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In the beginning......of my journey

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AAAAAAAAAAAAGGGGGGGGGGHHHHHHHHHHH!

Right now I am feeling great amounts of stress and anger. I called my surgeons office to see if the pulmonary clearance had been issued yet. ( Was tested Friday- knew I might be pushing it) I also wanted to verify they had received the paperwork from my PCPs office for my two years medical records and his letter of recommendation. And the answer is.....NO! Week before last I went through this run around and I "thought" I had it worked out. My PCPs office said they had never received the request, but would be more than happy to submit to the surgeon once they got it. (the request) I called back the surgeon and gave them that information and a fax number they could send the request through directly. The surgeon's office said they would handle it. Obviously it wasn't handled. I do not know who is dropping the ball here, but it is starting to really piss me off. I know the surgeon's office did send out requests for records that I had signed off on in the beginning because my orthopedic doctor had to have me sign their version of one. ( Because they did not accept my surgeon's version) That was over a week ago. So whether my PCP is being slow or my surgeon is, I have no idea. But I am taking the bull by the horns and I will make sure the paperwork is transferred, if I have to take it to them myself!!! I have a call in to my PCP about it. When they return my call I will ask if they can just do it ( send records / letter) on my request. After all, I have to give my approval for the records to be released. I have read many stories on this site about people experiencing the same issues. What I don't get is why this is such a widespread problem and why it is acceptable??? In my job and many others, if we did such a shoddy job we would be terminated / replaced. I suppose it is because they have us by our proverbial "balls". What are we going to do about it? Not get sick? Never need doctors to keep records? Go someplace else? ( that will do the exact same thing) No wonder health care costs in the U.S. are so out of hand. The bureaucratic BS is insane!! I would like to be fair and patient and say "well they are busy" and "everyone wants their case to be important". But when I am doing half their work for them, and they still can't get it done? I am busy at my job too. Everyone wants me to get things done that need done NOW. Yet I can manage it. Been here 18 years. If I were not competent enough to get the job done I certainly would not have it. It just galls me to no end the case is so not the same when it comes to the medical field in general. Our records are computerized, how hard is it to obtain or send files via a computerized system?? Needless to say I will have to stay on top of this issue. My hopes for an October surgery date are waning. This month has passed by so quickly already. Even if the records are sent this week, and the final clearance is in by Friday, they probably still would not submit to insurance until next week. Then however long it takes for my insurance to decide on it, could be another few weeks. ( I pray to be in the lucky group of "just a couple days" for approval. But I will not hold my breath for that to happen.) Given the steps I have to do after approval, before surgery, it is looking less and less likely I will get in for October. I had just hoped to be far enough healed before my daughter's birthday and the holidays start, but I may not get that. The best laid plans........
Roo101769

Roo101769

1
 

A New Day

Yesterday I sailed through my psych evaluation. The doctor said the fact I have already been making changes and trying to create new, lifelong habits will increase my odds of success. He said he has no problems supporting me because he knows I have researched this a great deal and I know the risks/benefits. I'm not the internet diva for nothing!!! LOL So his report will be turned in today and I am that much closer. I got my "check list" from Dayton Bariatrics yesterday. Many of the to do items are things that are out of my hands ( like requesting 2 yrs medical records and my PCP letter of recommendation) Considering my PCP is the one who referred me to Dr.Bruce I am not very concerned he will provide the items requested. I have my NUT appointment today. Not exactly sure how many of those I do, but I will do them. I also have to have a pulmonary check since I had the two pulmonary embolism. I'm not worried about that though, my lungs are fine. The only thing that "may" hold me up is the misinformation about a required 6 mos. medically supervised diet. Dayton Bariatrics stated that my insurance listed it as a pre qualification. Yet I have now verified TWICE with Anthem that it is NOT required by my plan. The rep I spoke with Monday said he would contact the office and let them know it is incorrect information. I have no doubt Anthem screwed up. Considering they initially told them I was excluded from coverage for the surgery when it is covered!!! But even if this miscommunication fails to be cleared up I am still sitting in a pretty good place. I actually started a "medically supervised diet" in March. My old insurance required 12 mos. of it. So, before my leg took a turn for the worse, I had started taking the steps I needed to qualify. Granted there has not been much dieting going on these past 5+months, and little exercise. But I have been under constant medical supervision, thanks to my leg. And it is on record I started in March, therefore September will be 6 mos.!! So to avoid another 6 months of waiting, I am sure my PCP will state I completed the required 6 months if they fail to clear it up. Wait...I just got a call back from the Anthem rep!!! Wow, ok he earns a gold star in my book. He did research things further and found the only thing the plan requires is you receive the nutritional counseling and must follow their advice. So if they want you to do counseling for a few months you have to. But heck, your bariatric doctor would require you to also. But there is NO, I repeat NO, required medically supervised diet time frame. The guy had actually already tried to call the office but the girl who does insurance was not in yet, so he will be calling them back this afternoon. I thanked him very much for his help. As I told him, I have no issue at all if I am required to do nutritional counseling. It is part of the process. But I do not want to be held back from surgery just because my doctor believes there is a requirement of my insurance that there is not. He agreed fully and said he had no problem at all making sure they understand. So now I am STOKED!!! Not sure how it will go with the NUT today. I am hoping that they will be like the psychologist and see I am already working to change so I can succeed. I have done a LOT of research about what to eat, nutritional needs post surgery. So I won't be walking in there clueless. Just have to wait and see what they think....
Roo101769

Roo101769

1
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