Waiting to Exhale

[Sharon1964 2,530]

...100% will be covered after I've met my OPM...(even though wls surgery has a 50% coinsurance)...BCBS says doesn't matter, once OPM is met all approved procedures covered in full. WELL...the coordinator at surgeon's says she's not seeing that info on my policy.

OPM - out of pocket max - is exactly that. It's the maximum you will pay out of pocket for your plan year (usually calendar year but not always). Once you've met your max out of pocket everything will be covered at 100% no matter if they're usual coverage is a smaller percentage.

I doubt that the term will be defined on the webpage where she is looking up your policy info.

You can ask your insurance for a plan coverage booklet if you don't have one; they almost always have definitions. Or you can do a three way call with her and your insurance company. You can also ask to speak to the office manager and discuss this person's need for more training.

As someone who works in the business of medicine, including teaching people how to bill and understand insurance, it strongly annoys me when people in these positions (surg coordinator) don't know what they're doing.

[Catherine Gray 11]

Any news OP?? Bcbs Finally got my bbc.co info, and denied as planned. I am now waiting on secondary!

[Mrs. Reid 392]

MORE FRUSTRATION!!! Called the insurance company this morning and they say my pre-authorization is pending due to errors! So I call the program coordinator and she says Kelly the insurance person is off today but they will look into it and give me a call on Monday. Kelly never calls back...I'm going to have to call them. It just seems so amazing to me that this is what these people do for a living...this is all they do...and yet it has been a full month since I met all the requirements for the surgery and they still have not been able to get my case properly submitted to the insurance company! So now the soonest I would be able to have surgery is the beginning of February. My whole life is on hold waiting for this to happen. This is just unbelievable!

[mrsmith901 18]

I just got my approval with Cigna!! Now to wait on the surgeon's office to get a copy of it so I can schedule a date!

[kyrickchick64 468]

Good to hear

[bangbangbarbie 52]

OP- if I were you, I would go somewhere else. This is ridiculous. Sorry for my french, but F whoever this Kelly lady is!

[Mrs. Reid 392]

OP- if I were you, I would go somewhere else. This is ridiculous. Sorry for my french, but F whoever this Kelly lady is!

I really wish I could go to a different hospital. I would have to start the whole process over and that means another 6 months of waiting. I would say it's not possible for these people to drag it out for six months...but I don't know. If I had the money to go to Mexico I would schedule my surgery today and forget about Hennepin County (where I am having the surgery done). But I don't have the money....and so I sit in limbo waiting for this thing to work out.

[kyrickchick64 468]

Time to show up in person and start being the squeaky wheel !

[Mrs. Reid 392]

I have decided to give them one more week and then I am going to write a letter to the chairman of the bariatic department describing the problem I am having and asking for his help to get things straightened out. Monday it will be one month since my last NUT appointment. I am going to call the insurance company on Wens and Friday to see if the problem has been cleared up. If not, then I am going to write my letter on Friday and take it to the hospital myself. I really don't take lightly to being jerkerd around and that is what I feel is happening.

[Mrs. Reid 392]

UPDATE: talked to insurance today and my paperwork is complete! Now I just have to wait for a decision!

[nandjsmom 12]

I am so annoyed with the waiting. I just want to get things rolling. Excited but nervous!

[Catherine Gray 11]

Can you believe im stilk waiting too. Ive been calling my secondary everyday and my doctors have not reacehw out to them. I am on a tight deadline. Im calling my drs in a fee. Praying we get answers soon

[mrsmith901 18]

Hope you all get answers soon! I am still waiting on a date. I go next week for labs, Feb 6th for a EGD, and then the week after that is my final consult and I will get a date. I hate being in somewhat limbo!

[Catherine Gray 11]

Spoke with my surgical dept. And she basically told me se has no clue whats going on. Im beyond irritated! Its been a month as of tomorrow since my paperwork. I cant believe their office is handleing my surgery this way. If it wasn't for the fact that I did everything thorough them, I would be switching to a new office. I have less then 2 weeks before im bk in school to finish my last semester as a graduate student. I was told I'd have my surgery well before then. Ahhhhhhh. Im ready to pull my hair out. I don't want to seem like a bitch but jeez.

[time4change15 15]

So i got my approval today! I am so ecxited! I will have my procedure within 3 weeks if my pre-op testing goes well. I am so glad this part is behind me!