really remember anything or bring it up. I'm super glad I went to the hospital and got help because they helped me cope and be there for my son. It seemed like the worst situation possible but we got through it. And we are both in counseling right now to make sure everything is good.

Time heals. I always remember now from experience this too truly will pass.

You were just in shock. The same thing happened to my sister's son and daughter with our father. My sister blamed herself for letting their grandfather baby sit but who would think the kids own grandfather would do that to the kids? She and the kids were all victims, just like you and your son were victims. It's just a fact of life that there are many sick people out there but you certainly aren't one of them.

Hopefully appealing the hospital's decision will allow you to go ahead once you get a psych clearance. We are all here for you!!!

Cheyenne

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Responses are focused on insurance, but if I understood the original question, it wasn't the insurance that denied, it was the hospital. In that case, going to another medical center could negate the problem.

That said, I'm glad you're going to speak with the folks at Cleveland Clinic. Sometimes decision-makers are off base, but sometimes they hone in on something that matters but that we discount, because we don't see it's importance. Ultimately everyone you to be successful.

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Having WLS is a BIG deal and it does play a role in your mental health.  My guess is that they want to see that you are stable for 2 years prior to you going into a surgery that will cause some mental stress.  Many people do not think this is a mental thing, but it so is.  You have to be prepared physically and mentally to deal with all the changes.  If you are a year out from a major pysch issue, they want to make sure you are stable, it is common to relapse when you are early on.

 

Take it step by step, the hoops are there for a reason, it is what is best for you.  Talk to your psychiatrist,  see how they feel about you going through something so big right now.  Step by step, getting yourself mentally prepared for this process will only help you be successful in the long run.  If they do make you wait use the time to try and loose some weight, put some of the step into play early that you will have to do after surgery, then once you do have surgery you will rock out!

 

 

Good Luck

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I'm so sorry to hear this. I'm glad you felt No YOU KNOW you can come here to discuss this type of thing will all of us.

You sound like a wonderful mother if you ask me.

Thank you Amber. I'm a really open person. Maybe that is the kind of thing I should keep to myself but I am an open book lol.

I think you have a great plan.  Go to the psychiatrist affiliated with your current program requesting approval, go back to the insurance coordinator with your current program and get an appeal lined out.  And then submit your appeal to the insurance company.  Appeal their decision based on facts!

Maybe. It's not the insurance company that is the problem. It's the hospitals decision.

You were just in shock. The same thing happened to my sister's son and daughter with our father. My sister blamed herself for letting their grandfather baby sit but who would think the kids own grandfather would do that to the kids? She and the kids were all victims, just like you and your son were victims. It's just a fact of life that there are many sick people out there but you certainly aren't one of them.

Hopefully appealing the hospital's decision will allow you to go ahead once you get a psych clearance. We are all here for you!!!

Cheyenne

Thank you Cheyenne. It was hard to get my head around the fact that it wasn't my fault but like I said time has really helped and counseling.

About appealing..I guess I'll just have to call them and ask how to go about that.

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Having WLS is a BIG deal and it does play a role in your mental health.  My guess is that they want to see that you are stable for 2 years prior to you going into a surgery that will cause some mental stress.  Many people do not think this is a mental thing, but it so is.  You have to be prepared physically and mentally to deal with all the changes.  If you are a year out from a major pysch issue, they want to make sure you are stable, it is common to relapse when you are early on.

 

Take it step by step, the hoops are there for a reason, it is what is best for you.  Talk to your psychiatrist,  see how they feel about you going through something so big right now.  Step by step, getting yourself mentally prepared for this process will only help you be successful in the long run.  If they do make you wait use the time to try and loose some weight, put some of the step into play early that you will have to do after surgery, then once you do have surgery you will rock out!

 

 

Good Luck

This is hard to hear but thank you

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i concur with kimelou. as someone who was suicidal about 5 years ago, i can definitely weigh in on the whole mental thing. although i haven't tried to take my own life in a long time (and have no urges to do it now), i still struggle with the mental aspect of surgery. it's tough not going back into old habits, and i can't say that i haven't since surgery. but you have to be mentally and emotionally strong enough to pick yourself back up and get back on the wagon, if in the event you do happen to fall off from being compliant.

 

and you can't deal with certain situations the same way anymore. that's the worst (best) part. forget stuffing yourself with a bag of chips if something stressful or traumatic happens in your life. you're physically unable to do so.

 

i'm not saying you're not ready. don't get me wrong. but getting surgery is definitely a life-changing experience. and i would have not been ready at 23 years old. i wasn't mature or responsible enough to handle everything that goes along with it. just something to think about, i suppose.

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I would continue to work with Cleveland Clinic,  closely.   Because they will go to bat for you with the insurance to APPROVE you in the end.  In the mean time,  follow the diet, increase exercise and turn things around. 

 

I think you will get the SAME response from any program, because they are all centers of excellence with the same criteria.   Waiting a little is not a bad thing.  

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nofearonlyheart, I know how hard it is.  I have struggled with mental health and after years of depression and an anxiety disorder I can finally say I am better than I have ever been.  But, I needed to be stable for the surgery.  Even though I don't struggle with depression and anxiety thanks to Paxil, the first couple of weeks after surgery were rough, it was a tough time, not being able to eat anything, it is totally mental.  This process is 40% physical and 60% mental.  

 

Don't give up.  Work hard to get where you need to be.  Talk to you counselor and get their take on your process and if they feel you are ready, think long and hard talk to other WLS patient about the feelings they had afterward.  If the counselor and you both feel you are ready, have the mental health professional write a letter to your insurance company.  

 

One step, one day at a time, you will make it!!!

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two things.  well maybe three.  first it doesn't sound like it was an insurance denial.  it sounds like the clinic denied you.  find out.  it will make a difference on how you proceed.  second I concur with everyone else that this is a mental process and the mental part is much harder than the physical part.  if the clinic is the entity denying than I would try to find a counselor who is also well-versed in bariatric-surgery issues.  not every counselor will know about our specific issues. 

 

and third - I am a survivor of early childhood sexual abuse.  it is not true that young children don't remember.  just because he doesn't talk about it doesn't mean he doesn't remember.  some part of him does.  good for you for getting him counseling.  my parents were of the sweep-it-under-the-rug school.  helping him to deal with it now may prevent many of the issues that so many survivors have to deal with far into adulthood.  don't ever think he doesn't remember.  if nothing else, his body remembers.  I still have a very hard time letting people touch me.  no casual hugging in my world.  the only person who can touch me spontaneously and without thought (on my part) is my daughter.  maybe that would be different if the adults in my life hadn't decided that "forgetting" about it would be the best thing.  i'll never know.  maybe that's why I'm such a big fan of therapy. 

 

facing the hard stuff and dealing with it will only help you in your journey toward wls.  the good parents are not necessarily the ones who prevent all the bad stuff.  the good parents are the ones who deal with the bad stuff no matter how hard it is.  sounds like you are working toward being one of the good ones. 

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Did you have a psych evaluation with the practice? If they want you to wait another year perhaps it would be in your best interest to find out more about why they want you to wait. It very well could be that it's their standard operating procedure but maybe they are protecting you from something that you don't really need to deal with yet like the stress of surgery. Maybe someone recognized that this is an "elective" (sort of) thing and it won't do any harm by waiting but could do harm to you by moving too soon. I'm not suggesting that you take what they're saying and just say oh well. I just feel a little protective of you and don't want surgery to have any necessary negative effects that could possibly be avoided by waiting a while. Sometimes what we want to happen is different from what we need to happen. Only want the best for you!!

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Cleveland Clinic called back today. They said they had no way of knowing how long ago I was in patient for psychiatric reasons so they sent a rejection letter. However since I called them and let them know it was January of 2014, they are now setting up my appointments for me and will call me back with them. It has to be at least 12 months since your last psych hospitalization.

I have an appointment with st. Vincent that I will need to cancel soon. 

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don't give up - it took me 3 rejections until it was finally approved - my surgeon was my advocate and wouldn't take NO for an answer - and I am so glad he wouldn't!

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Cleveland Clinic called back today. They said they had no way of knowing how long ago I was in patient for psychiatric reasons so they sent a rejection letter. However since I called them and let them know it was January of 2014, they are now setting up my appointments for me and will call me back with them. It has to be at least 12 months since your last psych hospitalization.

I have an appointment with st. Vincent that I will need to cancel soon. 

I'm very happy to hear this.

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