Weight Loss Surgery - 1 week until surgery, still not approved. Kidney stones too




Disneygirl52
04-08-2013, 11:15 PM
I'm just so frustrated. I'm scheduled to have gastric bypass next Tuesday. I've been denied, I've been sent for every test under the sun. My surgeron finally resubmitted everything to tricare last Thursday and now I can do is wait and pray. Then yesterday out of no where I start having severe pains in my back, I went to the Er and found out I have multiple kidney stones, fantastic. I hope this wont effect the surgery. I'm thinking of not even telling my surgeon, although he is in the same network as the Er so I'm sure he'll find out. I haven't even started my diet as I have no idea if the surgery is even gonna happen. Why tourture myself?
:?:


jiffypop
04-09-2013, 09:26 AM
you HAVE TO tell the surgeon. he needs ALL the information - yes, even the stuff you don't want to admit - so that he can take proper care of you. And he'll be able to tell you if it's safe for you to have surgery so soon after the kidney stones [yikes!!!!]

and i'm soooo sorry you're hitting so many roadblocks and challenges. but please take care of yourself while you're jumping over them and banging into them.

Disneygirl52
04-09-2013, 11:10 AM
Just got the call that surgery isn't happening. My dr office resubmitted my package with the additional test results tricare requested ( cardiologist, blood work, pulmonary dr, & chest X-ray ), they are now saying I need to appeal that denial.


jiffypop
04-09-2013, 01:57 PM
good grief. please hang in there - take a deep breath - and get ready for a long heart to heart with your doc and perhaps with your insurance company about exactly why they denied the surgery. it could be any number of reasons - including administrative stuff that have nothing to do with your health.

amandie
04-09-2013, 02:07 PM
you HAVE TO tell the surgeon. he needs ALL the information - yes, even the stuff you don't want to admit - so that he can take proper care of you. And he'll be able to tell you if it's safe for you to have surgery so soon after the kidney stones [yikes!!!!]

and i'm soooo sorry you're hitting so many roadblocks and challenges. but please take care of yourself while you're jumping over them and banging into them.

good grief. please hang in there - take a deep breath - and get ready for a long heart to heart with your doc and perhaps with your insurance company about exactly why they denied the surgery. it could be any number of reasons - including administrative stuff that have nothing to do with your health.

I doubly second what jiffy said! I'm so sorry this happened and just keep hanging in there! :hug: I will be praying that you get approved ASAP!

Disneygirl52
04-09-2013, 04:06 PM
Thanks ladies. It really helps to have this site, it's been the first place I turn.

I just got back from my surgeons office, I had to sign a paper giving them permission to do an expedited appeal on my behalf. I should know something by Friday, surgery is Tuesday. At least there is hope.

Has anyone ever done an appeal like mine?

thinkfit
04-09-2013, 04:19 PM
I haven't had (and hopefully wont! :( ) an experience like yours so I can't give much advice, but I'm just popping in to wish you luck! Stick to it, I really hope it works out for you <3

2Chi
04-10-2013, 02:51 AM
How horrible!! Hope the appeal works!

Zeitgeist
04-10-2013, 05:15 AM
I was initially denied due to some missing paperwork from my PCP. If I'm not mistaken, I think my surgeon's group also had to submit appeal paperwork. Once they received all the missing forms, the appeal approval happened fairly quickly (within 2 days if I recall). Good luck!

Disneygirl52
04-10-2013, 11:13 AM
Zeitgeist- that's good to hear! This waiting game is killing me! I really hope it's approved. I have been waiting so long. My parents, sister and husband all took vacation to be here for me. I've schedule my sons 1st birthday party around the surgery. I wish I could just crawl in a hole until I get an answer.

Disneygirl52
04-11-2013, 12:07 PM
Guess what......

I'm approved!!!!

elvislover324
04-11-2013, 12:14 PM
Guess what......

I'm approved!!!!

:carrot::carrot::carrot: So happy for you!!! I was following this thread hoping you got your good news soon!! Good luck!!! :carrot::carrot::carrot:

amandie
04-11-2013, 01:10 PM
Guess what......

I'm approved!!!!

Whoo-hoo!!!!! So happy for you! What a relief! :hug:

thinkfit
04-11-2013, 02:31 PM
YAY!!!!! omg! I had my fingers crossed for you, so glad you didn't have to have this drawn out any longer!

:congrat:

jiffypop
04-11-2013, 04:41 PM
good heavens!!! what changed??? ?congratulations! ya know - i've heard of some companies that'll turn people down for <fill in the blank here> just because they don't think the person will appeal the denial and they won't have to pay. and then when the appeal is filed, they approve it quickly.

wow. i'm so happy for you!!!!

Zeitgeist
04-11-2013, 07:35 PM
Yeah!! Good news indeed!

Disneygirl52
04-11-2013, 11:20 PM
When they denied me a couple weeks ago they requested more tests, within 2 weeks I completed those and they were sent in. Well apparently their process requires an appeal to every denial before they'll look at anything even though we were told to just fax over the results within 30 days. Thank goodness I called and found out about an exediated appeal.

Disneygirl52
04-11-2013, 11:29 PM
So about this pre- diet, I plan on starting tomorrow. I honestly didnt think I would be approved after being told I was denied. Oh well, better late than never.

I'm also still nursing my son at night. I know I can't do it after surgery and I'm more than ready to stop, I'm just not sure he'll agree :) Luckily hubby took off all week to care for the kids and me.

Oh another question - My monthly is due on the day of my surgery. That shouldn't be an issue right?

2Chi
04-12-2013, 12:41 AM
WooHoo! Congrats!

mom2sands
04-12-2013, 10:11 AM
So glad for your approval!