3/7/11: Attended the seminar at the Bariatric Center of Kansas City at Shawnee Mission Medical Center. Delivered my paperwork and insurance and ID copies to the staff. Met Connie - what a sweetheart!

3/10/11: I called Jill, my case manager, in the morning to check that the dates I meant to schedule with the doctor who is supervising my diet will work within the parameters of the requirements. I had to leave a message and wait for a return call.

About 2:00 pm I received a phone call from Jan at The Bariatric Center. She called to tell me that my insurance only pays for a maximum benefit of $10,000 of weight loss surgery expenses, not nearly enough to cover even just the expense of surgery, let along the additional office visits and evaluations required. We decided not to set my appointment with Dr. Hoehn until I sort out if/how I should proceed with this new information. She explained that Dr. Hoehn's surgeon fees alone are $5000, and that to get the cost of the hospital stay, I should call Shawnee Mission Medical.

Of course I flipped - and it only got worse.

Next, I called and left another, frantic message with Jill. My first appointment was scheduled in just a few hours with my DO to begin my supervised diet. At this point, I couldn't be sure it was even possible to pay for the surgery and all of the appointments associated. After waiting a few minutes, I decided to call the member phone number on my insurance card to check if the $10,000 was accurate. The lady I spoke with assured me that the cap existed and was not subject to my yearly out of pocket max of $1000, so all excess costs are mine to bear. I started to ask which office visits would be billed against the maximum benefit, knowing that if the supervised diet, the psych eval, etc, etc were all debited from that bucket, there would be no money at all to pay the surgery. She wasn't sure of the answers, so she transferred me to the UHC bariatric specialists’ location where Jill is located so that I could ask more detailed questions. By this time, it was 15 minutes until I was leaving for my appointment. I tried to explain my problem to the operator. She wanted to know "what my question was" and I tried to explain that I had many questions, all relating to how my benefits work, and that I really needed answers before I left for my appointment. She insisted on knowing what my appointment was, and assured me that if I told her what appointment I was going to, maybe she could get my question answered. I told her the appointment had nothing to do with my questions. The operator (who had been extremely rude and could barely be heard over the constant, furious clicking of her plastic fingernails typing as she spoke) told me that elective procedures are not considered urgent by UHC and I would have to leave a message and await a phone call.

Waiting for my work phone to ring (oh, yeah - all of this is happening on my work phone, where nosy co-workers can easily overhear, my bosses keep coming by for one reason or another and find me still on the phone, red-faced and frantic...it wasn't pretty or good for my career), I took out my cell phone and called Shawnee Mission Medical. I was directed to Patty at (913) 676-7736. Patty explained that the actual cost for the hospital stay in considered outpatient, though I would be observed overnight, for a average total of $39,000. However, UHC's contract allows them to bill about $7500 ($5735 + observation hours). Then she dropped the bomb - this did not include the fee for anesthesiology. My heart sank. Even with a sizeable chunk in my flex account, there was no way I could afford this surgery. $10,000 isn't coverage, it's a tease. My stress level and psychological health would have been better served if my policy didn't claim to have any benefit for weight loss surgery. I said as much to Patty, who cheerily replied, "At least you don't have to pay $39,000!" Some consolation. Patty was kind and helpful, even if she did not understand my predicament. She gave me the billing code all of the docs will use for the surgery expenses (43843) and the name and number of the anesthesiologists’ office so I could call them to see how much they would charge. (Anesthesiologist Midwest Anesthesiology Group (913) 234-1600). In the meantime, it was time to leave and I didn't receive a call back from UHC or Jill.

I did begin my 6 month supervised diet, despite the turmoil. After all, a supervised diet that included accountability with my doctor was better than taking no action for my health at all, right? She prescribed daily caloric intake under 2400 calories and to resume my training with Bethanie at the gym where I currently belong.

3/11/11: Received a phone call from Jill fist this in the morning. I explained what happened. She assured me (numerous times, at my insistence) that there is no $10,000 cap on my weight loss surgery benefit. There is a $10,000 cap on travel and lodging expenses, if I were over 100 miles from the nearest approved Center of Excellence, but that is not the case. The promised she would call Jan at the Bariatric Center to clarify the insurance terms and she would ask Jan to call me to set up my appointments.

At this point, I'd like to ask for something in writing. But first, I am waiting to see what happens if/when Jan calls me. After so many dark moments in this process that has only barely begun, dare I hope it will all work out?

Upcoming appointments:

June: Call Jill, my case manager at UHC to update her on my progress