The waiting

Anyone that knows me knows that I hate waiting.  I have little to no patience.  And it is only exacerbated when I have no control over the situation.  So waiting for office staff and my Insurance company to get the paper submitted and make a decision was so HARD for me!  The office staff at Spokane Plastic Surgery did a great job getting the information submitted.  However my insurance company did not necessarily do a good job receiving the information or being consistent on what they wanted submitted to consider the surgery.  This made me crazy.  I would call the Insurance Company to be told that my Drs. office did not send pictures or start a file properly.  And then hear from SPS office staff that the Insurance company did not request pictures or start a file for them properly.  All I can say is that Alicia at SPS is a saint!  She worked so hard to make sure the Insurance company had what they needed and in a timely fashion.  She dealt with my weekly sometimes daily (ok 3 times daily) phone calls for updates with complete courtesy and professionalism as did Toni!  Even when I was losing patience with them and maybe not being my sweetest self  (I'm sorry Alicia and Toni).

Additionally Toni and Alicia gave me clear ad reasonable expectations that it usually takes 30 BUSINESS day so about 45 calendar days to get an answer from an Insurance company.  They tried to gently set me up to not freak if we still were waiting in January.  Oh man did they try.  But I REFUSED to accept that answer.

I knew that with my original Gastric Bypass Surgery approval that the squeaky wheel gets oiled with my Insurance company.  I called for updates, spoke to the nurse that actually makes the decision and made sure she had all the documents that were required for my WLS.  I  believe it was because of my diligence that I received approval for gastric Bypass Surgery in such a short amount of time.  The difference there was that I had tests that had to be preformed and sent back to them before they would approve it.  But once they had all tests and all the information my approval was made within days, not weeks.

I approached my Abdominoplasty with the same attitude.  If you speak nicely, follow up with the decision makers and make sure they have everything they need then the process will move more quickly. Additionally, in making my follow up calls I got to actually speak to the Nurse Manager that makes the decision on my surgery.  I got to plead my case to her and explain all my health issues related to the extra skin.

I don't want to share too much, mostly because it is embarrassing and most people don't really care.  However if you are reading this blog to find a way to get your surgery covered by your insurance company it may be helpful to hear how I got mine approved.  The primary issue was the extra skin kept getting infected.  No matter how clean and dry I kept my skin I had recurrent nasty itchy skin infections under the apron of skin and in my belly button. I had gone to both my primary Dr. W and my WLS Dr. V over the past 2 years and been treated for these infections.  I refilled prescriptions multiple times over the years.  In the summertime was the worse.   This is what all of my Drs sighted for my primary complaints in their letters of support to the Insurance company.

What I also got to tell the nurse at the insurance company was that I suspected I had a separation of my abdominal muscle which makes me at higher risk for a hernia.  This separation happens from being morbidly obese as well as carrying 4 babies to full term.  And my babies where big squishy 9 pounders.  :)  Also you can get hernias or increase your risk of them developing anytime you have abdominal surgery, of which I have had my bypass but also in 2004 I had my gall bladder removed. By pulling that muscle separation back together, it could help prevent hernias.   I also got to tell her how the extra skin was effecting my ability to exercise.  I told her stories of how I had to strap the skin down to run, or do any cardio with spanx or other binders.  And lastly I bared my soul to her and told her the extra skin was negatively effecting my marriage.  I felt unattractive due to my extra hanging skin and it was effecting my sex life and thus my marriage.  (Please note:  these were MY hang ups.  Tim never once complained or probably even noticed the extra skin.).

The nurse told me she had everything she needed to review the surgery and she would be making her decision soon but gave me the standard "it can take 30 days to make a decision".

Again with the waiting.  By this time we were past the middle of December.  I actually told my husband that despite all my efforts it would probably not happen before the end of year (and thus in time for us to use our already paid deductible since my transfusions over the summer were so expensive).  I was doubtful we as a family could come up with the deductible plus our co-insurance for this surgery until the end of 2015 if we couldn't take advantage of what we had already paid in 2014.  So even if I got approval after January 1st I could not have the surgery for another year.  I was sad.  But with my 15 year wedding anniversary on the 18th of December, Christmas fast approaching and my oldest sons 12th birthday coming up on the 29th I just put my disappointment aside and focused on my family and the holidays.