Need to Vent!

[karaserene1985 1]

Hello All,

I just need to vent and I thought here would be the perfect place.

I was going to have the sleeve done April 15th of 2010 as a self pay. I cancelled my surgery date as I was not comfortable at the time with how fast the process went and I did not have the support of some very important family members.

~~~~ Fast forward to June 2010~~~~

I got a new job with excellent insurance that covers the sleeve at 100%. All I have to pay is my $250 deductible for the hospital stay.

I started my insurance requirements which were 6 months worth of a supervised diet and a psych evaluation. The other item was that I need to have the surgery with a Center of Excellence. I located a center only 45 minutes from my home, (15 minutes from work) and that this would be great so close to home and I will have time to better prepare myself for this.

~~~~Fast forward 6 months later~~~~

I met with my nutritionist for 6 months and also did my psych eval. The nutritionist suggested meeting for one more month as I did not lose any weight during the 6 month supervised diet. So I met with her for the 7th month in a row on February 8th. At that time I had all my requirements for the center of excellence to submit to insurance.

The center also had their own requirements which was I had to meet with their psychologist and their nutritionist. ( I did my entire 7 months with her and did my psych eval with thier person as well) I also had to have a letter of reccommendation from my PCP. I got a letter from my doctor who I saw for 15 years prior to moving to this area, as well as my new PCP who just did my annual exam and blood work. I also got past doctors notes from previous weight loss attempts as well as copies from my gym memberships showing attempts at weight loss. All of this was sent to the center of excellence prior to my February 7th NUT appointment so they would have everything in place to send to insurance.

I also have been going to support groups, and a life skills group that was "suggested" by the center to go to. I have done everything I possibly can to make this easier.

I have been in contact with the Bariatric Coordnator since my Feb 7th appointment to find out about my submission to insurance. She stated to me that they had everything they needed and it would be reviewed by the nurse practioner and then go to transcriptioning, after that it would be sent to the surgeon for a signature and then sent to the insurance company. She stated I would get a letter in the mail when it was sent out, but if I was able to get a fax number to send the information to, it would speed up the process.

The very day I got the email from her, I called UHC and got a phone number for them to call to open up a case, and the fax number for them to send my information to.

~~~~Fast Forward to Feb 16th~~~~

I still hadn't heard anything about my submission to insurance so I contacted the coordinator and she told me that they are reviewed in the order they are received and mine was next to be reviewed by the nurse practioner. That is understandable I know they have to go in order. So I asked if mine was what a rough estimate of time would be for it to be reviewed. She could not give me an answer as the time varies for it to go through each step.... Yes... that is also understandable....

~~~~Fast forward to today March 1st, almost 2 weeks from my last contact.~~~~

I emailed the coordnator to once again find out what was going on with my submission as I still have not received the letter that it was sent to insurance.

I got a very rude email back saying that they went through a computer conversion last Friday and that the conversion took their time away from processing the submissions and that there is only one N.P. who works for the surgery department who also sees patients etc and that was the hold up on my submission.

It has been over 21 days since they have had all my information to send to insurance and she stated on the 22nd the N.P reviewed it and it has been sitting in transcriptioning since.

Now I know it seems like I am a Bi*** regarding the submssion, but really.... Does it need to take almost an entire month just to "review" it before even being submitted to insurance.

The N.P. told me today she would ask transcriptiong to type up my letter... I just really hope they don't half A** is now and leave things out causing more delay!

Sorry,

I just really needed to vent about this.

****Crossing my fingers that by the end of the week my information will at least be sent to Insurance so I can find out if I'm approved or not****

Kara

[Caitlyn_Cat 7]

Hang in there. It sounds like the surgeon's office is getting overwhelmed by things and needs some time, but I also heartily agree with your staying on top of things. My advice (as one who works in the medical field) is to call weekly and be as sweet as sugar, no matter how stressed they seem. You can guilt them into helping you!

[snowfie9 6]

Wow. I do hope you find a resolution soon. I'm really dreading the insurance dance and I haven't even started yet. I'm really want to be done and over with surgery and get started with living.

I'd probably be crying if I had as many delays as you have.

[karaserene1985 1]

Wow. I do hope you find a resolution soon. I'm really dreading the insurance dance and I haven't even started yet. I'm really want to be done and over with surgery and get started with living.

I'd probably be crying if I had as many delays as you have.

No crying here.... Just lots of frustration.... I think that is why this it is so hard.... I have been doing this supervised diet for almost 8 months now. Work out on average 3 times a week for an hour and a half and I have only lost 4.5 pounds. If you don't count what I gained while my body was getting used to eating all the higher fat more Protein items.... It is very hard to stay motivated and I just want to have the surgery to have the "tool" to help my efforts at losing weight.

Its no wonder after 7 months I have only lost 4.5 pounds. The story of my life... Thats why I need the surgery to help. The biggest step to getting the surgery for me at this point is getting approved by insurance and I am having a very hard time waiting...

[karaserene1985 1]

OMG! WOULD YOU BELIEVE THAT AT 4:31 THIS AFTERNOON THE CASE MANAGER FROM UHC CALLED ME TO SAY I HAD BEEN APPROVED?!? THIS NEVER WOULD HAVE HAPPEND IF I DIDN'T STAY ON TOP OF MY SUBMISSION. I KNEW AS SOON AS IT WAS SENT I WOULD RECEIVE A FAST DECISION BUT I DIDN'T EXPECT WITH IN 3 HOURS! SIMPLY AMAZING... NOW JUST NEED TO SET A DATE!

[Douceur72 3]

Yaay! that is great news. I am still 3-4 months away from submission but will need to remember that persistence is important! thanks for sharing

OMG! WOULD YOU BELIEVE THAT AT 4:31 THIS AFTERNOON THE CASE MANAGER FROM UHC CALLED ME TO SAY I HAD BEEN APPROVED?!? THIS NEVER WOULD HAVE HAPPEND IF I DIDN'T STAY ON TOP OF MY SUBMISSION. I KNEW AS SOON AS IT WAS SENT I WOULD RECEIVE A FAST DECISION BUT I DIDN'T EXPECT WITH IN 3 HOURS! SIMPLY AMAZING... NOW JUST NEED TO SET A DATE!

[ASBgirl 53]

Congratulations!!!!!!!

I had my last appointment today that completes all the things required before the surgeon submits to insurance. I am praying it will be submitted by the end of the week and hope to get an approval like you did!

Best of luck to you! Keep us updated!

[StacyS 20]

Congrats!!!!! So happy for you!!

[Cheryl 1]

Woohoo! So how are you feeling now that it has been approved? There's anxiety and frustration with waiting for approval and now there isa different anxiety while waiting to have surgery. HAPPY FOR YOU.

[karaserene1985 1]

Woohoo! So how are you feeling now that it has been approved? There's anxiety and frustration with waiting for approval and now there isa different anxiety while waiting to have surgery. HAPPY FOR YOU.

Yes it is very strange the way my feelings changed. I was anxious and frustrated for approval.... Now I'm scared and anxious to get a surgery date and start this new chapter in my life. Very strange how fast the emotions came!

Best of luck to all of you who are still waiting.... and sometimes being persistent is a good thing!

[MRSKOUBiK 27]

That really stinks. I hope your stuff will be submitted soon!