Another bump in the road

[peacequeen 434]

It doesn't sound good when you tell your ins coor that you are concerned about getting scheduled for surgery because the year is almost up (already waited 1 year) and your insurance is going to change..and she says she is getting concerned too. I have several areas to get clearance in due to some of my health problems. It's like pulling teeth. I was hospitalized in July and they did all kinds of tests on me,,including the ones that are required for me to have surgery. They told me they could get my medical records and that would keep me from having to have all the tests again..and more than likely my insurance wouldn't cover them a 2nd time since it was just a few months ago. So I downloaded the release forms online,,filled out my part and took them to the bariatric center so they could request them,,since that's the "quicker" way to go. It normally takes a patient up 30 days to get their own med records where a doctors office can get them within 24 hours. Well,,today my coordinator tells me that she still hasn't rec'd them..it's been a week. So I'm doing all this leg work to try and get something,,no luck yet. I'm almost ready to give up..I feel like crying and it's just stressing me out so bad. Does anyone have any clue what I can do? Has this ever happened to any of you? Just reaching out,,so frustrated and sad.

[redmtn 0]

I know your feeling of discouragement. After 8 months and 2 denials, I finally got the ok from my insurance. I was actually really surprised and didn't realize how depressed and frustrated I was until I got approved. I would encourage you to hang in there and keep trying. Things happen that you'd never think would.

wishing you best of luck!

[peacequeen 434]

Thank you, redmtn. Your words of encouragement really help.

[CoffeeBean 4]

Peacequeen, I feel so bad for you. You've waited so long already. Hang in there. I didn't qualify to have surgery in the states, so I went to Dr. Kelly in TJ Mexico. I'm so gratefull to even have that option. I'll be praying for you and your decision makers.

[longer-life 139]

Don't give up! :hug:

[SKCUNNINGHAM 298]

I did the insurance two step for a year, and my approval came last December 29th - on my birthday. Maybe you will have the same year end surprise. This time next year you could be a 100 pounds lighter - like I am.

Good luck!

[Geno 3]

I so sorry Peacequeen, I had a very sad moment today at my doctors office, I was approved right away, but I asked and asked if there was any out of packet charges for me and they said no a few times, today they told me I had 2,000 dollars deductible and I am a single mom with a mortgage and I dont have that money, so they offered if another doctor who is never there could dso the surgery, I felt like a child that was not given what was promised and I almost broke in tears, so Dr Vorha saw me and he said no, that there was no issue and that the surgery will be on 11/22, i need to start on Optifast by Monday.

Now I am just waiting for the day and hoping there are no bumps.

[Lissa 2,631]

Peacequeen, I understand your frustration. I was self-pay, so thought the process should have been smooth sailing. That was before the surgeon said he wanted a filter installed, which meant visits to vein doctors, then blood doctors, a neurologist. I finally asked the surgeon if all these doctors were related or had some mob connection that required them to refer every one of their patients to each other so their kids could have paid for college!

Good luck on your journey, and don't give up on the phone and in person visits/harrassment of the docs until you get the approval you need. It WILL be worth it. And, tell them that your insurance is getting ready to change (or that you will have to meet a whole new deductible next year) if that is the case.

[peacequeen 434]

Thanks, everyone. I wish I could even think about self pay but I have 2 kids in college..there's just no way. It's all or nothing where the insurance company is concerned. I wish all of you self payers luck though,,I feel for you having to come up with so much money.

Lissa,,I know how you feel..I've had blood work, psych eval, therapy, I have to have an EGD, cardiac clearance,,already had pfts when I was hospitalized in July so that's 1 down. I'm sure there's more,,I just haven't been told yet.lol

I had an appt with my neuro and got one silver lining..I was able to get the clinician's notes from when I was in the hospital proving I had the pfts..I had an echo done but not sure that will be enough for the cardiac clearance but ya never know. I think my ins coor sent off my paperwork to the ins co waiting on approval...I think..she didn't reply to my last email but she said my EGD would be scheduled after they hear from the ins co if I was approved or not...it sounded promising..again,,I think??

[peacequeen 434]

I forgot,,yes, Lissa..I've met my ded and out of pocket for the year and my husband will have the same insurance but the policy will be changing..I'm not sure if they would even cover wls next year. That's the reason I'm very anxious to get the ball rolling faster.

[Lissa 2,631]

Good luck with everything. Just keep slugging and hopefully, it will all work out so you can have the surgery this year!!!

[longer-life 139]

she didn't reply to my last email

You will call her first thing in the morning right? :boink: (That should be you in yellow and her in the blue! LOL)

[ProudGrammy 8,322]

Peacequeen, I feel so bad for you. You've waited so long already. Hang in there. I didn't qualify to have surgery in the states, so I went to Dr. Kelly in TJ Mexico. I'm so gratefull to even have that option. I'll be praying for you and your decision makers.

I know a lot of people go to mexico for their surgery. My only concern would be what will be done for your necessary follow ups, question, problems etc. What is done, how do you handle it? kathy

[peacequeen 434]

I can't self pay so I won't be going to Mexico. I would have the same concerns if I was thinking about it though..thanks

longer-life..lol If she doesn't call or respond to my last call and email..I will call or email her..you are so funny

[Thomas CPA 496]

You should be able to sign the release forms at the doctors office and get the records immediately. At Kaiser if I sign the release I can get copies of xrays, ct scans etc put on a computer disk the same day. Many doctors have the information on computer systems. I know kaiser does and can can pull down all my blood work.

If you are going to do self pay, just get Kaiser insurance - as long as they deem a medical necessity and you take the two month course you will get surgery. I had good policy and had zero copay. Didn't even have to pay to be in hospital. All I paid for was the antacid medication at the pharmacy.

Don't let the medical offices fool you, they can get you the records without it taking 30 days. They can get in in 24 to 48 hours.