The Insurance Battle

Anybody who knows me knows I am pretty persistent.  I usually don't let things go for very long without follow-up, it's just who I am.  So, today, I contacted my surgeon's office to see what progress was made on the submission of my file to XYZ Insurance Company (the name's have been changed to protect the guilty).  The response I received was less than optimal...

"Hi, this is Chris Nicosia and I was calling to check on the status of my insurance approval."  "Ok, let me transfer you to L. (name deleted to protect the innocent)...she was working on that for you."

"Thank you." 

"Hi Chris, this is L.  We ran into a bit of a problem.  When I called XYZ Insurance Company, they said that Dr. G (surgeon's name deleted to protect the innocent) was not an approved provider.  I told the guy I spoke to that he needed to check is computer again or look at a different screen because I submit these every day and I work with XYZ Insurance Company every day and never have a problem."

Insurance rep: "Well, I'm sorry, but he is not on the list, so your claim has been rejected."

L: "Don't worry, Chris.  This was not the case and I know that XYZ Insurance accepts Dr. Garrison.  I forwarded this over to M. (name omitted to protect the innocent) who deals with insurance issues.  Let me call over there and see what progress she has made to straightening out that darn insurance company and I'll call you back."

Me:  "Thanks, L.  I'll talk to you shortly."

A few minutes later, she called me back.  L: "Ok, I spoke to M. and she said it was a simple problem...the guy who I talked to apparently didn't scroll to the third page...which coincidentally is where all the updated information is posted in their system.  Of course they found Dr. Garrison.  She told me to just inform whoever I speak to when I call back that he is on the 3rd page of their system and it will not be a problem.  Since I have your file in front of me and we are talking about it, let me call over there right now and I'll call you right back."

Me:  "You have got to love these darling insurance companies.  Thank you for your help, I'll talk to you soon."

A few more minutes go by, I start writing this blog and post on Facebook that I hate insurance companies.  As I start typing this up, L. calls me back.

L: "Ok, everything is submitted...it is in their system and hopefully we will know something by Friday.  Feel free to give me a call back on Friday, don't think you will be buggin' me or anything...we'll talk then and see what is going on."

Me:  "Thanks so much for all your help.  Dr. G. said everything submitted by all my doctors was sufficient and he signed off on it?"

L:  "Yes, he reivewed it and said it was ready for submission, so it is good to go."

Me:  "Thanks again, I'll speak to you Friday."

I give a transcript because it takes all of this extra work because  somebody at the insurance company doesn't know how to properly search for a provider in their computer system.  This same person is informing policy holders every day who they can and cannot see for treatment.  My frustration level goes up every time I have to interact with them.  Thank goodness for my surgeon's team in his office...they take some of the stress off me.

Ok, so it is submitted.  I may be able to get a surgery date as early as Friday when I call L. back.  I am really pushing for the Thursday before Good Friday...we can hope, right? 

Oh, and I am so happy because I broke the 300 lbs. barrier yesterday...I was 297.5...the lowest I have been in about 6 years.  So, it was a good day...I am having a good day again.  Talk to you all Friday!

The beginning...well...we'll start at the six-month mark

The beginning of my blog doesn't start at the beginning of my journey...it starts a lifetime later.  I have battled with my weight since I was 11 years old.  Ever since then, it has been a constant struggle that I have lost time and time again.  A battle to lose weight, get healthy and live an active, normal life.

Unfortunately for me, as time goes on, the damage to the body becomes more and more difficult to repair.  I was born with a slight hip rotation that makes exercising somewhat difficult, especially when carrying a lot of extra weight.  My liver is packed full of cholesterol - I have the liver of a 50+ year old.  This condition, known as hepatosteatosis, or fatty liver, occurs when excess fat builds up in the liver.  This condition can later lead to cirrhosis of the liver, which can lead to liver failure and death.

So, as time goes on, the condition worsens despite medication.  Given traditional methods of weight loss have been less than successful, my doctor strongly urged me to consider weight loss surgery.  I had been thinking about the surgery for some time and when he recommended it, I was already in the mindset to get it done.

On top of the fatty liver, I also have very high cholesterol, mild/moderate sleep apnea and hypertension with edema.  I take 9 pills a day to try to control the different issues I have.  At 28, I know that I can't live like this.  Without a permanent fix, the road ahead only goes down.


In September 2009, I chose a surgeon to perform Roux-en-y gastric by-pass surgery.  In order to receive insurance approval for the surgery, I had to undergo 6-months of pre-operative, medically supervised diet and exercise programs, receive a nutritional evaluation, a psychiatric evaluation and visit with my primary-care physician monthly for regular check-ups.  In addition, all the doctors had to write reports on my behalf with recommendations, evaluations, test results and analysis.  The pre-approval requirements have all been met...the insurance company is now reviewing my file and I should know in the next two weeks when my surgery will be scheduled.


That is the background, in a nutshell.  Over the past six months, I have been on an exercise and diet regimen that has prepared me for the weight loss surgery.  I slowly reduced my calorie intake from over 4,000 calories a day to less than 1,800 calories per day.  I exercise in different forms several days a week.  In the past month or so, my weight has dropped 31.5 lbs.  It took a while for results because I slowly reduced my calorie intake so my body didn't go into shock...that would have lead to binge eating, which would not have been good.  My calorie intake is between 1550-1800 calories a day, depending on the day.  After my surgery, I will only be able to eat 2 oz. per meal, three times a day.  My calorie intake will be around 800-1000/day total.


Now a little about me as a person.  I am 28 years old.  I am married to my beautiful wife Nicole.  I am an ex-executive that led a very active and stressful career managing condominium and townhouse communities in some of NJ's most well-to-do neighborhoods.  I am also a classically-trained singer who performs throughout the NY/NJ/PA tri-state area.  I have recently performed with the NJ State Opera, Coro Lirico and multiple other groups, taking me to prestigious venues like Lincoln Center's Avery Fisher Hall, Carnegie Hall and the Academy of the Arts in Philadelphia.  I am currently the tenor section leader of the Russian Chamber Chorus of NY and will be performing with the group at Madison Avenue Pres. in NYC in May.  I am also a pretty good amateur chef and love working in the kitchen.  The reason I tell you all of this is I have tried not to allow my weight to interfere with my life.  However, property management was never my career goal.  I am happy with other parts of my life...but my career has been a disappointment to me for a long time.

I have always wanted to be in law enforcement.  Eventually, I want to be in the FBI, but my main goal (5-year plan, you could call it) is to lose the weight and become a NJ State Trooper.  Law enforcement sort of runs in my blood...many of my family members are police/FBI/military and I have always been drawn to the calling of helping people, enforcing the law and providing a service to my community.  I am limited now in how much I can do because of my weight, but that changes when the weight is lost.

So, over the next year, I plan on writing this blog to document my journey.  I will post once a week...I will post pictures as I go, so you can see how I change.  This is my journey to a new and healthier life...I hope you will come along for the ride.