kindof! I met with the new PCP this morning and really like her alot. She was very supportive of the band as long as I didn't get it done in Mexico. She said they won't do followup care on anyone that has a procedure done out of the country. So far so good, I only want to go 3.5 hours to Albuquerque lol. Tuesday my insurace carrier told me my PCP office had to get the ball rolling and they would send the requirements to her. Well she had never heard that and had no idea how to get it started without guidelines from ins. So PCP will talk to the office ins coordinator and I offered to call carrier back.
Well I got someone so helpful this time. She read me the basics, first my policy definitely covers the band (lady before wouldn't ever tell me for sure) so that was a relief. You have to have a BMI over 40 w/o co-morbities or 35 with and she read off several. Either way I'm covered, as I'm on BP meds also. No smoking, good there. Then I got a little confused....
She said I needed to be on a supervised diet/exercise program for 6 months, ok heard this Tuesday. But then she said something about being on plan for 3 consecutive months with a weight loss. So this brings up 2 questions she couldn't really answer.....
If over the last 6 mos PCP and I have talked about diet/exercise and I say I've tried does that qualify? or if I pull my head out the next "3" mos and loose weight will that work?
It's a little confusing at this point, which is to be expected I suppose, it is insurance after all. But they are going to fax me the guidelines this afternoon and I'll meet with PCP again. So all in all it sounds fairly hopeful. She was surprised to see that former PCP had me getting a B12 shot only every 3 mos. So she is changing it to every month for a few and recheck my levels. Then they also did a blood draw to check everything else. Plus I've lost 2 lbs since my last B12 shot so maybe these last 2 mos can count toward my 6! lol
And I'm sure I'll learn more about the insurance game when I go to the seminar. As this is the only surgeon, Dr. Adam Smith from Ft Worth, that is contracted with my carrier.
Now I need to start dealing with the tell/don't tell decision. I understand both sides. I've already told my mother that I'm thinking about it and one friend that I used to work with (at in insurance agency no less lol). I quilt with a group of ladies that I'm not real sure about telling because I don't really know them well enough to guess how they will react. But the hard ones are those closest to me, my DH, kids and best friend.
I'll start with best friend..... she's not real keen on WLS. She's worried about the dangers, but as an overweight person herself she understands the dangers of being heavy also. And if I decide to do it I have no doubt at all she will be totally supportive. I'm just a little hesitant for some reason.
Then my kids...... they will be worried I'm sure because there are risks after all. But they'll be glad to see me loose weight for health reasons. I'm just terrified of telling then "yet again" I'm going to loose it and not do it yet again. I could get away with not tell DD, she lives in Phoenix and is going to law school. But DS lives in the same town and works for us. And is nosey....... It would be extremely hard to hide it from him. Even if I only had to miss 2 or 3 office days he would be like a dog with a bone trying to figure out why!
Then there is the DH...... (dont' ask what the "D" stands for right now) I've very hesitant to talk to him about this. I'm sure this sounds complete insane to most of you (if not all) because all the blogs I've read so far say you're married to your best friend. Not so much here. We've been married for 31 years and for the last 5 years we've also worked together. O.M.G. that part is so much harder than what I thought it would be. He's an incredibly hard worker, has provided for us very well (he likes to spend the money and doesn't mind at all if I do too. rough huh? :) I know he loves me and I do love him (altho this may make that hard to believe lol) but my weight has been a source of contention for years. So I know he won't be opposed to the band. But......
What if that contention (or maybe the word I'm searching for is uneasyness? can't find the right one at the moment) is still there AFTER? I know loosing weight won't make be suddenly happy and content. It also know it won't fix whatever might be wrong in our marriage. I've recently come to the realization that this is a big part of why I've self-sabotagded (omg sp?) any efforts at loosing over the last 15 years, I'm scared. And HOLY CRAP I can't believe I'm telling a bunch of strangers this........
So am I happy "now"? no not really, but like anything this to shall pass.
Is it my weight? partly
Is it my marriage? I don't honestly know, because I do love him. But I hear alot "my DH loves me the way I am", not so much here. But has it gone on for to long and we've grown to far apart?
Good Lord I need a therapist............................
But at least now I'm asking these hard questions. For years I ignored them and ate and ate and ate. So I think I'm off to a pretty good start!
T.
oh and thank you all for the nice comments! They made me smile!
Woohoo for the ball rolling! Yay and so glad to hear your PCP is onboard with this!
ReplyDeleteWhat ins co do you have? I'd be curious to know if what they are faxing you is an actual copy of the rider for WLS. If it is, great. If not, go to their website and do a search. That rider will tell you exactly what you have to do. And I know what my ins co told me and what they faxed me were a bit different than what the rider said.
Personally, I'd say don't tell until you know more. And I learned tell only the people that you know you will turn to for support. I regret telling about half the people I told because they doubted this process and even me, in some cases.
Will you have to do a pysch consult for your insurance or for your surgeon? If so, after you do the testing, you'll have an opportunity to talk about concerns. Maybe wait on talking to your (D)H until then. Sounds like a hard place to be.
I think you are off to a great start, too! And what wonderful news to know your PCP is ok with it!
Glad you've got the ball rolling. As for the tell/no tell...such an individual choice. I found that those I thought would be super supportive aren't and the ones I thought would judge...don't. Your DH is a whole other ballgame. This is your husband and as such, I think you should tell him. If only for the power of attorney, medical emergency type thing. Only you and he know what your marriage can survive. Part of it is making clear you want to lose weight for YOU and not anyone else. You might want to try counselling...I've heard it's not only great for a marriage (hehe) but a lot of folks with the band have found it VERY helpful in attempting to achieve their weight loss goals. Good luck!
ReplyDeleteI didn't learn a lot about insuance requirements at my seminar, but the insurance coordinator in my surgeon's office went over all everything at my first appointment. So I went to the info seminar, scheduled my first appointment for the following week and then learned what insurance requirements/tests I had to have done. I have CareFirst in MD and they have the same guidelines as far as BMI of 40 w/o comorbidities and 35 with. I had to do 6 months of medically supervised nutritional counseling prior to getting approval. There are some insurances where if you can show documentation that you've done Weight Watchers, Jenny Craig, etc, they'll put that towards the required 6 months. I have had some rough times with my husband - mostly when my children were younger - and there were times I didn't think we would make it. But we did and now we are stronger than ever. Being married for 31 years and working together for 5 years is amazing. I understand that losing weight isn't going to automatically make you happy, but let's face it - being thinner does make us happier, more confident, more adverturesome, more sexy...this could be a new phase in your marriage.
ReplyDeleteBonnie - maybe they meant it has to be started from the surgeon and not my PCP. Maybe that's where the confusion is coming it. Thankfully I saved most of my WW cards over the years, maybe that will count for some of it :)
ReplyDeleteThanks for the calming comments guys, I think I was having a freak-out moment earlier. It's one thing to think about it to myself, but talking outloud to the doc made it very real. I'm talking to him tonight about it and hopefully the work schedule is to where he can go with me next week.
Hello, I can do this... Wish you had a name but understand about putting yourself out there. I've been married almost 29 years and it hasn't been the true bliss that everyone talks about. I can't say he is my soul mate but there is something I miss when he is away. Things change at every event in your life. Please tell him. I remember texting my Dear Husband (DH) after seeing the surgeon and asking if he would spot the bill (I was self-pay for $16,000) and he replied "any amount" because he knew "I" wanted this and had made the decision myself. I didn't have the band for vanity but health. Looking good will be a great side effect. My DH was worried because I might not be there to grow old with him. And he felt helpless. He lost about 40 pounds and got into good physical shape about 20 years ago and is also a black belt in karate. He cares but knows that harping on my weight would get him no-where. I was only banded just over 2 months ago but I know this time will work. Go for it and tell those closest to you. I also should add that I told my son who is 24 and my daughter who is 26 and they didn't react too much to it all. I did ask them to keep it "secret" unless I let shared. Right now few people know and I am very selective as to who will know but being banded was really the best decision of my life. Sorry for the length of this post, but keep going. It will only get better.
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