Almost Home

Though the last twenty-four hours have been nerve wracking, I think we are in the home stretch.

I couldn't talk about this yesterday because I was waiting for some news to give to the Brit that was positive and that didn't happen until today.  Yesterday morning, I called the insurance company just to see where we were in the approval process and much to my surprise, I was told that I had been approved just within that morning.  My excitement was short lived however, to find out that the Brit's request was still being reviewed, so I sat on my own happiness in anticipation of his approval.

When I got home from work, I had a message from Teresa, who is the insurance person at the surgeon's office, for me to call her as soon as possible.  Upon contacting Teresa, she told me that the insurance company had told her that the Brit was not covered for WLS.  If ya'll remember, the insurance people and I had already had this conversation in January.  Teresa had actually told them that they had already approved me, so they needed to check my account.  She also advised that I contact the insurance company to clear up any confusion.

I called the insurance people to find out that they had already checked my account and that the Brit's stuff had been escalated to be reviewed and that a decision should be made before the end of the day.  I checked in with them periodically and finally just before 5:00, I found out that the Brit had been denied.  Reason?  Because when we met with our surgeon, the Brit's case had three possible scenarios.  Scenario #1 would be of course, lap RNY.  If that was unable to happen, then it would be open RNY.  For those of you not in the know, that would be one large incision to complete the surgery instead of four small incisions.  If there were still concerns, then it would be broken down into two surgeries.  The first would be the gastric sleeve (and actually I find this definition interesting because the Brit's BMI is NOT 85 or more by a long shot.  I'm thinking this really may have been a precaution maybe) and then about 7 months later, there would be a second surgery to do the actual bypass part of the procedure.  So, when this was submitted to the insurance company, it was submitted as a two part surgery (worst case scenario) and the gastric sleeve is still considered by many insurance companies as "experimental" due to not enough medical documentation yet.  Therefore, he was denied.

This placed me in an absolute tailspin.  How could I tell my husband, who together, we had vowed to go through this, that he had been denied?  Could I even in good conscience go forward with my own procedure if he was unable to?  There were so many questions and so much uncertainty.  Yesterday, should have been a really happy day for me as I finally had the approval I had been waiting for.  Truth be told, I had never had any doubts about the Brit being approved; I was the one afraid of being denied because of all things, there aren't enough things wrong with me!  But instead of a happy day, it was one of the most stressful days I'd had in a very long time. 

I elected to wait things out another day after speaking with the Director of the bariatric program at Hopkins, Christine.  She didn't seem too concerned and said they would talk to the surgeon and see what we could do. 

This morning, I spoke again with Christine and with Teresa.  They had spoken to our surgeon and he had stated that if it was all right by the Brit and myself, they would just resubmit his request as lap, possible open, RNY.  This made me wonder why we had just not done this in the first place, but after further investigation with the surgeon, he had wanted to do the two procedures as with the Brit's BMI it places him in a higher rate of complications category, such as infection or hernia.  So, at that point, I called the Brit at work and gave him the lowdown and made sure that was what he wanted to do.  There is no reason for the insurance to deny him for this procedure because they have already approved me, so now we just have to wait for the approval. 

The whole experience of the last two days has left me drained and with a bit more understanding of what the Brit's healing time could entail.  If they have to do his as open RNY, we're looking at probably 6-8 weeks total healing time, which will easily push my surgery into probably May, but at least I know what I'm looking at.  I'm still feeling borderline tearful tonight so I hope that no one looks at me wrong.  I'm not sure what is causing it, but I think it is having the reality of approval combined with not knowing if the Brit's was going to be approved.  It just opened up this whole new can of worms that I had never even considered before and didn't know how to feel or what to do.  Would he have given me his blessing on surgery?  Were the table reversed would I have been able to do that for him?  I think I would have been happy for him while at the same time feeling very depressed and jealous. 

The other issue in my head is wanting him to get as healthy as possible prior to his surgery, so that the risk of complications is as low as it can possibly be for him.  It's going to require some work and dedication with not much time to do it in. 

I had a brief moment today of wondering if God was trying to tell me that He didn't want the Brit to have the surgery.  The thought both rattled and depressed me.  Then like a voice directly to my heart, the thought was there that maybe God didn't want him to have two surgeries.  Who knows.  I just know I have to continue to trust.