This is almost comical?almost

sleepyjean · December 6, 2005

**update**You can read the whole saga below, but anyway, I just found out that yes indeedy UCLA has discontinued the lap-band surgical procedure due to the “poor success rates and expensive after care.” (????) They just haven’t gotten around to updating their info packets or website to reflect the change. Sheesh.

I asked the insurance guy if I choose to keep UCLA as my medical group, could they refer me somewhere outside of the group where they still do banding. He said they don’t do that kind of referral and I’d have to file a grievance if I wanted it. I wanted to argue with him - I mean, what if I needed brain surgery and my medical group didn’t include a brain surgeon? Would they just let me die? – But I left it alone.

So now I have to find a new Blue Cross HMO provider by Thursday. They sure don’t make it easy! I’m having to go through every single medical group in the directory and look them up on the web and see if they’ve got a bariatric program.

Good grief – what next?**

I’ve been keeping track of how this whole process unfolds, so I can look back a year from now and laugh and laugh (because it’s definitely not going to seem funny until then!)

So far, it has taken ten weeks just to get a referral. Next, I have to send in a questionnaire, the referral, and proof of insurance. Then they’ll need three more weeks to decide if I’m worthy enough to speak to the program director. And what comes after that? I expect I'll have to walk across a pit of flaming coals?

I was all set to fax my paperwork this morning, then I found out that my employer is changing our insurance carrier from healthnet to blue cross, effective Jan 1, 2006. But I also found out that I will be able to keep my same PCP and medical group (UCLA). I called UCLA to find out if I could go ahead and send my paperwork in or if I have to wait until the official switch to Blue Cross. This is where the real fun began.

*ring ring*

Press 1 if you need to schedule a post-op appointment.

Press 2 if you want information about the program or the status of your authorization.

Press 3 if you are a patient in the program and want to leave a message for the staff

Press 4 for directions to the center

Press 5 for a list of education classes and locations

Press 6 if you are a doctor or are calling from an insurance provider.

You’d pick option 2, wouldn't you? But you'd be WRONG. If you choose option 2 they tell you to go to the website or leave a message with your mailing address and they’ll mail you some stuff. Strike one.

Options 1, 3, 4, 5, and 6 were equally useless - they all took me to the exact same voice mailbox. I finally gave up trying to find a live human to talk to and left a message. A couple of hours later, I get a call from someone named Maggie from the academic office(???) and she says they do GB but not banding. (Strike two) Either she is completely clueless or else UCLA has completely changed their program since they mailed me a packet 3 weeks ago. This is their website: . http://www.uclabariatrics.mednet.ucla.edu/aboutsurgery/surgery_intro.htm. Does it look to you like they don’t do banding?

I called UCLA again. Did I mention that their phone system is COMPLETELY jacked up? Because it really really is. I called the same old number and got the same old runaround. I called the main UCLA number and they transferred me to the nutrition department. I called the UCLA medical center operator and got transferred me to the same extension old voicemail box as before. Quelle surprise! (strikes three and four)

The inefficiency of this whole process offends every last one of my Virgo sensibilities. How do any of these places ever get anything done? If my company operated like this, it would’ve gone out of business years ago.

Is every place like this?

No wonder people go to mexico!

the best me · December 6, 2005

Seems like someone else ran across this same thing at UCLA...maybe do a search? Yep, sounds exhausting. Yep, I went to Mx.

BCBS doesn't have a good rep for paying just yet. I have it. No go. Maybe it's better in Ca?

Whew! Good LUCK!!!

vinesqueen · December 6, 2005

Uhm, no, I suspect it's becaue it's a university... I'm finding that my university is totally sucky when it comes to organizational expertise.

ReneBean · December 6, 2005

Uh - NO. It's NOT better in California. If your BMI is over 50, you will have to fight and scratch and maim to get even a slight chance that BC/BS will pay. I am working on my submission to the State Board of Insurance for Independent Medical review, now. If you can get your insurance pre-auth from the current company and have your surgery before Year-end DO IT. Go to another doc, do whatever you have to do.

I may never get this surgery if the State rejects my appeal.

bandayed · December 6, 2005

Don't be discouraged -- it is definately a process. Not sure how the insurance plans vary state to state, but I live in MA and have BC/BS and had no prob getting approval. The policy says anyone with BMI 40+ is eligible, and I got my approval within a week of scheduling my surgery. Just lucky I guess. Getting in to the appts/program at my hospital was a little more tricky -- had to go to an info session first and then fill out an 11 page app! But once I was in it was easier to schedule subsequent appts.....Stick with it, the results are worth it!

sleepyjean · December 6, 2005

Well, I just faxed over my packet. Let the games begin!

My BMI is just a hair over 40, so they won't reject me for being too high - I'm sure they'll think of plenty other reasons to reject me though - I'm right handed, the planets aren't aligned, my birthday is during an odd-numbered month, etc. LOL

I think sometimes the downfall of the internet is that there's TOO MUCH info available. I was on obesityhelp yesterday and there was post after post from people in CA who have BC and were approved within a week or two. Then you go someplace else, and just as many people have horror stories. I can't imagine what people did 20 years ago and there was no internet and you just have to take your doctor at his word!