Hoops Denials and Appeals

[AnneG 7]

It's been a long journey and a fight every step of the way but I'm sitting here at what should be the

last bit of pre surgical ordeal. I really hope things go more smoothly.

There are some things that are important that I can't even really go into right now because I'm going to

go back after I have surgery to really take on the full scope of the situation so that I can give my full attention to it but-

I started this journey last year and went to a seminar in November of 2010. In January I called to

confirm coverage and was told I did not have coverage for any type of weight loss surgery.

That was a real bummer and set back because my company switched medical insurance companies and

we were told that our coverage would not change in any way and with our previous insurance policy we did have wls coverage.

I spent about a month back and forth with the human resources dept of my company and with the insurance company

only to get some wording issue that stated oh!- sure we have coverage but only a pcp can perform

any kind of surgical wls- this was just really over the top because we all know that a pcp can not perform

bariatric surgery and so it seemed that the wording was implemented to suggest coverage but not really..

Ya know? It was SO wrong. Anyway- It took another month and our company had to review regarding the medical policy coverage dept about the small print of our insurance policy and they got it all sorted out and I was notified that I did indeed have

coverage. Thank God! I can't begin to express the amount of time I spent going back and forth trying to

get to the bottom of that situation.

After that was cleared up things went pretty quickly- I went in for my consult, scheduled lab work,

a light scan, and psych eval, support group meeting, and classes with the nutritionist and an exercise class.

I was notified that I had h.pylori. I'd never even heard of it. Have no idea how I might have contracted it-

and never had any symptoms relating to it. Not even one. I also was told that I had a serious Vitamin D

deficiency. I thought that was odd because I'd been taking Vitamin D supplements for nearly 2 years and

thought I was probably right around target area for that.

H. Pylori was a 6 week set back because I had to take the PrevPak for 2 weeks and then wait for 4 weeks

to be retested. My test came back negative at the end of 6 weeks. That was a relief.

I also felt much better after taking the Vitamin D. 50,000 iu per week. I hadn't realized how crappy I'd been

feeling relating to that issue. I'd been getting sick really easily for some years which is why I initially began

supplementing. I also had a lot of muscle and bone type pain which I attributed to arthritis but it's really

decreased significantly since I've been supplementing with the prescription vitamin d. I'm finished with the

prescription doses they gave me but you know, to be honest, I'd like to stay on it for a while longer.

I'm supposed to get my levels retested soon so that will give me a clue regarding if I'm back up to

normal levels just yet.

I'm really glad that I had that test and found out that I was in need of higher dosage of supplements- its

made a huge difference in how I feel and I've not gotten sick in months- not even once.

After doing all of the pre surgical requirements there was an issue that I was concerned about and

mentioned to my surgeons office and they seemed to not be too concerned about it.

I don't want to go too much into detail- just yet but- it was a really serious thing that happened-

I had a problem with a health care professional NOT related to my surgeons office or staff-

Needless to say, this health care person- caused a huge problem for me due to some issue on her part-

and it caused my insurance to deny me. She actually did it intentionally and it really upset me-

It didn't just upset me- it appalled me- I can't believe someone would or even could do something so terribly

unprofessional and just wrong! Anyway- the bottom line is I'm not one to stay down long when someone kicks me.

I'm pretty good at working through problems- resolving things over the long haul- I'm consistent and dedicated.

I'm a great researcher on my own and very willing to listen to the feedback of others to learn through their

experience and implement advice given to me.

And so, of course I did not give up when I hit this unfortunate obstacle. But I'm not finished with it by a long

shot. No. I'm not finished with it for so many reasons. But mostly I'm not finished with it because I can't

sit back and not address it because I know this person will do this again to some unsuspecting poor soul-

and the next person might not know how to work through the blow- It's not right and it's not fair.

So, after I have surgery, I'm definitely coming back to deal with that issue very indepth and I probably

will write it all up here in detail.

In the meantime I worked very hard to undo the damage and spent the past 3 weeks writing very long wordy

essays on my behalf and enlisted other medical professionals who stood behind me who did the same. Which was very liberating

and definitely gave back some of the strength and confidence I'd lost with that last battle which did kick my butt- no doubt about it-

But that's ok- I'm ok if I don't win every battle..but I WILL WIN THIS WAR. Yes, I will.

I've come too far to back down and I will have a successful surgery, recovery, and reclaim my health which

is my goal.. that IS WINNING THE WAR!

So- I'm sitting here this week, waiting to see if my insurance company will approve my surgery- after having

denied it. My surgeons team has been awesome- I feel very confident and know I'm in good hands.

I just really hope- the insurance finds things in my favor with approval now and that we can go forward because

I'm ready.

[meggiep 57]

I am so sorry someone small and mean hurt you in this way and congratulations on battling through! My journey was similar- every step of the way I hit another roadblock and had to battle and battle. Each one had the potential of delaying my a month or more- even up to the week before when I had a cold on Tuesday, six days before my surgery date, and they wanted to cancel because of the inconvenience of waiting until closer to the date to see if I got well- I had to battle one last time to have them see ME- the person and not the inconvenience, the person who had battled and battled to get this surgery. And I did get it- on May 9th. And I will keep you in my prayers as you wait to hear about the appeal. Something tells me you will prevail as you are a strong fighter! Good luck!

[sarsar 824]

Good for you sticking to your guns and working through this! I am anxious to hear about what happened, I'll be looking for that post. In the meantime, keep us posted and let us know WHEN not if you are approved!

[StacyS 20]

I'm so sorry to hear about your struggle to get approved! But let me just remind you of something... What doesn't kill us will only make us stronger!! And I can see, this HAS made you stronger already! And, KARMA IS A b***h!!! That chic will get what is coming to her!!! Just watch! Please keep us all posted on your journey!