Awaiting approval UTMB Galveston

pneschich

I've done my 6 months as required by my insurance, had all the tests and visit with the psychologist. I have lost 45 pounds. I got denied last week. It was awful. The insurance company wanted a weight from 2013. It should have been there and wasn't. I got the hard copy and delivered it. Thursday my Dr. has a peer to peer phone conference that I assume will go fine. I should be able to schedule after that, barring anything else.
Has anyone else gone through UTMB? How quickly do you normally go from approved to surgery. The limbo of not knowing is stressing me. The "after" and the "forever" part scare me. I can't wrap my head around a 800-1000 calorie diet. I can't believe my dr wants me to drop to a weight that's less than I graduated high school at- a long long time ago. I'm worried about going back to work on a liquid diet and having no energy. Basically I'm worried about stuff in the future that may or may not be a problem. I know that but it gnaws at my mind. Another thing, why do so many more women do this than men? Where are my skinny brothers?

akindofmagick

2013??? It is sooo maddening, the hoops they make you jump through! Best of luck!!

I went back to work after a week, still on liquids, and was fine - and I was 56 years old. There are always more women on forums than men. Look around the forum for a men's group?

I tell my kids: don't borrow trouble. Worry about the things you can do something about TODAY, and let tomorrow take care of itself until you get there. e.g.: Sufficient unto the day is the evil thereof. I found the post-surgery process surprisingly easy to follow, and 800-1000 calories filled me up perfectly (and then some).

YOU CAN DO THIS, FELLOW TEXAN!!

StevenGarrigus

Hello pneschich, fellow er..."Fellow" here! I had my surgery on 08/18/2016. Not sure about your insurance company or their "requirements" to approve you, but my insurance is through UMR (United Healthcare) which sucks, but wasn't as bad as what yours sounds like! I had to have a six month supervised diet, psych exam, bloodwork, EKG and my primary physician had to write two letters of approval. One stating I am physically fit for the surgery and one saying I would be a good candidate as it would improve my quality of life. Yes, two separate letters to say basically the same thing. I went to my first seminar to get the info about the procedure back in October 2015 at which time I picked out which surgeon at the hospital I wanted to perform my procedure. Turns out, my doctor of choice Dr. Scott retired left to pursue other endeavors three months into my supervised diet, so I switched over to Dr. Minkin who also performed my wife's surgery back in 2012. The only holdup after the six months (which was agonizing and aggravating as all get-out) was the insurance company kept saying they wouldn't approve the procedure because the doctor wouldn't give them a surgery date. The doctor's office wouldn't schedule a surgery date because the insurance company wouldn't send them an approval letter. I tend to 100% believe UMR was at fault, since I know over a dozen people with the same insurance that have had no issue, several of them at the same surgery center and doctor that I used.

As for the surgery and what life is like afterward, I can only tell you how my experience has been as it is different for everyone. Before surgery, I was that guy who ordered a Double Quarter Pounder meal at McDonald's. Large fries, large Coke and an extra Triple Cheeseburger on the side. Why not? I was always hungry. I was always thinking about what I was going to eat. It was constantly on my mind. After the surgery? I eat a measured cup of food at most per meal. I kid you not. I don't think about food. I don't crave food. Food tastes good, but I am happy with eating what I can and don't push it. I don't feel any need to. I eat an average of about 1,000 calories a day. Some days more. Some days less. Within a week after surgery, I started having "zaps" of energy. Laying in bed, suddenly I would just have this burst of energy like my adrenaline kicked in. I started walking. I find myself just wanting to take off running now. Just because I CAN run now. My OCD that has dominated my life has all but disappeared. I no longer check light switches on the stove repeatedly. I don't check the car handles more than once when I get out and lock it. My life-long obsession with collecting "things" no longer affects me. Since I was a kid, I went from collecting Transformers and G.I. Joe's to comic books, to Star Wars to video games to.....you name it. I just HAD to collect something! Now the only thing I find myself buying is new clothes because I have shrunk.

Ultima_Morpha

pneschich wrote: »

I've done my 6 months as required by my insurance, had all the tests and visit with the psychologist. I have lost 45 pounds. I got denied last week. It was awful. The insurance company wanted a weight from 2013. It should have been there and wasn't. I got the hard copy and delivered it. Thursday my Dr. has a peer to peer phone conference that I assume will go fine. I should be able to schedule after that, barring anything else.
Has anyone else gone through UTMB? How quickly do you normally go from approved to surgery. The limbo of not knowing is stressing me. The "after" and the "forever" part scare me. I can't wrap my head around a 800-1000 calorie diet. I can't believe my dr wants me to drop to a weight that's less than I graduated high school at- a long long time ago. I'm worried about going back to work on a liquid diet and having no energy. Basically I'm worried about stuff in the future that may or may not be a problem. I know that but it gnaws at my mind. Another thing, why do so many more women do this than men? Where are my skinny brothers?

It is more likely the restrictions and requirements of your insurance company than UTMB that is the cause of the long approval period; assuming, of course, that UTMB has submitted all that they should. I started my process with a Cigna insurance program with a UT Physician's surgeon in March and I had my surgery in July. I could have had it in May or June, but I had scheduling conflicts and July worked better for work and family.

Times are changing, but I think that traditionally woman feel more pressure to be slender and are therefore more likely to undergo surgery. Men also generally, are more successful at weight loss efforts due to having a higher ratio of lean body mass as designed by nature.

Of course, every individual is different!

I wish you luck in the rest of your process. Take advantage of the months before and immediately after surgery to maximize your losses and change the habits that need changing!

pneschich

@Ultima_Morpha thanks, im not doing it for looks doing it for life.
I think it was UTMB not sending or not double checking what was necessary. They are doing a peer to peer Thursday so I think I will have a positive answer. I have all the check boxes and all the requisite co- morbidities. I've done everything required. I am ready.

pneschich

OK, Thursday and no phone call. They will call tomorrow. Right?

StevenGarrigus

I hope they call you. In my personal experience with UMR insurance, I played hell getting my date set. After I had completed all the prerequisites, the insurance company kept refusing to give an approval because the surgery center wouldn't give them a surgery date. The surgery center wouldn't give a date because they didn't have an approval that they would be paid. This went back and forth for about six weeks. I was exasperated. The surgery center finally told me on the phone "Just tell them August 19th." Which wasn't a real date, just a placeholder. I called the insurance back. Bam. Letter in the mail three days later of approval. It was the insurance company being *kitten* or just plain incompetent. A true example of the left hand not knowing what the right hand was doing.

I was actually done with all of my tests, diet, appointments, etc. at the beginning of May. UMR has 30 days to give a "Yay" or "nay" on an approval. They first kicked it back because my primary physician sent a letter of recommendation, but NOT a letter saying it would "improve my quality of life." Yeah. They have to send in two separate letters. So that held things up a couple of weeks. Got that done. Surgery center sent everything in again. Oops. Sat in the wrong department for two weeks. How does this even happen? It's not like I'm the only person trying to get the surgery, right? Now a month has gone by with nothing accomplished because of the insurance company's BS. So now my 30 days starts for them to make their decision. We are in July now. Then we start playing the game of not getting approved without a surgery date. After we oke-doke around with that for several more weeks, we are at the tail end of July. Finally got everything approved and actually had the surgery on the 18th. I was put into the system for the surgery which typically takes about 2-3 weeks to get fit into the schedule. So all in all, around 3 months wasted because the insurance company's ineptness. That is three months that I could have been losing weight.

But it's all good. It's done. I feel fantastic. I've already lost 50+ lbs. I feel healthier than I have since...well, since as far back as I can remember really. High school maybe? I've kicked soda, sweets (aside from an occasional piece of hard candy), caffeine and fried foods to the curb and haven't missed them or looked back.

pneschich

Got Denied, again. Same reason. I hand delivered it but the info wasn't conveyed to the doctor. Have to appeal now. Anyone know how it goes from here?

StevenGarrigus

I'm not sure my friend. Each insurance company/HMO/whatever is different with the hoops they make you jump through. I hope you get your answer and an approval very soon!

akindofmagick

Keep squeaking!! You'll get there! I was denied the first time, denied on appeal, got older and fatter for 3 years, went thru the whole dang process again, and finally got my surgery. VERY HAPPY. (annoyed at the delay, but VERY HAPPY!)

pneschich

I spoke with the insurance facilitator at the clinic. Apologetic, sort of. Faxed over a letter and my complete record, noting the page where the complete weight history is. I may get an answer before Thanksgiving as the clinic gave them a proposed surgery date of 11/28. I. Worried it isn't going to happen I'm worried it's going to happen at the wrong time.
Sitting outside of the support group waiting to see who comes. Pot luck social tonight, didn't RSVP, can't stay just want to say hi. See if it will lift me from my funk.

StevenGarrigus

There really isn't a "wrong" time to get your approval. Hope you get some good news!

pneschich

Thx Steven. You're right but with the holidays and kids and family coming in I would like to be able to pull my weight. In my mind I was going to have this done by now and healing. So, I'm Extra frustrated with the delay I'm ready to go.