Insurance Companys Are The Boss

MR. BIG · March 1, 2006

About 6 months ago I STARTED THIS PROCCESS AND HAD THE HOSPITAL CALL AND VERIFY WHAT WE NEEDED FOR A PRE-DETERMINATION,AND THEY SAID ALL THEY NEED IS A DOCTORS LETTER. SO I GAVE THEM THREE LETTERS,AND WAITED THE 30 DAYS THEY SAID THEY HAVE FOR MAKING THIS DECISION, SO OF COURSE YES I CALLED THEM A FEW TIMES TO SEE HOW THEY WERE COMING, AND YOU KNOW THEY SAID ,YOU KNOW WE HAVE 30 DAYS.THEY WAITED UNTIL THE 29 DAY BEFORE TELLING ME THEY NEEDED A SYC EVALUATIN,MORE DOCTORS LETTERS 6 MO MEDICALLY SUPERVISED DIET AND A FEW OTHER THINGS.DO YOU THINK THEY WERE STALLING FOR TIME ANYWAY I HAVE GOTTEN EVERYTHING DONE BUT THE DIET, MY HOSPITAL IS GOING TO RESUBMIT AND SEE WHAT HAPPENS WISH ME LUCK.:bored

Mona · March 1, 2006

Hey there! I read your post and thought I'd respond with what little I know. I don't believe that your insurance co. is stallin' for time. I don't know what kind you have but their requirements sound pretty much the same as most insurance companies who need documention before they will approve. My insurance co. required the same thing--basically. In addition I also have to attend a pre-op nutrition class. Most ins. co. require at least a psych evaluation, 6 mth of documention of structured/medically based weight loss attempt, at least one Dr. letter and some require even MORE than that. Just hang in there though...it gets better. I'm still in the waiting process myself. May God bless you in your efforts.

DonnaB · March 2, 2006

Are you kidding? Of COURSE they're stalling for time. They're hoping you'll give up and go away. They're not there to make you happy OR healthy. They're there to make money. If you go away, they've saved money. Unfortunately you're going to have to learn to push without being pushy - get what you want without rubbing them the wrong way. They can make things easy for you or make your life a living hell.

Did I mention I'm a self-pay because of the &$*#*(%*ing insurance? :tired

MR. BIG · March 2, 2006

Maybe There Stalling Or Not, But Now Its Becoming A Quest. Did I Also Say That The Syc-eval Sent Me To A Therapist For Anxiety,i Wonder Why I Have That. Thanks For Your Response.

Mona · March 2, 2006

LOL--I understand about anxiety...I first started taking anti-depressant drugs more than 10 yr. ago--along with anti-anxiety drugs and anything else that could help me feel better about being so fat...I've been to so many counseling sessions I'd rather not say how many--but let's just say I've been to more than my fair share. Anyway, I discovered that the longer I was on these drugs, the more the psych dr. increased my dosage and my sessions--so I swithched dr. and the viscious cycle started all over again...lol...but I dedcided that enough was enough so I took my life back...one day at a time...one step at a time...and I believe a person can do anything they set their mind to doing...EVEN BEING PERSISTENT WITH AN INSURANCE COMPANY...maybe they're yankin' your chain and maybe they're not but in any case, the lady is right...you can push without being pushy...my insurance has changed within the last 2 yr so I have had to start all over with this process and I am well versed by now...Best wishes on your journey!

picardy3 · March 2, 2006

I understand your frustration. I'm also playing the waiting game with my insurance company. I get to make my weekly phone call tomorrow. Last week when I called they had "conveniently" lost my psych evaluation. Can't wait to see what the problem is this time.

Good luck and be persistent. Pretty soon the honey from my voice will start dripping through their phone lines.

Audra

Mona · March 2, 2006

LOL...your're so funny! And yes, I will also continue to be persistent. I know you'll come out the winner in all this because you have a very stick-to-it attitude and I believe that's just what it takes. Hope you have a great week and I will let you know if anything changes on my end...you let me know too ok? Good night! May God continue to bless you and your efforts.

Thinjen · March 3, 2006

Yes. They are the "boss". Funny how some kid in a cubicle makes a decision that overrides a board certified physician. They could have told you that information the first week that they had your stuff. No, they wait till day 29. They want you to give up. Insurance is a big game of risks. It's really no different than gambling. They realize that complications from obesity are going to cost them WAY more than this band. But yet, they gamble. Maybe by the time that it's time to have your cardiac bypass or your leg cut off from diabetes complications you'll change jobs or insurance companies, and this won't be their problem. Or maybe they'll just let you wait till the medical examiner does the autopsy to determine "medical necessity." Of course, at that point, they won't have to pay.

WE HAVE TO BAND TOGETHER (LITERALLY) AND NOT LET THEM WIN!!!!