Damn it all to hell!

[Stevehud 1,790]

So as you can see by my post title I am absolutely beyond angry. After doing so well busting my butt to do m pre op diet, meeting all these goals. it turns out my company is being bought out, so I and my surgeon have to push hard and fast to get my surgery in before the end of the year due to change sin benefits for the new company taking over. Well we submitted just before thanksgiving. I have Tufts Cigna Carelink, its a joint insurance through both tufts and cigna. Well they decided to deny my surgery today. Why you may ask? well they said I don't have 3 months of continuous care . Which is bull because I do. And they have all the clinical notes of same showing it.

But my surgeons office says cigna pretty much denied every first try outright. So now I have a peer to peer with my surgeon and their doctor who denied my surgery on this Friday. Here is the real problem. Now if this process goes any longer all the money I have spent on testing etc all the time off, all the sacrifices will be for nothing because while my new insurance may indeed cover bariatric surgery ( its a BCS plan) It does not have my surgeon and team in its network list. Meaning I would have to start from scratch with another whole team. So I'm thinking of just blowing up this whole diet tonight....f&^% all the work i've put in, ....sorry im really almost overcome with anger,

I honestly do not think I could do all this prep work again. and the new company would never give me the time off to do the surgery, they would make me file for FMLA leave which I couldn't do as I couldn't afford to be out of work without pay. So the whole thing would be one giant waste of time and energy. I am not normally a pity person, but I do not see a light at the end of the tunnel at this point in time. And if there is a light its likely to be followed by a train.

sigh Thanks for listening.

[Summer Rain 245]

@Stevehud I am so sorry to hear about your troubles. I hope everything turns out alright.

Summer

[Garifab_VSG 122]

I can't imagine how deflating that must be

[Elode 8,093]

Wait you said you have a peer to peer this Friday so you still have a chance right? You said your surgeon says this is normal to be denied the first time so there's still hope then right? It's only the 3rd of December so as of today you still have a full 4 weeks before the first....Am I missing something here? Are you pre-stressing if so stop that!

[old_rn 110]

I understand your frustration but like Elode said it isn't a written in stone denial so power on. You will succeed!!!

[Elode 8,093]

Oh and your lack of response better not be because your stuffing your face!!!! Stop that too! (I'm so bossy it's almost scary!)

[Brownbella 1]

I OVER STAND your situation as the same thing happened to me and I've been on a whirlwind! You need to be the calm like the the middle of the Tornado! Get clear write a letter to the insurance provider (it has worked for some) and only invest energy in geting you the outcome you want.

Give yourself a day or two to be really angry and then move on from it becasue if there is any chance you can get them to pay for it you want to at least know you put all your energy into that and not being angry. Sometines I dont allow myself to discuss things after a certain point becasue it will just make me re-invest in all the anger and hurt!

Be sincere, be kind a be concise when sharing information and it should go a long way! I am sending positive thoughts your way get your Cape out and rescue yourself! You can do it!

[SuperDave 1,115]

That's a rough situation. I hope it all works itself out. It's not over yet my friend!

[Stevehud 1,790]

I was tempted to end my diet last night and grab mcdonalds or something on the way home. But I didn't want to let the insurance company win twice. Yes the peer to peer is tomorrow and I will find out then what my fate will be. I believe I would get the ok if I went though the whole appeals process, it is just that I do not have time to do so. Also my HR person brought up the fact that the insurance company knows I wont be on their rolls again next year and maybe they are trying to save money by dragging out this process until I wont have to bother with them anymore. Which I would not put it past an insurance company to do.

Thank you all for being behind me. I will let you all know how this turns out tomorrow. keeping my everything crossed until then.

[Stevehud 1,790]

so here is the first update....

My surgeons office called. The peer to peer review is..cancelled. Yesterday I had to go and get a weigh in in a rush from my pcp to show the three months of consecutive weight loss care because we had moved up the date of my nutritionist meeting from dec 1 to nov 26. So we had to show care in December. so I did that and faxed that off to the insurance company along with some other minor stuff and the insurance company decided they don't need the peer to peer, they say they escalated the decision to the same doctor who denied me the first time for him to review this "new" paperwork, and will have a decision either today or Monday. .its amazing how they keep stringing me along. Knowing damn well , each day pushes them closer to having to pay nothing. If they string me along just 6 to 7 more days the surgery will not happen until well after the new year, which means a new insurance, new surgeon and hospital all new appointments and testing, and probably 6 to 9 months on a waiting list as well. which pretty much would mean the surgery will never happen and then I will be not only fat , but look like a jackass as well.

anyway ill keep you all informed. man its f***ing depressing.

[maplemaple 1]

It might be crazy but I am avoiding the headache and having my surgery done by an American Dr in Mexico. I wasted 6 months of my life for them to deny me after paying an arm and a leg on premiums. F that. I will save more getting being healthier with cheaper insurance AND I wi have my life back.

[BLERDgirl 6,417]

so here is the first update....

My surgeons office called. The peer to peer review is..cancelled. Yesterday I had to go and get a weigh in in a rush from my pcp to show the three months of consecutive weight loss care because we had moved up the date of my nutritionist meeting from dec 1 to nov 26. So we had to show care in December. so I did that and faxed that off to the insurance company along with some other minor stuff and the insurance company decided they don't need the peer to peer, they say they escalated the decision to the same doctor who denied me the first time for him to review this "new" paperwork, and will have a decision either today or Monday. .its amazing how they keep stringing me along. Knowing damn well , each day pushes them closer to having to pay nothing. If they string me along just 6 to 7 more days the surgery will not happen until well after the new year, which means a new insurance, new surgeon and hospital all new appointments and testing, and probably 6 to 9 months on a waiting list as well. which pretty much would mean the surgery will never happen and then I will be not only fat , but look like a jackass as well.

anyway ill keep you all informed. man its f***ing depressing.

This may not be a bad thing. I once had to file an appeal with my insurance company (over a medication I think I needed). They sent me a hearing date and everything. The day before the hearing I received a call saying the hearing was canceled. I was pissed! The day after that I received a letter saying they had approved the medication after all. Not sure why although my doctor seems to think that so many people rarely challenge them that my determination is writing a letter and filing the appeal made them change their minds.

I hope it all works out for you!

[peteyrulz 82]

I feel your pain! I've been playing this game with BCBS since March. I'm currently at the external appeal stage. I'm really upset because if the doc's office had not sat on my records for a month, it's very possible I could have had surgery before Dec 31.

BUT NOOO...now I'll have to meet the new year deductible...blah blah blah. At this point I am seriously considering Mexico. Not sure if I'm more upset with BCBS or surgeon's office. This has been one big comedy of errors since the beginning. I could have gone to Mexico during the spring...I would probably be at my goal weight by now.

Good luck to you!! I hope things work out for you soon, even if it's next year. Thanks for letting me rant!

[briefs199 337]

Ugh! Good luck. I am following your blog so I understand what a long journey this has been for you.

[pinkbunies 359]

This completely sucks. You have made up your mind about surgery it sounds like.

This is what I would suggest. If you can afford $3299.00 consider using the surgeons that this forum suggests.

Mexico is a great place for surgery. It sounds scary, but I assure you it isn't.

When my insurance company denied me, I didn't let them win. I went to Mexico and now I'm nearly 50 lbs thinner.

They will let you use a credit card or they also offer financing. Def. consider it.

I hope things start to go well for you.