Yep, it's a big word - and it was a new one to me.... until January. That's when I was advised this was the procedure which would get rid of my excess skin. Some doctors do an abdominoplasty (a "tummy tuck"), but that is more involved and I would assume more difficult to get approved through insurance. A panniculectomy is strictly the removal of excess skin, whereas abdominoplasty (I've come to learn) has muscle involvement and sometimes some liposuction.
Now for the insurance part. I'm all but pulling my hair out over this one. I first saw the surgeon about this surgery on 1/8. I was put on the scheduled for 3/7, pending insurance approval. And there I sit - waiting. I have asked friends to pray for patience as I wait to hear one way or another so I know what step comes next. Well, push came to shove last Monday and the insurance company still showed my pre-cert request as "pending" so the doctor requested my surgery be pushed a week to 3/14, as it can take up to 15 days to receive a determination. UGH! My need for patience grows with each passing hour. I cannot get my pre-op EKG and blood work until I get approval because they will not pay for the workup. So I wait. And wait. And wait some more.
I got tired of waiting. We had a snowstorm here on 3/7 so I called my insurance company, knowing my doc's office would be closed. I was told that additional information had been requested the previous Saturday (say what?) by fax and they hadn't received anything in response. I was told some vague information about needing more evidence of prior treatments tried. Well, that was something I could get on! With my Mom being a nurse at my gyn's office (and my gyn being the one to document the rash which is the medical need for me to have this surgery), I called her up and she got on it when she got to the office the next day - after the storm. I received a letter from the insurance company on Thursday stating that they needed the pictures SNAIL MAILED in addition to the extra documentation. I immediately picked up the phone and called "K" (the surgery scheduler) to see if this was something I needed to handle. I left her a message, but didn't hear back from her that day. So...more waiting. Friday, K called me that she was on hold with the insurance company for an hour, transferred 3 times and eventually wound up in a voicemail. When she got a return call, she advised them that she needed to email the pictures (I mean, c'mon people, it's 2018 - it should not be that hard!) and that I'd already been rescheduled once and they didn't want to have to do it again. I let her know that I'd been in touch with the other doc's office and they had prepared documentation of other treatments used. She gave me her direct fax number so there'd be no delay.
And then there's more waiting because it's the weekend.....
Monday rolls around and I lose track of time until the surgeon's office was closed. So I picked up the phone and called the insurance company again. Thankfully I've gotten some incredible people (shy one) every time I've called. This was no different - if anything, it was better! I got a wonderful Customer Service (CS) rep who said that my account still showed that they were waiting for information. FOR REAL??? I'm supposed to have surgery in TWO DAYS and the requested information isn't there? The CS rep stayed on the line and called Utilization Management (UM). She helped me talk to her and the CS woman asked the UM woman if there was a place in their department where things sometimes got lost. Sure enough, the UM woman found the pictures and documentation! Praise God! The UM rep said she'd send my case along to a nurse reviewer with expedited status, but that it could still take 48 hours. I didn't have 48 hours! When the UM woman hung up, the CS rep asked me if I'd like her to check on my case first thing the next morning. It's like she was an angel.
After an incredibly restless night with very little sleep, I climbed out of bed and took the phone into the shower with me - because don't all important calls come through when you're in the shower? Well not this one. Sigh... It's TUESDAY and I don't know if I'm having surgery the very next day. I know that the hospital would call between 2 and 5 to let me know what time to show up the next day. I also had an appointment that would have me away from the house from 1:30-5:00 and my anxiety was through the roof.
11:15 am (Tuesday) comes and the PHONE RINGS! It's the surgeon's office. I anxiously picked up the phone to hear K on the line saying that it was approved!! The insurance company neglected to mention that the 15 day clock reset when the new information arrived. Thankfully, the power of prayer is strong and it was put through in 18 hours! I had a huge adrenaline rush and was super excited. Then it hit - I'm having a massive surgery the very next day. I'd put so much time and energy into getting it approved that the reality of it didn't hit until that moment. Before I left the house at 1:30, the CS rep at the insurance company called and told me that it had been approved! She gave me numbers that I needed and I was so touched and impressed that she followed through on what she said she'd do. There is a time difference so when she called I did already know, but I didn't tell her that; I was just so impressed that she went that extra mile! The Hospital did call and let me know that I had to be there at 12:30 pm. It wasn't ideal, but at that point I would have shown up at 2 am or 6 pm (fasting, mind you) if they told me to!
Keith and I arrived at the hospital early - in part because that's my personality and in part because we have to travel a road which is constantly under construction, unpredictable, and generally known for being horrible so it's always necessary to allow extra time when we travel on this road. I gave my information to an admin person, went back to the room and spoke with the nurse who checked me in and then I changed into the gown and got my IV. I reviewed a wide array of information with no fewer than 4 people (when did you last eat? drink? take <each> med/supplement/vitamin? blah, blah, blah...). They were all very efficient and things were moving smoothly. Then people kept coming in asking if the doctor had been in yet. I repeatedly had to say "no." They called him and said he'd be over any minute.
He arrived and it was almost as if I heard a choir of angels. He sat down and started to go over a list of questions I'd sent back in January. If you've had surgery, you know they will draw on you so everyone is in agreement before the surgeon makes a cut. He started to do that and then.... then he got to the sagging skin. He lifted it up and the rash - the whole reason I need the surgery - was too infected for him to operate. It's exactly where he'd be making the incision and the risk of an infection getting into my system (something I'd be dealing with for months) was too high. There was no room for negotiation. The risk outweighed the benefit at that moment. I tried my best to not lose it in front of him. He was visibly upset telling me. I've known him for years and we've shared some very heavy conversations. He said he'd put me on a 10-day course of antibiotics and an anti-fungal and advised me to take impeccable care of it until we schedule again for 2 or 3 weeks. I asked for 2 weeks, but of course it depended on when there was a time slot available in the OR.
The nurse couldn't come in fast enough to yank out my IV so I could put on my street clothes and get out of there. I just wanted to go home. If you recall any of the story of my bariatric surgery, it was the same outcome of a failed attempt. That time, however, I was under anesthesia and my blood pressure plummeted to the point where I nearly died. The pumped meds into my IV for 40 minutes trying to get it back to a normal level, but it never leveled out. When I woke up and was asked if I was in any pain, I was pleasantly surprised to say that I wasn't. Only later did I find out why and I was devastated. I had been working towards that day for 4 months and done 2 weeks of a liquid diet only for it to fail. This was just reminiscent of that.
One thing the doctor hadn't told me at my initial consultation was that in his experience, only 1 in 30 or 40 people get approved for insurance coverage. That's about 2-3%. I'm not sure if it was the amount of information put in front of the reviewer or the content, but it worked! I feel so thankful and so blessed to have had K and my Mom advocating on my behalf.
Let me say, if this is a procedure in your future or that of a loved one, please, see a doctor often and make sure there is consistent documentation of the issues your excess skin is causing. Don't be discouraged by the numbers above. Be consistent with getting those medical issues documented! I'm convinced it's what made the difference...what had me in that 2%!
I hadn't gotten home yet and K had called, leaving a message that she put me on the schedule for 4/6. I just had to call her to confirm. When I did, she reiterated that the doctor was really upset and that she was shocked after all we'd been through to get the approval.
If you're a prayer warrior, I'd love any prayers for my patience during this time and as I struggle with understanding why the disappointment. If positive thoughts are more your style, I'll happily take those!
So now I wait...again. I'd like to think that I'm not waiting alone. I'd like to think that anyone reading this blog is waiting with me. I'd like to think that my little blog can be far-reaching. The goal of my transparency with this little blog is to impact others. I want to be there to answer questions, to offer encouragement - not only with my bariatric journey, but in general. But if you know someone having bariatric surgery, or considering it, don't hesitate to give out my blog information. Reach out to me. Have someone with questions reach out to me. If you've read my blog for any length of time, you'll see I'm somewhat of an open book with many difficult topics. I try to be intentional with what I share and sit back and hope that it touches someone....better yet, lots of someones. Make comments. Ask questions. Reach out.
