250lbs Lost!!! & Now Success W/ My Insurance Company!!!

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
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