Tuesday, April 29, 2008
Got a letter from BC/BS yesterday

And the frustration continues.....

Got a letter from Blue Cross yesterday, basically saying they are not able to make a decision at this point. It layed out the prerequisites, and one of them is a 6 month diet!!!! I am so angry and sick about this. I can't believe they originally told Josephina there were no prerequisites. Now, suddenly, everything changes. It is so annoying.

I did talk to Josephina today, she said she was suprised all the fuss they are putting up. Evidently, the doctor wants me to get all my ducks in a row... 5 yrs weight history, anything I can get from Weight Watchers (I went there about a year and a half ago..though not for 6 months...started doing it online, but don't have any proof), psychologists exam, nutritionist (something he didn't require before ins. started getting so picky), and, of course..the results from my sleep study (which they don't have yet). Once they have all this they will send in the request again.

I asked Josephina if it can be done secondary to my hernia repair, which should be considered medically necessary. I say should because who knows with this crappy insurance???? I also questioned if I could self pay for the lap band in conjunction with the hernia surgery.

As usual, I am so pissed and frustrated....

posted by Julie's Journey @ 1:13 PM 0 Comments

Sunday, April 27, 2008
sleep study = no sleep

Went for my sleep study last Thursday evening. For anyone who has never had one..it is quite an experience. They hook you up to about 20 diferent wires, you have wires on your head (glued into your hair) you have wires all over your face,wires attached to your legs, you even have 2 sensors stuck up your nose!!!

The tech explained to me she needed to observe 3 hours of REM sleep (Yep, they watch you sleep via a camera in the ceiling) she would count the number of "occurances" during my sleep. She told me if I had x number of occurances she would come in and put a CPAP on me.

I feel asleep fairly quickly (though I would have sworn I did not sleep) In no time she was coming in to put oxygen on me,,, great, something else stuck up my nose!! This was about 12:10AM. After that I just couldn't get back to sleep. I was so restless, I kept pulling the wires off my legs as I tossed and turned. She kept having to come in to retape them, finaly she just put practically half a roll of tape to hold them on. Time passed verrry slowly. I just layed there, worrying. I knew they needed 3 hours of sleep. She was going to wake me up (assuming I ever fell asleep) at 6:30 AM, and it was already 4!! Then 4:30. Then 5. Next thing I knew I heard her over the intercom telling me she was going to get me up. I figured they were sending me home early since I was not sleeping anyway. She came in and told me I actually did fall asleep, and she observed 1/2 hour of REM sleep. I asked her how I did, but she told me she wasn't allowed to say. Very frustrating, though I do understand. She told me the report will be sent to my doctor in about 10 days. She did kind of hint around that I did OK...she told me I do pretty well on my side. I am hoping that if they don't have enough time in to make a diagnosis they call me in for another one, rather than just say I do not have apnea, since I was OK when she observed me sleeping on my side. Again, I guess this is just a waiting game, too.

posted by Julie's Journey @ 9:32 AM 0 Comments

Heard back from the insurance company

Josefina called me last week. Told me the insurance wanted the results of my sleep study, as well as 5 years medical documentation of weight. She feels I should be OK, especially if my sleep study comes back showing apnea, since I have other co morbidities (high blood pressure, diabetes, high body mass index (BMI) ) I need to get on my doctor in MI to send my results. Soon it will just be a waiting game.

posted by Julie's Journey @ 9:27 AM 0 Comments

Monday, April 21, 2008
My Lap Band Decision

Years ago I tried to get insurance approval for gastric surgery, I wanted the gastric bypass (Roux-en-Y) done. My insurance denied me. I fought them for awhile, then just gave up. Since then I have met a wonderful man, married and had a beautiful little girl, she just turned 4.

I feel bad that I am unable to run and play with my daughter, I also don't want her to grow up with a "fat mom", or ever be embarrassed by me. OK...I'm sure I'll do things to embarrass her...but I don't want it to be because the other kids are calling me names. I also want to be healthy and around for her.

Because of my daughter, I feel gastric bypass is too extreme. I have decided to have a Lap Band done. I feel this is the right procedure for me. There is no "cutting and pasting" of your internal organs, no malabsorption, and a lower mortality rate. The lap band is a flexible band that is placed around the upper portion of your stomach, it is filled with saline which can be reduced or more added as needed. I fully understand this is not a "magic pill", just a powerful tool that will enable me to make the life changes I need.

I called my surgeons office to make an appointment, at that time they took my insurance info. The girl at the office, Josefina, called back and told me bariatric services were covered..no copay, no deductible, no prerequisites. I was so happy, I went ahead and made the appointment. I went to my appointment, and was quite impressed with the surgeon, Dr. Melniczek. He told me what he would do, explained that morbid obesity (I just hate that term) is a metabolic problem, it has nothing to do with who you are as a person. He infomed me I have an incarcerated umbilical hernia he can repair at the same time, as well as he is pretty sure I have sleep apnea, judging by my symptoms.

He ordered a sleep study for me, wants me to see a psychologist (this he has everyone do), gave me preop labs to have done and informed me I would have to take an injectible blood thinner 5 days before and 5 days after surgery. This is because I am on coumadin therapy for a Pulmonary Embolism I had while 8 weeks pregnant with my daughter. I was so excited..I was really doing this. I was already thinking of "when I'm healthy/thinner" in terms of the future. "When I'm thinner I want to get a dog and walk it every day", "Once I'm thinner we can go on vacation where we have to do some hiking", etc.

Then, reality set in. I called and made an appointment for my sleep study. I got a call back from the hospital I am supposed to go to saying the insurance denied the test!!!! They want 12 months medical documentation about sleep problems. WTF????? Sleep apnea can be deadly, people with sleep apnea are at a higher risk of heart attacks an other issues. Here is a little info on the comlications of sleep apnea:

Complications

Sleep apnea is considered a serious medical condition. Complications may include:
Cardiovascular problems. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system. About half of people with sleep apnea develop high blood pressure (hypertension), which raises the risk of heart failure and stroke. If there's underlying heart disease, these repeated multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from a cardiac event.

The more severe the obstructive sleep apnea, the greater the risk for high blood pressure. In contrast, central sleep apnea usually is the result, rather than the cause, of heart disease.
A study published in November 2005 in the New England Journal of Medicine reported that obstructive sleep apnea greatly increases the risk of stroke, regardless of whether a person has high blood pressure. However, effectively treating obstructive sleep apnea can lower blood pressure and the risk of other cardiovascular diseases.

Daytime fatigue. The repeated awakenings associated with sleep apnea make normal, restorative sleep impossible. People with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may have difficulty concentrating and find themselves falling asleep at work, while watching TV or even when driving. Children and young people with sleep apnea may do poorly in school or have behavior problems.

Complications with medications and surgery. Obstructive sleep apnea also is a concern with certain medications and general anesthesia. People with sleep apnea may be more likely to experience complications following major surgery because they're prone to breathing problems, especially when sedated and lying on their backs. Before you have surgery, tell your doctor that you have sleep apnea. Undiagnosed sleep apnea is especially risky in this situation.

Sleep-deprived partners. Loud snoring can keep those around you from getting good rest and eventually disrupt your relationships. It's not uncommon for a bed partner to sleep in another room, or even on another floor of the house, to be able to sleep. Many bed partners of people who snore are sleep deprived as well.

People with obstructive and central sleep apneas may also complain of memory problems, morning headaches, mood swings or feelings of depression, a need to urinate frequently at night (nocturia), and impotence. Gastroesophageal reflux disease (GERD) may be more prevalent in people with sleep apnea. Children with untreated sleep apnea may be hyperactive and may be diagnosed with attention-deficit/hyperactivity disorder (ADHD).

Geez...even if I weren't having the lap band done I would still need surgery for the hernia. How can an insurance company deny you this life saving test?????

The surgeons office faxed my preauthorization request for the lapband surgery in today, I am waiting (none to patiently) for the answer. I have a terrible feeling it will be a denial, comsidering they don't want to pay for a less expensive, possibly life saving test.

More when I get an answer.

posted by Julie's Journey @ 2:22 PM 0 Comments

The F word

I have been overweight (OK.I'll say the word..Fat) my entire life. While we are on that subject, when did fat become a bad word? It is a description, nothing more. Unless you are fat. Then it can be used to hurt. Believe me...my feelings have never been hurt if a stranger has come up to me and said "Boy, you are a redhead" It is just a descriptive word. But being a redhead does not bring back feelings of insecurity, crueulty and teasing. Being a redhead doesn't make you feel less worthy, afraid you will not fit in restrarant chairs, theater or airplane seats. Being a redhead does not make you flinch when kids (or worse, adults) make fun of you, it does not make you accept unacceptable behaviour from others. It's just a description.

posted by Julie's Journey @ 9:48 AM 0 Comments
Julie's Journey

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Julie's Journey
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aurora, CO, United States
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