Dealing with Insurance Companies

[heynowkc 329]

I am so frustrated with my insurance company now.

I had to complete a 12-month education program in order to qualify for my surgery. During this time I got all of my pre-op testing done and even had a sleep study (not required, but I did it anyway!) and have lost almost 50 pounds (49.6). I checked and double-checked throughout the year to make sure I was doing everything right.

On Sunday I "graduated" from the education program, and my coach, a nurse, forwarded my graduation information to my insurance company. I called on Monday to get the ball rolling for pre-authorization and to schedule surgery. I knew it was early, but I was being optimistic. Then I was hit with a curve ball: the bariatric benefits coordinator tells me I need a psych-eval in order to qualify for surgery. I was flabbergasted. Not only had I specifically asked both my insurance company AND the surgery coordinator one year ago (almost to the day!) about a psych eval (and was told no) but I have been constantly (all year!) checking and re-checking to make sure I had everything done, and now this at the 11th hour?

Luckily, I don't need a "full" psych eval, just a meeting and a letter from a health care professional that says I am good for surgery. Luckily I got in today with a very nice doctor who normally treats children and adults with ADD and ADHD. She was literally the only doctor in the area that had any availability before Thanksgiving, and so she said she'd help me out. The meeting and evaluation went great and at the end she confirmed she would send the doctor a letter recommending me for surgery but that it probably wouldn't be until Monday, Friday if she can swing it.

I am happy to have it over and done with, but am also a little deflated because of the setback, and the waiting I will have to do. Also, next week is a holiday week so I am hoping that won't push things back even further. I was so eager to get my surgery date and now I am facing a set-back that is a result of the incompetence of a number of people, and is no fault of my own. It's unbearably frustrating. I can't believe after checking and re-checking that none of the many people I spoke with over the year told me this was required. The worst is that I specifically asked about it and was flat out told that it wasn't required by two different people. How does something like that happen?

Because of the way our leave works, I have two fully paid weeks off over Christmas and it doesn't come out of my personal, sick, or annual leave. It's built into our schedule. For that reason, it's really important to me to have the surgery scheduled before Christmas. I am still hopeful, because I was told by their scheduler that usually once given the OK to schedule that you have surgery in about 3 weeks. So even if I can't schedule until the 1st of December I may still be able to get a date near the time-period I want. But if this set-back has taught me anything, it's not to hold my breath!!!

Truth be told? I'd be okay with waiting longer than expected. It would mean I could try and lose more weight prior to surgery. (I am losing about a pound a day for the last 50 days!) And It would mean that I could actually enjoy my Christmas break instead of recovering from surgery at that time. But because of the way our leave works, I don't want to risk running out of my personal leave (I only have two weeks, and am told that recovery before returning to work can be up to 3 weeks.) It's just very frustrating to have everything planned and for it to all go up in smoke right before your eyes.

Edited November 19, 2014 by heynowkc

[shizwiz 197]

Wow! I can't imagine how stressful that must be for you. I will keep my fingers crossed for ya

I am SUPER big on planning (which it sounds like you are, too) and just hate it when people don't follow my plans! It sounds like you are on the right track with staying in touch with the coordinator and doctor's office.

But, I think you're right: Either way, things will work out. I am not religous, but I do think that things do have a way of working out just when they are supposed to

Hang in there!!!

Edited November 20, 2014 by shizwiz

[bamagirl 31]

Insurance companies are frustrating. While going through my 6 month hoop jumping, I mean weight loss program, for the second time, I soooo feel your pain. I also envy where you are in your journey. You are on the last leg of Pre-op!!! Soon you will have a date and it will feel like Christmas! What a wonderful gift! Good luck on this last pre-op insurance hurdle. I wish you well during your surgery and a speedy recovery, soon hoping all the insurance hoopla is just a vague memory.

[heynowkc 329]

Wow! I can't imagine how stressful that must be for you. I will keep my fingers crossed for ya

I am SUPER big on planning (which it sounds like you are, too) and I can imagine how frustrating that would feel. It sounds like you are on the right track with staying in touch with the coordinator and doctor's office.

But, I think you're right: Either way, things will work out. I am not religous, but I do think that things do have a way of working out just when they are supposed to

Hang in there!!!

I'm not religious either and I won't go so far as to say that things work out WHEN they're supposed to. But I have no doubt that I will be ok either way it works out, haha. It may be frustrating and a pain in the neck but it's not the end of the world!

Insurance companies are frustrating. While going through my 6 month hoop jumping, I mean weight loss program, for the second time, I soooo feel your pain. I also envy where you are in your journey. You are on the last leg of Pre-op!!! Soon you will have a date and it will feel like Christmas! What a wonderful gift! Good luck on this last pre-op insurance hurdle. I wish you well during your surgery and a speedy recovery, soon hoping all the insurance hoopla is just a vague memory.

Oh my gosh! Why did you have to go through it twice?!?! That's terrible. Now I am worried that something else is going to go wrong on my end. My gosh! Good luck to you as well!

Edited November 20, 2014 by heynowkc

[bamagirl 31]

No, don't worry. My situation is nothing like yours! I applied for WLS 2 years ago. I had a BMI of 39 for two years and over 40 for a year with no comorbidities. I began meds for high blood pressure at the end of my 6 month weight loss plan required by my insurance. I was basically denied because I was not heavy enough or sick enough due to my obesity at that time. Two and a half years later, I have now had a BMI over 40 and am treated for hypertension. I have decided to try to get approval once again in February of 2015.

[heynowkc 329]

No, don't worry. My situation is nothing like yours! I applied for WLS 2 years ago. I had a BMI of 39 for two years and over 40 for a year with no comorbidities. I began meds for high blood pressure at the end of my 6 month weight loss plan required by my insurance. I was basically denied because I was not heavy enough or sick enough due to my obesity at that time. Two and a half years later, I have now had a BMI over 40 and am treated for hypertension. I have decided to try to get approval once again in February of 2015.

Oh, I see. That is a bit different. I would just scream if I had to do this 12-month program all over again because of some paperwork snafu. That would be just my luck though. Seriously.

Edited November 20, 2014 by heynowkc