Dawn the Twinsmom
My journey to Gastric Bypass Surgery, has been a long one to say the least. It started a year ago when my diabetes doctor suggest that I look into Surgery so that I can loose weight, and avoid having to go on insulin shots. The decision to call the Umass weight Center was a hard one. I am not HUGE by any sense of the word, but, I am considered Morbidly obese, weighing in at 230 lbs, at a height of 5’2”. I attended the informational sessions, like a good patient, and even attended the session that followed that, the intro to gastric surgery.
After completing the initial steps, I called my healthcare provider, to inquire about coverage. I was told that I was fully covered, and if I chose, I could go ahead and start the procedure to get into UMass’ program, which I had resolved myself to do. I attended appointments with a nutritionist, a behaviorist, and behavior modification and pre surgical skills classes. At the end of the classes, I had gained weight, through fault of my own, because I was eating as if I was having a “last supper”. So I had to book another nutrition appointment with the nutritionist. In the meantime, I became a regular staple at the gym, ate a lot less, and followed the slim-fast diet plan. After my appointment with nutrition, I was down to 224.5 lbs. and was now given a date to meet with my surgeon, Dr. C.
I was elated to say the least. So on March 12, I went to the appointment, taking time off from work. When the Nurse Practitioner came into the room, she sat down and said, “I have bad news for you.” My heart sank, as I was sure she was going to tell me that I had not lost enough weight, and was no longer a candidate for surgery. She then told me “I am really sorry to tell you this, but a few days ago your insurance decided to no longer cover this type of surgery.” I was hysterical, sobbing incessantly. Begging to find out what I could do. They told me to appeal the decision. I called my insurance, and was told that it had to be denied approval first before it went to appeal and grievances.
A month later, I was told approval was indeed denied, and I went to the insurances internal grievance dept, and filed an appeal. Again, I was denied, based on the fact that I had not completed THEIR program!!! I had already completed a program, I was supposed to get booked for surgery on the day I was to meet the surgeon, on the day I was told what the insurance company did 6 days earlier, without ever informing any of the people that they KNEW were in programs such as I was.
I again appealed the decision, this time to the state of MA, who sent it out to an outside, impartial agency. I was told not to expect a decision from them until August. Well, 2 weeks ago, I got the letter that they overturned the decision of my insurance, and that they would HAVE to cover the surgery!
So, now I have my date, and am working hard on getting the last few pounds off of me. I am very determined. I did not fight this so hard to fail. I will Prevail!
