The process. part 3

After I was done with my appointment with Dr. Schmitt, they let me sit with Gwyn while we both spoke with the patient coordinator, Ashley. She filled us in on what it would take to have insurance pay for the surgery. This part of the process is different for everyone depending on what state you live in and what doctor you use. I had to complete a sleep study to determine if I had obstructive sleep apnea which can cause complications during surgery while under anesthesia. A general physician would also need to monitor my health for seven months. My doctor would fill out forms that documented my activities including exercise routines for the month, what my weight and blood pressure were, and what I did to try to lose weight. It was important that I tried my hardest so Dr. Schmitt could prove to the insurance company that I either didn’t lose enough weight or that I would gain it back.

Our forms would be forwarded to an advocate named Sunny, who would go back and forth with the insurance company to have them pay for the surgery. Some insurance companies are easier to deal with than others. At this point I was sad and frustrated. I had already waited 10 years to get here and now it was going to take almost another year for the surgery to happen. Before we were done with that first visit they took my picture. I didn’t want them to though. I was so big at 323 pounds and ashamed of myself but I knew they needed it for my before and after. I knew somehow I would get through this process and be successful.

YEAR

Having a general physician sign off on this is sometimes easier said than done. I lucked out and my general physician was happy to help me with this part of my journey. He was thoughtful and never made me feel ashamed for wanting to do this. Gwyn couldn’t find a general physician to agree that she needed the surgery right away. Each doctor she spoke with, and she spoke with several, all had their reasons for not signing the paperwork. Most of them only wanted to have her diet and exercise. Others didn’t believe in that type of surgery as a useful tool. Gwyn eventually had to stop her process because she couldn’t find a doctor who would help her.

I got a bill for that first Visit which had to be paid out of pocket because insurance didn’t deem it medically necessary. An hour office visit was 250 dollars and I was upset that it was such a big bill but at the same time I was happy to start the process. I was nervous to be going through this on my own. Looking back on it now, I wish I would’ve opened up to my mom more about what I was going through emotionally. I was not really talking to her about how I was feeling and that is something I wish I could go back in time to change but you can only move forward. She was there to support me when I would let her though and for that I am very grateful.

 

The next seven months went as expected. I would go to my doctor, have the paperwork filled out, they would fax it over and then repeat the process next month. In month 5, my general physician referred me to a doctor for my sleep study. I saw him once in the office and then picked my night out to go to the study. This was delayed twice due to weather and when I was finally able to go it was in the middle of a work week. I was instructed to come in by 8:30 so they could prep me. Which included attaching a lot of wires! They were on my head, chest, legs and attached with goopey goo. They concluded I had severe sleep apnea. I woke up over a hundred times in a 4 hour period and when I did reach the REM stage of sleep I wasn’t there long.

Author: fullonfigure

mom. wife. sleever.

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