2017 Is My Year - Miami, FL

Today started off great... I worked half a day, ate lunch with my colleague and headed to the doctor for my monthly check in. Remind you I'm still waiting on the appeal process for insurance. I know getting your doctors to fight and sign off on document for the appeal is the best way to go. So tomorrow I have an appointment with my PC doctor and I figured I would get together with my neuro surgeon and kill 2 birds with one stone. I tried call all numbers at the office, I even googled to make sure the number was correct. Thank God I had my physical therapist number to reach out cause every number I tried gave me a recording of not in service or this number is disconnected. I was in total shock at the disappointed news I got back.... are you ready for it?? the doctor that has performed 3 surgeries with one year has closed their office and files for bankruptcy. I'm lost for words. Remind you he's the one forcing me to have this surgery because of my spine. Stating that this could save my life, which I agree and just maybe I won't end up disables in the process. I'm so worried this may affect my appeal process of getting the insurance to approve my surgery. I so hoping and prays something good and positive come through for me.

2017 is my year, I have stalked this site since I've joined and I finally gain the nerves to share my story and mission. I haven't don't my procedure yet, but I'm having some issues with Insurance approval. I'm wondering if you're in an appeal process what is the best way to go about it, and how long is the approval process?

Let me properly introduce myself... hello RS Family, thanks for taking the time to listen and give me advise. On 2012, I feel down about 5-6 stair steps or solid concrete. All I remember was opening my eyes to my legs stuck in the railing in the fetal position. I ending up walking on a cane for almost a year, it was the worst 9 months of my life. Fast forward... in 2013 I ending up with having spinal surgery due to my fall. I ended up with 4 screws and a plate in my cervical spine. I had to stay in the hospital for about a week and then to rehabilitation facility for 2 more weeks, where I had to learn all over again the abilities to walk, to use my arms and legs. I had to learn how to stand, reach and gain strength just to get in the kitchen to cook a meal for my family. Taking a bath along was even challenging. I know what you're thinking... all that just from a cervical spine surgery. Thank God I'm still here and walking normal again, because I was told by my surgeon that if I didn't have the surgery I would have ended up paralyze.

After a year of recovery I just knew I was on the right track. I joined a gym and was enjoying the fact I was trying to loose weight again. I was tired of being stuck with steroids and we all know what that does to our bodies. At that time I blew up to about 270 - 280 pounds which was a heck of a lot of weight. But not able to walk nor exercise for almost a year can surely add pounds quickly on you. So in the ending part of 2014 I encountered yet another fall... clumsy right? Well, this time it was not my fault to say the least. During this fall I injured my shoulder and entire spine. In 1 year I had 3 major surgeries, which one the anesthesiologist jumped up quickly because I was not breathing and my son was there to witness this. Scary, but thank God I'm still here.

So August I had shoulder repair, now with my shoulder you couldn't even touch me the pain was unbearable. I was unable to shake someone's hand let along give or receive hugs due to the pain. I complained so much to the doctor of the constant pain that he referred me to see a neurologist cause my shoulder was fixed. He figured it was more nerves. So after seeing the neurologist and running some test I ended up having surgery in March. Yep, I know another cervical spine surgery. The doctors removed the pinched nerves, but upon recovery again I was subjected to walking with a walker. Again I was sent to the rehabilitation hospital to learn the process all over again.

I went to my follow up with the doctor to his surprise I was on a walker. If you could see his face... he was shocked, he said "What in the hell is this?" "I fixed your neck to help you with your shoulder and you're on a walker??" Remind you I been on this walker for 2 months at that time. Even physical therapy and rehab didn't work. After more complaints of not walking, oh let's not forget I've gained more weight. More test was done x-rays, MRI's and nerve study test. I ended up have another spinal surgery just 4 months apart this time the surgeon went through my buttocks to enter my spine. Talking about walking!!! I was miserable what use to take me 4-5 minute to walk took me 10-15 min. Not able to stand nor sit for long periods of time was very hard for me, even sleeping became a problem. After being in rehabilitation twice and physical therapy 3 times after each surgery, my surgeon suggested that I have bariatric surgery before he opt to go back in my spine for the 4th time.

I'm currently still on a walker and it been a year now, my weight has gone up to 320 pounds. Just the last surgery alone I've gained over 20-30 pounds. And my spine can't take the weight I'm currently carrying. I visited my PC doctor and he started the process which he told me not to expect this to have over night, but I was determine to start the process.

I knew going in the bariatric surgery was not in my plan and that my insurance would give me a hard time, but I also figure and did some research that if it was deem medically necessary that they would approve it. I've completed the seminar which was weird to have a referral from the insurance company to go. I've completed 2 visits so far to the dietitian, which I see here again on Monday coming. I've also seen the physiology and had an appointment to see the surgeon for the first time to discuss our next move. Sadly I was stopped before I could even see him. Their office called to inform me that my insurance doesn't cover that procedure, which I was already aware of. But my whole confusion was why would the insurance approve referrals for me to have 2 visits with this doctor and not cover it? So, I jumped some hoops and got in touch with some higher place people in hopes of getting help.

I informed them that I was over weight, had 2 spins surgeries in one year, currently on a walker, I'm pre diabetic because of the weight gain. I'm suffering from gerd and having issues to control both my bladder and bowels. That having this surgery will give me a better outcome of being healthy again and just maybe having this surgery and loosing this weight I probably won't need the final spinal surgery after all. How long is an appeal process and what's the best way to win my approval?

Since Jan 23rd my weight was 320. Since I've changed my eating habit under the care of my dietitian I'm down to 303. Hopefully I've lost some more on Monday.