Humana working on it...I think

Busy · November 3, 2006

Contacted my insurance company today to inquire where they were with approving my surgery. The lady on the phone said they had not received any information from my doctor's office since 01/06, so I called the doctor's office and they insisted they had faxed the insurance office 32 pages on 10/21/06. The doctor's office contacted the insurance company and found out since the insurance had denied surgery 01/06 because they required 6 months of supervised diet, they sent the newly submitted info to the Appeal Department and I should hear something within 30 days. I do not think they realize my heart already has enough stress because of my weight, now the waiting process is adding additional stress. I may "stroke out" before they make up their minds!!! :faint: Prayers Please!!!

PJ

carmillejoanita · November 4, 2006

That really sucks, sorry to hear about that. I have humana too, why did they require 6 mnt diet? I changed my doc because the doc required $4000 upfront fee but the insurance approved mine as long as I went to the psych doc first. Iam going to a new doc on nov 7. Well see what the insurance is really going to do. I won't trust them until I see it on paper. Keep me posted on your insurance problems. Everything will work out for you, don't stress.

Carmille

carmillejoanita · November 4, 2006

PS, I forgot to ask you which humana do you have? I have KPPA

~Carmille

StephC · November 4, 2006

that stinks! I'm playing the waiting game too. I went through the whole 6 month consult stuff, all the tests, sleep, heart, liver, pysch, breathing...and never missed an appt with pcp and now I wait to see if they will approve it. I have UPMC and I'm told they usually approve it after all the previous mentioned are in. I called my doc the other day and I was told they had sent everything in and it would be 1-4 weeks before we hear from insurance.

They want you to have 6 months to make sure you are serious about the surgery. My pcp told me not to miss a month because they go by calendar months and if you miss one month you have to start all over. I wasn't feeling impatient or anxious until I got through my final visit and started this waiting. It hasn't really been that long - last visit was Oct. 11, I called surgeon Oct. 18th and they had all the info, Dr. was just going through it to make sure all was intact. I called yesterday, the 2nd and was told its all been sent in. I guess I'll wait until the end of next week and then call the insurance company.

I'm praying for you - say one for me too.

carmillejoanita · November 4, 2006

I'll pray for you too! Do you think my insurance will make me do the 6 mnt thing? I started the diet pills with my doc in 1/2006 so I wonder if that will count? Who knows. There is always something that will slow us down. Stay positve.

~Carmille

Busy · November 5, 2006

Carmillejoanita,

My insurance is Humana Choice Care PPO. I don't know if your insurance will require the 6 month monitored diet. I assume you were required to see your doctor everymonth to receive diet pills, at least that is what my doctor required. Talk to your doctor and see if he will use that time period as your 6 month diet. Of course it also depends on the notes the doctor documented in your file. When my pcp turned my information into my wl doctor's office he had to include his notes for the 6 month diet and I was required to attend every month, not to miss a month. Good luck to us all, my wl office said for me to contact them again in 4 weeks so I will twiddle my thumbs until them. I will include all of you in my prayers.

PJ

Busy · November 10, 2006

Not wearing my happy face today. After having a wonderful day off, 76 degrees outside, took my 93 year old aunt on a drive in the country, went down and got a pedicure, picked out a Christmas present for my hubby, I came home and found a denial letter from Humana. They said the denial was due to me not having life-threatening co-morbidities. I'm thinking, "no, not yet, but I am 47 years old and get rounder every year, I am attempting to prevent from having life threatening problems, hence the weight loss surgery!!" I am upset and need to know what the next step is. By Sunday I will be good and mad and ready to do what I need to do. Right now I need chocolate and a hug!!

carmillejoanita · November 12, 2006

Sorry to hear about that. I went to my second seminar (different doc) and Iam punking out of this whole thing. The doc mostly talked about gastric bypass. I prayed while the doc was talking and by the time I walked out of the office my mind was changed. Besides humana requires 6 month diet and I just don't feel like waiting, so I quit. I go to my doc Wed so Iam going to talk about getting back on the diet pills. I know those pills aren't any good for your health but theres nothing else. I had my hopes build up but I really believe its not ment to be. Iam 32 yrs old weigh 280 lbs and 5'11 hopefully I can get enough will power to lose my 80 lbs.

Maybe you should call humana Monday and complain I know theres something you can do about that. I know its hard and your feelings are hurt. Good Luck

~Carmille

Busy · November 12, 2006

Carmillejoanita, Just because the doctor at the second seminar supports the bypass does not mean you have to, thats your choice. Since you are going to the doctor to get back on diet pills, won't you have to visit the doctor every month for a new script?? 2 birds with one stone, make him aware that your insurance requires 6 months of monitored diet for you to be considered for the band. Do not miss a month, when you go to the doctor for your 1st appointment go ahead and make appointments for the next 5 months. It passes quickly. As far as myself, don't count me out, I'm a KY girl and we don't give up without a fight. Monday I will start by contacting my surgeons office, then I will contact my insurances office, then I might go with legal advice. I am 47 years old and plan on living long enough to become a pain in the butt to my great grandchildren. When I do go I want my gr. grandchild to say, "man, she was fun", but I don't see it happening with me weighting what I do. The Lord says in his time, I just have to be patient enough for him to decide when the time is right. Until then I will complain, LOUDLY to the insurance company, do my research, and take a hint from kygal and exercise some, (thanks for the support kygal) So don't you punk out. I expect another voice yelling besides mine!!!!

PJ

carmillejoanita · November 14, 2006

You Go Girl thats the sprit!! I still have little feelings about getting the band but Iam going to take your advise and go to the doc every month and go from there. The surgeon wants me to do the blood work and everything else but Iam going to hold that off until I make my final decsion in 6 months. Keep your head up and you'll go far! GO KENTUCKY GIRL!!!!

~Carmille

Busy · November 18, 2006

Update, I contacted obesitylaw.com for legal advice and talked to Kelly Lindstrom. She told me there is a program backed by the makers of the lap-band that if you are denied based on "none life threatening co-what evers", obesity law office will do the appeal and not charge the patient. (I am assuming the manufacturers of the band reimburse the law office or maybe they are that supportive of the band) Anyway, the request for their help has to come from the surgeons office; therefore, I contacted my surgeons office today and gave them the information, they contacted Ms. Lindstrom in CA, she faxed the info to the surgeons office who faxed info to me. I have already completed the application and will fax it back Monday morning. Needless to say, I am tickled and trying not to "count those chickens before they are hatched", (my mother's favorite saying) Ms. Lindstrom said very few people are aware of the program and she wishes more would participate.:clap2:

PJ

__________________

regnur617 · November 18, 2006

Sorry to hear some are having such difficulty with insurance coverage issues. I have Anthem BC BS and did not have much trouble. I had lap band on 3/29, have only lost 34 or so pounds, but mostly my fault. It is so hard to watch people eating all kinds of goodies in front of you and not want to eat them. Especially around the holidays. I went to the Dr. Thursday and had gained 1 pound since last month instead of losing. Last time I hadn't lost any, I cried. I am embarrassed at being a nurse and knowing I need to exercise and follow the strict diet and don't always do it. I hope all goes well for each of you. MW