250lbs Lost!!! & Now Success W/ My Insurance Company!!!
Bootjockey
Posts: 208 Member
Soooooo...here's my deal...here's why yesterday was such an wild ride...most of my friends here know that I've lost a lot of weight...250lbs, as a matter of fact. I don't have many "new" friends, they are mostly "vintage" friends, who've known me for a long time. So you knew me at my heavy weights. I started out at 450ish pounds, and am now down to around 207. I've been as low as 202, but 207 ...is what I "maintain", and consider my goal weight.
Since I lost that amount of weight, fat goes away, but the skin lasts forever. Nothing natural does anything about that. You gain a few pounds, you lose a few pounds, that's not a big deal. You lose 250lbs, you're going to have excess skin. When I stand naked in the breeze, I flap like a flag. *lol*
Three times I've petitoned my insurance company to approve a panniculectomy. For those of you who don't know what that is, it's basically the removal of excess skin around the stomach area (the pannus, hence, panniculectomy. A panniculectomy is like a "lite" version of an abdominoplasty) Do a Google search on it, it's out there. As a long-shot, we also requested approval to do an abdominoplasty.
Abdominoplasty is very similar to a panniculectomy, but more intense. In addition to the remove of excess skin, they re-shape and re-contour some, tighten the abdominal muscles, etc. It's sometimes called a "tummy tuck", but I think that's a very poor description.
Anyway, three time I petitioned the insurance company to approve this. I was declined three times, as it wasn't "medically necessary." As you can imagine, definitions for "medically necessary" vary greatly. But I've been lucky, I had a primary care physician (my own) who has followed me closely and taken great care. Perhaps out of the gate the documentation wasn't great, but, she really stepped-up her game after the insurance company denied it, and took great care to document carefully.
Today was supposed to be my "2nd Level Appeal", where I went to Portland (Maine) to present my case to the insurance company. Basically, this was my last opportunity for insurance approval. It's been lined-up, the insurance company has their panel and I am ready, I'm going, My wife was going to go with me, my PCP did all the documentation, and she even agreed to provide testimony, live, on my behalf. Answer any of the panels questions, etc.
Late yesterday morning, I emailed the insurance company representative that I have been speaking with about my appeals. I wanted to ask the best way to submit some new photographs to support my case. She didn't answer for a couple hours, but then she wrote back and asked me to call her. So I did.
What she told me when I called was that the panel was reviewing my records and documentation for today's hearing, and that they felt I (we) had presented a very strong case, and they agreed yesterday, pre-hearing, to approve my petition. Not just for the panniculectomy, either, but for the full abdominoplasty. Just like that, eight months and three appeals are over. Fini. Complete.
Obviously, I'm happy that they felt my case was strong enough. I've certainly worked hard at this, and I really feel that I'd be fine either way, having it done, or not. But I'd always wonder. Well, wonder no more, I guess.
I'm approved.
Couldn't believe it. After three requests and denials, and a scheduled hearing, they changed their minds. I don't have to go to Portland at all today for the hearing. Or to present my case. Or get naked in a room full of people I've never met.
You can see why yesterday was such a roller-coaster day...it really wiped me out.
The surgeon's office told me they could do the surgery as soon as the 18th of this month. I am not certain that I can be ready that fast, but, we'll see. I have to work things out with my boss, first. I would be out of work most of a month, and be on "light duty" most of three months or so. Which is okay, I do do a fair amount of physical work for my job, but I also do a fair amount of desk-work, and my boss has never been anything but supportive. I'm sure we can make it work. I scheduled the surgery for July 17th. :-)
I'm a lucky man. I have a wife who loves me, a job I (mostly) enjoy (and let's be honest, how many can say that?), and support from my doctor, and other's who are around me.
I've a fortunate guy.
Life -IS- good.
-BootJockey
(Admin) - http://www.facebook.com/DoItNowLifestyle
Since I lost that amount of weight, fat goes away, but the skin lasts forever. Nothing natural does anything about that. You gain a few pounds, you lose a few pounds, that's not a big deal. You lose 250lbs, you're going to have excess skin. When I stand naked in the breeze, I flap like a flag. *lol*
Three times I've petitoned my insurance company to approve a panniculectomy. For those of you who don't know what that is, it's basically the removal of excess skin around the stomach area (the pannus, hence, panniculectomy. A panniculectomy is like a "lite" version of an abdominoplasty) Do a Google search on it, it's out there. As a long-shot, we also requested approval to do an abdominoplasty.
Abdominoplasty is very similar to a panniculectomy, but more intense. In addition to the remove of excess skin, they re-shape and re-contour some, tighten the abdominal muscles, etc. It's sometimes called a "tummy tuck", but I think that's a very poor description.
Anyway, three time I petitioned the insurance company to approve this. I was declined three times, as it wasn't "medically necessary." As you can imagine, definitions for "medically necessary" vary greatly. But I've been lucky, I had a primary care physician (my own) who has followed me closely and taken great care. Perhaps out of the gate the documentation wasn't great, but, she really stepped-up her game after the insurance company denied it, and took great care to document carefully.
Today was supposed to be my "2nd Level Appeal", where I went to Portland (Maine) to present my case to the insurance company. Basically, this was my last opportunity for insurance approval. It's been lined-up, the insurance company has their panel and I am ready, I'm going, My wife was going to go with me, my PCP did all the documentation, and she even agreed to provide testimony, live, on my behalf. Answer any of the panels questions, etc.
Late yesterday morning, I emailed the insurance company representative that I have been speaking with about my appeals. I wanted to ask the best way to submit some new photographs to support my case. She didn't answer for a couple hours, but then she wrote back and asked me to call her. So I did.
What she told me when I called was that the panel was reviewing my records and documentation for today's hearing, and that they felt I (we) had presented a very strong case, and they agreed yesterday, pre-hearing, to approve my petition. Not just for the panniculectomy, either, but for the full abdominoplasty. Just like that, eight months and three appeals are over. Fini. Complete.
Obviously, I'm happy that they felt my case was strong enough. I've certainly worked hard at this, and I really feel that I'd be fine either way, having it done, or not. But I'd always wonder. Well, wonder no more, I guess.
I'm approved.
Couldn't believe it. After three requests and denials, and a scheduled hearing, they changed their minds. I don't have to go to Portland at all today for the hearing. Or to present my case. Or get naked in a room full of people I've never met.
You can see why yesterday was such a roller-coaster day...it really wiped me out.
The surgeon's office told me they could do the surgery as soon as the 18th of this month. I am not certain that I can be ready that fast, but, we'll see. I have to work things out with my boss, first. I would be out of work most of a month, and be on "light duty" most of three months or so. Which is okay, I do do a fair amount of physical work for my job, but I also do a fair amount of desk-work, and my boss has never been anything but supportive. I'm sure we can make it work. I scheduled the surgery for July 17th. :-)
I'm a lucky man. I have a wife who loves me, a job I (mostly) enjoy (and let's be honest, how many can say that?), and support from my doctor, and other's who are around me.
I've a fortunate guy.
Life -IS- good.
-BootJockey
(Admin) - http://www.facebook.com/DoItNowLifestyle
0
Replies
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Congrats on your weight loss, you should be very proud of yourself.
Also YAY!!! on getting the tummy tuck paid for! I have lost over 120lbs since my twins were born and I have went to my first consult for the same procedure last week, I have a second one tomorrow! The cost here in Canada is upwards of 10k and I can't get any of that covered. It is my dream to have it done, so if there is a will, I will find a way to pay for it LOL
Keep us posted.0 -
Congratulations and good luck! Thank you for sharing this.
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Your story is AMAZING!! I have also creeped your pics..
And you look GREAT! What a great job! Good for you! 0 -
That's awesome! Congratulations :drinker:0
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Congrats!!! I can't imagine how excited you must be. You've worked so hard and now to really be able to reap the rewards for your efforts once the extra skin is removed must be a wonderful feeling.0
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Congrats !! Very happy for you !!0
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wow !! you have came a LONG WAY !! congrats to you and for fighting your insurance company until they gave in !!!0
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Hey there,
You are welcome to look at my pics, I have no problem with that. I have lots more, but I haven't posted to many here. :-)
-BootJockey0 -
Congrats to you!! On both the weight loss and the win with the insurance company so great!!0
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:flowerforyou: your transformation is admirable :flowerforyou:0
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this is so awesome that you have been approved after the swelling goes down you should def post those before and after pic's on here for all to see Im proud of you and I have never met you Im sure that your friends, family, and doctors are so excited and proud of you it isnt funny!
Good luck on getting things worked out at work and your surgery on the 17th! You are one Blessed man!0 -
Congrats on the weight loss and the awesome news!0
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Awesome news!0
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Congrats on your approval. I just read your success story to my husband. We have both just started using MFP and are very excited. Thank you for your great story...we wish you the best0
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Persistence played a super part in not only your weight loss, but your appeal process. Congrats! Congrats! Congrats!0
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Congratulations! I am very happy for you! You have a great weight loss success story and now the confirmation from your insurance company for the surgery. Way to go!
Congratulations again!0 -
Congratulations. You worked hard and you deserve it. Be sure to post pictures0
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Congratulations! That's such great news!0
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Wow! Between the weight loss and having your surgery approved...CONGRATS!!! :drinker:0
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Absolutely awesome!!!! Congrats!!!! :bigsmile: :bigsmile: :bigsmile:0
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Awesome! You are living proof that persistence is key and anything is possible with hard work and determination! *Never give up!0
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Love a Good news story, and THAT my friend was a Great one. Well done for your persistence in your battle for what was right and Congratulations.0
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Persistence DOES pay off. Congrats to you, I pray that you have a speedy recovery. I wish I could have that done after having twins.0
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I am in awe! I can only imagine the journey that 250+/- lbs loss was like. I applaud your dedication and persistence to change your life and am so happy you have finally gotten the approval you deserve. Just awesome. I feel like crying. Lol. Good luck on your upcoming surgery!
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Great story! Thanks for sharing and good luck with the surgery!!I'm glad everything worked out for you. 0
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Thank-you! I wish you and your husband the best! My wife and I both use MFP, and we are both much healthier than we used to be. She has lost 75-100 pounds (she was a little over 100lbs, but she has regained a little), but she is still working hard at it!
Keep up the good work!
-BootJockey0 -
Thank-you, that is so nice of you to say! I do know how you feel, I know people like that who inspired me, and that's how I felt then too...It's great to feel like I've really achieved something!
Keep up your good work! You two look amazing!
-BootJockey0 -
That's great news! Please keep us updated on your progress.0
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What an amazing story. Thank you for posting it. It gives me a little hope, that when I hit my goal weight, that I may be able to have it done. I've lost over 200, but i still have a ways to go.0
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what an amazing success! In every way, thank you, you inspire!!!!0
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