Feeling Defeated

[triplenmomma 21]

Just wanting to vent. I've been on this Journey since last January with my first MD appointment on 2/7/14. We discussed surgery in May and the MD said that was doable. I was told that all I needed to do to get my surgery was the Psych eval, EGD, and one pre surgery class.

I got my Psych eval done in mid March 2014, and waited to hear from the MD office. In early April, I started emailing and calling the office and didn't hear back. I've been an RN myself for 18 years, and just couldn't believe that I was being ignored. My the end of April, I had given up on my May surgery date as I had never spoken to anyone from the surgeons office since my appointment in early Feb.

Out of the blue, in June, I received a phone call from a nurse in the office that stated that she was new, and saw my emails and voicemails, and didn't see where anyone had gotten back to me. She was nice and apologized, and stated that they had had major turmoil in the office with almost all the staff leaving. I got lost in the shuffle, she was apologetic, and sympathetic to my voicing my frustration and anger. She stated that she would talk to the insurance 'people' and have them call me with the next steps.

I never heard from anyone again. In late July, I called again, and left a voicemail stating that I would really like to schedule my EGD and finally move forward. I was actually called back within 2 days, and scheduled the EGD for the 9/2/14, and my class on 9/8/14.

On the morning of the 8th, I call and talk to my patient care coordinator that was just put into her position 2 weeks ago. I ask her if there is anything else I need to do because by the information that I was given in Feb, I was ready to be submitted to insurance for approval. She comes back and tells me that I have to do a 4 month supervised diet now.

I am so discouraged. I am so ready to have this surgery, and I've gotten nothing but the run around from this office. I can't afford to pay for it out of pocket and it's the only place that our insurance covers. (My husband is an RN at the same hospital.) So, while I've sat around for months waiting for the office to call me back, I could have been dieting but they neglected to tell me that my insurance had this new requirement. Ugh.

So, now I'm hoping to have surgery in late Dec/early Jan. Anyway, thanks for listening. My journey continues.

Any tips for the diet? What if I lose too much? We'll see what my PCP says about it next week.

[CowgirlJane 14,259]

Switch surgeons

[blondebomb 580]

I'd change an call my insurance they can help on surgeon. That is a mess!

[BitterSweet* 835]

I can feel your frustration. So sorry they are giving you the run-a-round. =(

[bellabill 253]

I go somewhere else... At least that's what I would have done. On the other hand you might lose more time. I understand your frustration.

[NavyMom2006 119]

I would definitely file a complaint thru your insurance company.

[triplenmomma 21]

Yeah. I wish I had the money to just go where I want, but I don't. I am going to file a complaint with the health care company, but at this point just need to jump through their hoops. I've gotten this far and don't want to start over and pay out of pocket. It sounds like many of you have more than one option. I wish I did. Filling a complaint is my only recourse at this time. Thanks for your thoughts.

[NavyMom2006 119]

Good luck and keep us posted.

[Miss Mac 6,262]

Since I have several long-term medical conditions, my insurance company assigns a case manager for me. That way, when something flares up or I need surgery (like with my knee replacements), the case manager gets involved. Since it is in their best interest, too, for things to proceed smoothly and quickly, I get support from their end when my medical providers cause a glitch. She makes calls for me to get providers off their a** and informs me of what I need to do to meet their requirements. She has called me to find out if my physical therapist is doing their job and how thay are treating me and do they keep their appointments with me, etc. etc.

Does your insurance provide anybody like that who can help you? The medically supervised diet is not so bad. You will learn how to have a more heathy relationship with food and gain new skills for successful maintenance for the rest of your life. I am so sorry that you have had so many struggles with this process. Just remember that delay is not denial. Hang in there and don't take NO for an answer. I wish you good luck and good health. (I just typed "good lick and good health!") LOL

[New nana 30]

You need a different surgeon. If they are that uncaring and that unorganized preop they are going to be just as bad if not worse postop when you really need them!

[WhoKnows 288]

I'm sorry you're not in a position to go anywhere else. I had similar trouble at the hospital where I first planned to go (I don't even know who my surgeon would have been because I met someone new every single time I went there), so after I finally FINALLY got approval, I switched hospitals. Luckily my insurer didn't care as long as the hospital had the same level of certification, which wasn't hard since I live in a big city.

Are you sure there aren't any other places your insurer would cover?

[triplenmomma 21]

Since I have several long-term medical conditions, my insurance company assigns a case manager for me. That way, when something flares up or I need surgery (like with my knee replacements), the case manager gets involved. Since it is in their best interest, too, for things to proceed smoothly and quickly, I get support from their end when my medical providers cause a glitch. She makes calls for me to get providers off their a** and informs me of what I need to do to meet their requirements. She has called me to find out if my physical therapist is doing their job and how thay are treating me and do they keep their appointments with me, etc. etc.

Does your insurance provide anybody like that who can help you? The medically supervised diet is not so bad. You will learn how to have a more heathy relationship with food and gain new skills for successful maintenance for the rest of your life. I am so sorry that you have had so many struggles with this process. Just remember that delay is not denial. Hang in there and don't take NO for an answer. I wish you good luck and good health. (I just typed "good lick and good health!") LOL

I've talked to my insurance a couple of times. The issue is that they had the wrong info at the start of the year. They changed from a 6 month diet to a 4 month diet, but their system erroneously dropped the requirement completely. Then my doctor's office failed to communicate that to me due to the staff turnover. They do not have a case manager for me. I'm still figuring out my options. I am going to call them next week to see how to file a complaint.

That is awesome for you though to have someone watching over both of your interests.

I'm sorry you're not in a position to go anywhere else. I had similar trouble at the hospital where I first planned to go (I don't even know who my surgeon would have been because I met someone new every single time I went there), so after I finally FINALLY got approval, I switched hospitals. Luckily my insurer didn't care as long as the hospital had the same level of certification, which wasn't hard since I live in a big city.

Are you sure there aren't any other places your insurer would cover?

I am sure. My husband and I have both been in this field for 2 decades. It is somewhat common for hospitals to insure themselves or only fully cover themselves. They will pay for out of network procedures for most things but not bariatric. I have to use their own services if I want any coverage at all.

I guess I didn't expect so many to have such flexibility on their coverage that so many of you can and do suggest to start over. That is eye opening. I can only work within my options though. Thanks to those that offered their support.

I will be ok, I'm concerned about the diet part, but agree that it will be good to get my head back in the game so to speak. My insurance sent me their guidelines and I have to show the inability to lose greater than 2 bmi points to qualify. I don't think I could do that if I tried in only 4 visits. My current bmi is so high. Hopefully this is the final hurdle though. Now, no more just switch your surgeon talk. I can't do it. I can give up completely, but I refuse to do that! I'm down but not out.