I'm Beside Myself...

[simplystace 1]

So with fingers crossed I thought this might be the week I hear about a surgery date. Low and behold I got the call today.....and scheduled it for Nov. 1st. I was so happy. She told me about all the pre op prep, blood work, classes etc. I was stoked....and of course asked the question.....so everything is cleared with my insurance, right? She said, oh absolutely....you don't get this far until you have a pre approval, so you're good to go. (I've been working on this process since Jan. 4th). So for my own piece of mind I call my insurance to double check my understanding of a few things, ( deductibles, out of pocket maximums)make sure I'm not missing something.........the woman on the phone says, ma'am...you do know that Bariatric surgery is not a covered benefit for you, right? I asked her to repeat that for me 3 times and no matter how's he said it I still heard the same thing. So I hang up and immediately call the surgeons office to ask for help. I explained my situation and the lady chuckled And said.... Oh, what are they doing.......I'll call them right away and get this straightened out.

So sure enough she calls me back and says the following.......I'm very sorry mrs. H---, somewhere in the process someone passed on the wrong information.....your insurance is correct, this IS NOT A COVERED BENEFIT under your policy.

Honestly, you would have thought I was just told I was terminally ill........I dropped the phone and stood there with my mouth open for what felt like an eternity.

Crushed, heart broken, deflated, sad, depressed, mentally exhausted.......absolutely beside myself. Tonight I am broken, I have cried a thousand tears.

[rpil003 101]

Oh sweetie, I'm heart broken for you. I'm so sorry that you were not covered and I hope and pray something will work out for you. Best wishes.

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[luvlife 43]

I am soooo sorry for what u are going through. I can't believe they did not tell u this until 9 months after your process started. Maybe they have financing? If not there, u could check around with.other surgeons. Again I am so sorry. Don't give up yet though. There has to be a way to get this done.

surgeversary 7/24/12, highest weight 267, surgery weight 262, current weight 216

[Vicki Loichinger 444]

my heart breaks for how i know you are feeling right now. I wish I knew what to say or how to help. What a blow what a huge disappointment. I am soooo sorry. Praying that there will still be a way.

[kristy3k 1,133]

oh honey.... so sorry to hear that . I am hopeful that something will come up that will allow you to have your surgery.

[kiwiladydee 402]

This is awful, they really should help you with some of the financing. Do u know if they cover none of the surgeries, even for medical conditions? Google your insurance and state and see what other people did for approvals.

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[BBdoodle 483]

Oh how awful, thank God you called to double check, I would hate to of see what would of happened if you went thru surgery = YIKES. I would be bummed too !!! Hopefully you can figure out a way to make this happen. Please stay positive even though it is diffficult!!!

[Cheryl Barfoot 69]

So with fingers crossed I thought this might be the week I hear about a surgery date. Low and behold I got the call today.....and scheduled it for Nov. 1st. I was so happy. She told me about all the pre op prep, blood work, classes etc. I was stoked....and of course asked the question.....so everything is cleared with my insurance, right? She said, oh absolutely....you don't get this far until you have a pre approval, so you're good to go. (I've been working on this process since Jan. 4th). So for my own piece of mind I call my insurance to double check my understanding of a few things, ( deductibles, out of pocket maximums)make sure I'm not missing something.........the woman on the phone says, ma'am...you do know that Bariatric surgery is not a covered benefit for you, right? I asked her to repeat that for me 3 times and no matter how's he said it I still heard the same thing. So I hang up and immediately call the surgeons office to ask for help. I explained my situation and the lady chuckled And said.... Oh, what are they doing.......I'll call them right away and get this straightened out.

So sure enough she calls me back and says the following.......I'm very sorry mrs. H---, somewhere in the process someone passed on the wrong information.....your insurance is correct, this IS NOT A COVERED BENEFIT under your policy.

Honestly, you would have thought I was just told I was terminally ill........I dropped the phone and stood there with my mouth open for what felt like an eternity.

Crushed, heart broken, deflated, sad, depressed, mentally exhausted.......absolutely beside myself. Tonight I am broken, I have cried a thousand tears.

i am so sorry for all of these mix ups but there is always a way to figure something out! google st. vincent's charity hospital and see what they might do. talk to someone there also, they might know of some way to help ya out! best of luck to you dear! great big warm hugs

[milan 6]

I had the time a state ins in wc that clearly said any was not covered. Knowing this my primart doc n bypass surgeon pursued"medical necessity. I was denied. Filed a n appeal, requested telephone interview with my doc, medical director and decision reversed . Anything can change. If this is what u want knock on doors

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[simplystace 1]

Thanks for all of the encouragement. I am doing my best to not give up. I have a lot of phone calls to make tomorrow. Fingers crossed for better news!

[kisersassy 369]

Milan is right. Sometimes you can file an appeal and get approved but doctor HAS to say MEDICALLY NECESSARY!!!

[simplystace 1]

Lots of calls today. No luck. Bottom line is my employer chose not to allow elective surgeries to be a covered benefit. I already have the letter of necessity for a multitude of comorbidities, etc from my PCP. There is a 'clause' in our policy that just says its not gonna happen. For grins I asked the surgeons office what the surgery costs.......around $30K. Yea, not gonna happen either.

So for now, I bid you a fond farewell. Good luck to everyone, thank you for your support and never forget that you are number 1.

On to strategize plan B. I got this, it's all good.

Take care,

Simply Stace-