Insurance Shenanigans

First of all, my insurance should pay for the hiatal hernia portion of my surgery. That is covered, however, as of yesterday - it was denied because they didn't think that the code provided by my surgeon was "specific" enough. 


FFS.


So I had to get the insurance co, the billing dept from my dr, and me on a three way conference call.  The billing dept confirmed that the coding is correct and all submitted documents were received.  Then insurance co. decided they would resubmit that code and see why it was rejected, as the code is correct and the denial gave no specific reasoning for the rejection. So the wait continues, as the insurance co attempts to weasel out a real reason from the "denial dept". 


I'm going to go ahead and assume that they just flat out deny all claims the first time, for no reason other than to see who really needs the surgery. Which (as a Canadian living in the US makes me SICK).


In 2012, after my first surgery with the hiatal hernia (insurance approved) repair and VSG (self pay) , I had a year long fight with the insurance to pay the portion for their portion of the bill for the hernia repair.  They denied the claim after first approving it because.... they claimed that the reason for the hernia repair was obesity, and they don't cover weight loss surgery. *BOGGLE*


I had to basically had to start a month long calling campaign and then threaten to sue them over the cost of the hernia repair. They finally acquiesced.


The hoop jumping required by insurance is brutal.


I am a smart, organized individual and they make it very difficult.   I am fully aware that they will very likely pull the same shenanigans this time - starting with denying my right to have my hiatal hernia repaired. 


So, I will document it all carefully, and then spend the next year post surgery fighting with them, but I won't play nice from the start. I'll just go straight to the jugular.


The worst part of me, is that this is just taking a lot longer to get done than I was hoping. I was really hoping that I would have a surgery date now, and I would be able to start planning my life around that. 


But... I guess I can count on this...

I am a terrible failure at weight loss

I am a terrible failure at weight loss.

I have been my whole life and so why would that change in my 40’s?  In letting go of trying to be “good at this” and accepting that I need more help (revision), I am doing myself a favor.   

 

I have already talked about how I don’t like to “blame” me for failing the sleeve, but the truth is that I did a lot of things wrong.  Stuff that I knew I shouldn’t be doing, but it was easy, familiar and comfortable.  I did a lot of good things, and I changed significantly, however, I want to take time to look at what I want to do now that I have more information and experience.

 

I have been seeing a lot of newly sleeved people doing things (that I also did) that lead to decreased weight loss. Specifically - Eating small quantities of shit food, and saying things to justify them. IAMGUILTY TOO....I used to say all of these things to make myself feel better about eating bagels, ice cream, chips, cookies, candy, etc. etc. 

• It’s just a little
• I still have to enjoy myself or what's the point
• I can’t eat anything else
• I can’t tolerate anything but carbs today
• Sugar is fine
• I’ll never have a life without being able to eat X (insert whatever food is your poison of choice)

 

These shitty foods feel good to MY brain, and in so…. I was willing to overeat more of those foods and damage my results because the BRAIN GOOD overrode the STOMACH BAD feelings. Overeating, overeating, overeating.  

 

The reward was worth the agony, and that agony lead me here.

- I can eat 3+ cups of food in a sitting.

- I can easily eat 3,000cal a day

I have learned a lot of things about the sleeve and bariatric surgery through trial and error, as many of us do.  I am one of many that has become obsessed with food in a completely different way from when I was super obese.

 

In the last few months while thinking about getting a revision, getting my consultation, check-ups, and now waiting on an approval and date for surgery - I have been introspectively looking at my behaviors and thinking about the corrections that I want to make this time with my revision:

 

1. Eat more “whole foods” in the puréed, mushy and beyond stages. 
- Eat less pre-packaged bars, cups of pudding or jello, easy soft carbs like oats and grits mixed with protein powder.
- I bought a blender to purée my own meats, I make my own soups now, and I’ll have a LOT more eggs in all its variety of forms. 


2. Stay off the Gawd Damn carbs.
- I went straight to bread as soon as humanly possible, but I had been eating oats, grits, and soft carbs like that for my soft and purred stages.


3. Better hydration. End of statement. 


4. Stop thinking of my new stomach size as a challenge.
- I used the sleeve as a challenge instead of a tool. How much can I get in there, instead of how much should/can I put in there. Be more mindful.


5. Eat slower. I'm still a wolfer instead of a chewer.



6. Take full advantage of the honeymoon period.
- Last time I thought the easy & fast weight loss would continue for(ever) or at least a year or more. It came to a quick halt after about 4 months.  Then I had another 8 months of slow losses, and then… stopped.


7. Exercise.
- I didn't do anything at all the first time. I bought a treadmill for this time around, walking more will happen and does happen now.


8. Forget what others think.
- First time around I worried about what people would think about my food portions so I was always trying to eat more to appear "normal".  
- Avoid eating out with co-workers, that is a big one.  Everyone wanted to eat with me and talk about my weight loss… ironic!  I spent entire meals trying to look “normal”, this is no longer a concern for me.  I’m busy and I bring my lunch.


9. Better meal planning.
- I was always good about getting in my protein, keep at it.
- Keep packing my lunches. Make more meals at home.


10. Set better goals!
- I was so excited to have lost even 30lbs that I didn't care if I ever lost another pound again. That changed!!


11. Stay away from dessert longer.
- I always followed up meals with a spoonful of whatever was for dessert, and stating that “one spoonful can’t hurt, look at how good I’m doing etc”.
- Food will always be there – so no need to eat dessert every night.