Insurance Update.

I got up the nerve to call the insurance company. Thursday makes two weeks since they accepted the paperwork...and the wait is killing me.

I tried to be all nicey nicey. I told the gal on the phone that my doctor had submitted a "claim" for pre-approval and that I just wanted to make sure they had everything they needed from me.

She told me that they would send me notification if something was missing or they needed more information. She said that my record still shows as "reviewing" and that it takes 15 days to review a claim. She also said that there was not much else she could do at this time to help me.

I forgot to ask her if that was 15 days days or 15 business days.

Drat!!!

-Frog

What if...

...the insurance company says no? What are my options? Do I somehow come up with $10K and go to Mexico to do it? Do I just continue to "grow"? Do I staple my lips shut and hope for the best?

I wonder if these thoughts rattling around in my head are part of the reason I'm not sleeping of late. I can't turn them off...I can't really address them. It's a lot like marbles in a hamster wheel...they just rattle and spin! I think part of the reason that I keep thinking about this has to do with both my couch and my bed. Let me explain.

Couch. I sit on the couch and watch TV. My couch creaks when I sit down. The main spots (I try to vary my spot for even wear) where I sit are soft, mushy and have LOTS of give. I go to a non-main spot and there is still firmness to the couch. I know that my fat ass is doing this wear. EEK...I bet the furniture salesmen freak when I come walking into the store! "Oh Lord...here's a fatty that is going to break our couches."

Mind you...I've never broken a couch. A chair, yes. In my defense, it was a patio chair that had been sitting in the unrelenting Arizona sun for about 2 years. I maintain it was sun rotted...and I just happened to be the one that sat down in it.

Bed. When I was pregnant with Tadpole, near the end, I had a very strong nesting urge. I rearranged furniture constantly. Anyway...about 1 month before I was due, I wanted to move my bed. My mother, bless her heart, was helping me. She grabbed the foot and pulled. Unaware that the frame was two side rails that fit into the foot board. She completely pulled all the parts and pieces out and broke the shit out of the foot of my bed.

Fast forward about 5 years to Fall 2009. My father has fixed the bed. All the parts are living in my garage. I have laminate flooring installed in my house (by my AWESOME brother-in-law). When the floor is done he puts my wonderful bed back together and I begin sleeping in it. Tadpole loves it...with the side rails it is very easy to climb into bed with me! About 2 weeks later, we have a "flood" in the house. Wake up at 0330 to an inch of water on the floor. Needless to say, wood floor...RUINED! After all the insurance stuff was done we had a contractor come in to put in the new floor. On day 2...my bed breaks on the head board end this time. I set the pieces on my kitchen counter and off to work I go. When I get home, I find that the contractor is also a carpenter. He and his crew have repaired my bed!!

Now, every night when I lay in bed I hear creaks and groans. This might very well be in my head...but I hear them nonetheless. I know it would be nice to have weight gone and not be afraid that I am going to permanently ruin my bed and break it all to hell.

As a result of this, I've been thinking about the insurance company verdict being "no" a lot this last week. I'm not sure what I will do if that happens. I wonder if any other people going through this process have the same thoughts at this point in time?

The waiting SUCKS!!!

-Frog

Friday Eve.

Well, it's official. My paperwork is on its way to the insurance company!

Cross your fingers for me!!!

-Frog

Manic Monday (and I am not singing a Bangles song!)

Oh yeah...hiccup number 1. Hopefully it will be the one and only.

I got a call from my surgeon's office. The lady on the phone said that she had my file all put together and ready to send to the insurance company. One problem. She said that the needed the note from my doctor saying that the surgery was a medical necessity. Can't you just see my face on the end of THAT phone call. I mean, come on, I went into the office with everything ready. I thought I was WAY ahead of the power curve.

I told her that the note was on the same Rx page that referred me to the doctor in the first place. Her reply? "Uh-oh." They sent that Rx page to the insurance company as the referral to the surgeon. I told her that my insurance didn't actually require a referral. She said that the program did. She then asked me if I could get my PCP to write another one.

I called, yesterday at 1600. I told them what happened and said that I needed a new note. I got a call this morning at about 0815 that said my note was ready. I went by this afternoon and got it. It looks just like the first one. Referral to the surgeon and note of medical necessity.

I will be faxing it to the surgeon's office first thing in the morning.

I sure hope they didn't want her to write some touchy-feely letter about me and why this would be a good thing for me!

-Frog

Typhoid Thursday.

I don't have anything much to share for Thursday. I'm getting sick.

Sore throat Wednesday, cough Thursday...

uh oh!

-Frog

Wise Wednesday.

I wake up this fine, rainy Wednesday and have a brilliant idea. I know the insurance is going to approve me (no negativity out there for me)! Going to do it...make an assumption.

Let's say that they are going to make me do a 30, 60 or whatever number of days doctor supervised diet first. What is to stop me from going to my PCP and starting it now? My thought is that by the time the insurance takes their 6 to 12 weeks to make a decision, I will be that far along in the pre-surgery approval diet.

Then, after posting on LBT, someone gave me another idea. Tomorrow, I'm calling the insurance company. I'm going to ask them what specifically makes this medically necessary surgery as far as they are concerned. I'm then going to ask, once it is deemed medically necessary, what else needs to be done before the surgery will be authorized???

Here's hoping that nothing else is required after the necessity is determined!!!

-Frog

Tuesday Trials.

I had my last appointment before insurance submission yesterday. Met with the nutritionist. She had on the funkiest shoes...looked like frog feet!!

She told me about the pre-op and post-op diets required by my surgeon! Pre-op is protein shake for breakfast and lunch and a small, sensible dinner ie. Lean Cuisine. Said I could have healthy snacks if I was hungry between meals. Post-op is liquid for a week. Mushy for 2 to 3 weeks and adding solids back in as you are able to after the 3rd week. I did a bunch of research today on Protein Powders and Bars. Soooo many choices.

After the appointment, Tadpole, Bug and I went to dinner. Macaroni Grill! I'm going to miss Chicken Scallopini after the band. Or at least the pasta part of it! I'm thinking the chicken and artichokes will still be doable. Anyway, second stop was Trader Joe's (here after I'll call it TJs). This is where I started looking at protein shakes and powders. I'm scared!

As we headed from the restaurant to TJs I remember that my Blackberry had been blinking and making sounds at me indicating that I had a text message. I was standing there looking in my purse in the store, while waiting to check out, when Tadpole had to potty. Search aborted.

About 4 miles from TJ's I remembered the blinking and making of sounds the phone was doing earlier. I was searching through my purse (at a red light!) for the phone. No joy. OH CRAP! I have already shut one in the car door...don't need to lose another. Bug calls my phone and we hear nothing. "That is not good," she says. "No shit," I was thinking and saying!!! I flip a major U-turn and head back to TJs. The whole way back I keep feeling my pockets, in my purse and all around the center console of the car. Bug points out that if it had been in the car we would have heard it.

When we get back to TJs, I pull up behind the car that is in the spot I was. I climb out of my car and am bent down (in the rain) looking under the car for my squashed Blackberry. It's not there. I'm in full fledged freak out now. I turn around to head back to the car and notice something on the floor at the edge of my car seat. I grab it. It is the phone! I pick it up and see a bunch of missed calls...all from Bug as we were driving back and hoping it would ring or someone would answer it! I look and notice that somehow the sound had been turned off. No wonder we didn't hear it ringing.

WHEW! Crisis averted! I spent about 30 minutes of the hour long drive calming down!!! In case it is not obvious, let me tell you...I'm a major clutz!

-Frog

Monday Musings.

I am sitting here eating Chicken Nuggets with Tadpole. Wondering if they will be something I can eat once becoming a bandster!?

I see the Nutritionist tomorrow. She is in the surgeon's office...so, no waiting for her to mail the report to them! The shrink said that his report should get to the surgeon by Wednesday, 02/03. Here's hoping!!

I would love an email or phone call by Friday (wishful thinking?) telling me that the paperwork is on its way to the insurance company!

I am the kind of person that says, "If it weren't for bad luck, I would have no luck!" I figure with luck like mine, it will take the insurance the full 12 weeks to review my file. Then, they will say no. I will appeal. They will eventually give in (12 appeals later) and tell me that I have to do 2 years worth of diet first.

I'm hoping that this falls into the 2010 is my year category!!!

-Frog