FEP BLUE......

[chinamama 104]

Just need to vent, and open to any help of anyone with any knowledge.

My story so far, ended up in the ER in November with a bad lapband slip (3rd slip) Doctor wanted to do an emergency removal, begged her to wait until after a family wedding in December (which we ended up not going to since I was so worried about the band, and flying). During my EGD it was discovered I have a bad prolapse of the band. food is getting caught in that pouch hanging down the back, pressing on the band and causing a lot of pain and stuck food.

Checked with insurance (FEP Blue (Regence in Oregon)) about removal and revision. Was told 3 mos nut, PCP, psy, sleep etc which I did. Removal approved, revision denied; no 3 mos supervised diet. Resubmitted 3 mos NUT, and started supervised diet w/surgeon. Surgeon did peer to peer with medical director, who said to send chart notes and finish 3 mos supervised diet. Which we did. NUT has been faxed at least 3 times (as well as in the original application), dr's chart notes sent the morning after peer to peer, completed chart notes faxed and mailed after 3 mos supervised diet two weeks ago. I called thursday and they old me they hadnt recieved anything, office faxed AGAIN. I called again this morning and was told they had recieved the notes after the peer to peer, but they needed to be MAILED not faxed! And not to the address in Portland that the office had sent them to, but a post office box in Seattle!!!! This morning I ran to the surgeons office, got the stack of stuff from the scheduler and overnighted them to their post office box, since they wouldnt give me a physical address..... Ahhhhh surgery is scheduled for monday, I don't think I am going to make it!

Any suggestions? Fep is usually so easy, I don't understand why this is so hard. Everyone and everthing is arranged. I have an autistic 16 year old, and my 84 year mother in law that lives with us. MIL broke her foot in january and is still on home health, husband can't take any other time off until the end of May.

Prayers would be welcomed! Thanks for letting me vent!

Laurie

[Deena505 1]

wow that is really strange!!! I have FEP BLUE as well and had lapband slip twice and got approved to remove it and do sleeve on coming up May 1st. I honestly think it has to do with Dr! you might wanna call FEP BLUE and find out whats is going on! that is strange i got approved less than a week.

[T'snewstart 251]

I know nothing about that insurance. However, my heart goes out to you and the struggle your in. I will pray for you and your family. Hang in there! Best Wishes

[chinamama 104]

I would agree with you about it being the surgeons office, but when I call, I get put on hold while the person at BC checks. I am getting different info everytime I call BC. Sent from person to person and given different info.

[rosehips 121]

I will pray & believe right now for the papers to get in the right hands. If for some reason the surgery can not be done on Monday then there is a reason for this. Hang in there, I will follow your journey & at this point believe Monday will happen.

INSURANCE AND STAFF PEOPLE CAN BE SO FRUSTRATING, I can only imagine the time you have spent on this.

P.s. my 102 yr old mil lives w/ us. She says 5 times a day "u've lost a lot of weight haven't you?". Week in and week out she says this. At least she is not saying the opposite.

Take Care

[chinamama 104]

Oh my goodness 102 not sure I could manage another18 years with my MIL.

I had a dream a couple of years ago, I was living in an assisted living facility with my daughter on one side and MIL on the other. I told hubby he must have died to escape. you have to laugh or cry. I choose to laugh.

Thanks for the prayers everyone. I also totally agree that the timing needs to be right, but I also know the band is causing more damage the longer it's in.

[SqueakyWheel&Ethyl 160]

China mama your plate is full! This is the advice I have:

When you call your ins co tomorrow, ask for "the Medical Director responsible for the approval of your procedure."

THAT is where the buck stops. You may only be allowed contact with a nurse in that office, but that's where you need to be. Tell her that you understand you have met all of their criteria and need to understand why there are more delays. Give them the chance to explain their stall tactics. Then, ask, "if you were me, what would YOU do to get this resolved ASAP?" Keep putting it in their lap.

Offer to send it Fed Ex for next day delivery. If they say, USPS only, ask them to justify the logic behind that. Remind them that all these delays are only increasing the risk of an emergent situation and it is in everyone's best interest to resolve this and move on.

I would be on the phone calling, leaving messages, etc EVERY SINGLE DAY until you are satisfied. SQUEAKY WHEEL GETS THE GREASE.

Good luck!

[chinamama 104]

Thanks everyone for the prayers and suggestions. I was going to give them until 3:00 today but no need. IM APPROVED!!!! Not sure if it was prayers, the overnight to the correct address, the nasty gram the coordinator sent, or some magic fairy here, but it's done!!! Ok now I'm scared instead of mad. And I have some much to do!!!!

I'm trying to write down passwords and everything else. Because you know Murphy's law if I do it all there will be no complications. But if I don't ill wake up in 6 weeks with the house in foreclosure because the husband didn't know to pay the mortgage.

[SqueakyWheel&Ethyl 160]

YEA!!!

ATTAGIRL!

Don't be scared! Be EXCITED! This is an adventure that is beginning for a new way of life that is going to make you FEEL BETTER! Jump in feet first! But, yeah, pay the mortgage before they knock you out.

((HUGS))

[rosehips 121]

Thanks everyone for the prayers and suggestions. I was going to give them until 3:00 today but no need. IM APPROVED!!!! Not sure if it was prayers, the overnight to the correct address, the nasty gram the coordinator sent, or some magic fairy here, but it's done!!! Ok now I'm scared instead of mad. And I have some much to do!!!!

I'm trying to write down passwords and everything else. Because you know Murphy's law if I do it all there will be no complications. But if I don't ill wake up in 6 weeks with the house in foreclosure because the husband didn't know to pay the mortgage.

RIGHT ON, I'd give it to God, (since you are the one who says & asks for prayers, I'm not wanting to be offensive w/ the God thing)...I am pretty sure you are meant to be alive & one more success story, I am so happy for you!!!