More Insurance Woes

[gogtigirlgo 0]

So, I don't know if it's my employer or my insurance company that sucks, but I am just growing more and more frustrated.

In order to be approved for surgery I need to complete a program through my insurance on top of the program through the hospital. I called in January and asked what the requirements were so that there wouldn't be any surprises. My insurance company stated that all I needed was a BMI over 40 - sweet, no problem, can do. Well in submitting approval to the insurance this week, the surgeon's office found out that really I needed to be on 6 month medically supervised diet and I've only done 4, so my surgery date - which was scheduled for 9/16 - is now pushed out to God knows when.

I'm so frustrated! AND! A nurse care provider called from my insurance company this morning and told me about that other program I have to complete. They stated I had to have the med. supervised diet, co-morbidities, that I have to work with a nurse before and up to 6 months after surgery to "ensure I get the best care," psych eval (that is only good for one year - WTH!?) and I have to review their documents and have a discussion with a nurse about treatment options before they will approve surgery. Meanwhile, I feel like it's just a bunch of BS. I am in a great program that is very thorough, and am so disappointed that all of this wasn't disclosed to me up front when I called to find out the requirements. I complained to my HR group at work today, but I want to make sure that if someone else has to go through this that they know what they're getting into, I don't know who else I should contact to complain.

The good news is, the only thing standing in my way is an appointment tomorrow - and one at the end of September and then I can start the surgery stuff, so it should only really be pushed out an extra month. But it just feels like such a let down, that I had all of this set up and get it all taken away because the insurance doesn't know its head from its ass. The other bonus is I can keep losing weight and by the time I actually have surgery, I should be under 300 lbs. Keep looking for the positives, right?

[chante53 0]

I have the same problem. My doctor's office wants me to be on a diet for a year before the band. I think I will call the insurance company likke you did. May it is just our doctors.

[Jess55 97]

I had a similar issue. I was told initially that having done WW in the past year for 6 months would cover my 6 month medically supervised diet. They said it in the seminar and the surgeon said this when I first met him. I went to my second appointment and they said they weren't sure about that it would suffice, then a few days after the appointment I got a call saying that it wasn't usable and I would have to do the 6 month diet. I was really pissed off, as I had planned to be able to get my surgery in September. Well, now the earliest I can get it is in December, (my last appointment will be late November).

[gogtigirlgo 0]

I'm so glad I'm not alone. For me, it wasn't my doctors saying any of this - it came straight from the insurance company. So, I filed a formal complaint against them this evening with the State of New Hampshire dept of Insurance. It's not right that I can be told one thing time after time by them, and then when it comes time for the actual approval they say, "oh yeah, you gotta do this this and this."

It's going to be November or December before I can have surgery now. I have an appointment tomorrow and another in september, then I have to start back at square one with the surgeon. It took me six weeks to get scheduled with her last time and surgery was scheduled 4 weeks out after I met with her.

To say I'm bummed would be an understatement. I can't wait for the weekend just so I can have a good cry. I'm discouraged and disappointed. I'm going to work with the doctor's office and see if they can get me scheduled sooner with the surgeon rather than having to wait. I guess I'll just have to wait and see.

[stateofzen 46]

How frustrating!

I had a similar experience-- I called my insurance, they told me what I had to do (6 month medically supervised), and when I was 5 months in I called back to find out about psychologists I could go to for an eval only to be told my particular plan from my employer excluded WLS.

I was pissed, and devestated. I had to wait to switch to my husband's insurance, and now, a year after that crushing phone call, I'm finally approved and scheduled.

Hang in there! It will happen for you.

[amybethy 0]

I just called my insurance today to make sure they cover the lap band and they do and she looked up the requirments for aproval are just the basic requirments yay now I can't wait for next thurs for my semanair