Lost
I found out this morning that I was approved for a referral to see a surgeon for weight loss surgery. I was able to celebrate this "first submission approval" for approximately 30 minutes.
I called the MD, made an appointment, and then the woman who scheduled my appointment called me back to advise that the surgeon does not do VSG surgery, he only does RNY and lap band.
So, I called my MD office and talked to the girl who does the referral submissions, and said, "Hey, the surgeon doesn't do the surgery I want to have done. What now?" She had no idea. She said a message had been left for the nurse (why? IDK!) to call me back to discuss it. She asked me what surgery I wanted to have done, and asked me to repeat it THREE TIMES before telling me she had never heard of it and they only do referrals for rny and the lap band.
After that unsuccessful call, I called my medical group (I have H.M.O.) and they said that my MD would have to submit a determination of benefits to see if this surgery would even be covered. Now, I know for a fact that BCBS covers VSG - their medical policy is available online AND I used to work for blue cross doing these exact approvals, the only difference being that I worked for PPO, not H.M.O. Absolutely NO ONE I'VE TALKED TO HAS EVEN HEARD OF VSG. They act like RNY and the lap band are the only options for weight loss surgery! Besides VSG, there's also the duodenal switch - I've worked in insurance for years and know about all these options. Why is it that no one else seems to have heard of anything else?!
The medical group also advised that once they verify that the surgery is covered, they would have to request out of network benefits to see a surgeon out of network that performs this surgery. What an absolute nightmare this is turning out to be.
I tried calling back to talk to the woman who does the referrals at my MD office and she won't take my call. It doesn't look like the nurse is planning to call me back either, since the office closes in about 6 minutes.
I've honestly been bawling about this for over an hour, I have a headache now. I feel completely devastated and lost.
The only option I can come up with at this point is to change my medical plan at work to PPO in January. I really don't WANT to have a ppo plan, tho. I'm so completely depressed.
This is NOT how I wanted my weekend to start.
I guess I'll go lay down and cry some more now. :*(
I really, really, really, really, really don't want rny. Is my alternative to just get that surgery instead?? Or a lap band (which I've always been totally against!)?
Defeated. Crushed. Inconsolable. Lost.
That's me.
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