Insurance denial 4 more months

[Big Opie 32]

Here is an update since I haven't posted in a while.....my surgery was submitted July 7th to insurance and denied on that following Tuesday due my psychiatric evaluation. The insurance coordinator said I have to do 3 additional months of monitored weight loss AND one week sessions for 3 months with a psychiatrist, psychologist, or psychotherapist. BEFORE I can evern appeal the denial. I completely lost my mind....bawling, hyperventilating and just in utter disbelief....at that moment I felt defeated, and like I've failed....yEt again... Now that I have had time to ask my questions, voice my concern and really sit on the fact it was denied, this is what has happened.

On Wednesday, I called my surgeons office, and spoke with the Insurance coordinator. Since I have to do once a week sessions for 3 months, I asked if I did twice a week sessions if I could finish early, her response; No. I asked if there was any certain information that I needed to take to the psychiatrist, psychotherapist, or the psychologist, her response; No. I asked if there was any way we can remove what was entered to insurance, If I could get a second opinion and have a re-evaluation done, and her response; No. I asked if I could come up and get a copy of the denial and what information was submitted to the insurance company, and she stated that I’d have to talk to the psychiatrist whom did the evaluation and my denial will be to me within the next few days.

With all of this not so helpful information, I took it upon myself to call a psychiatrist my friend see’s to see if I could get in ASAP. They referred me to another program, and I have my appointments for once a week psychologist meeting starting August 21, 2015 and going until September 25, 2015. When I go visit her for my first appointment I’ll have to schedule all my other meetings for the rest of the 3 months.

I also, took it upon myself to go to the doctor who did the evaluation and get a copy of the information that was submitted to insurance, so I can take it to the new psychologist so she can see what information we were working with. The receptionist called her supervisor, who directed me to the billing office, the receptionist was nice enough to be willing to contact the billing office for me to see what I needed to do. However, there was, standing behind her, another psychiatrist who normally does the evaluations. He asked what the problem was, and I told them that according to my insurance my surgery for bariatric was denied because of the information provided by the psych evaluation. They stated that because of my past in 2011: my past mental and substance abuse issues, I did not understand the process and the possible outcome of the surgery (Summarized of course, since I don’t have my letter as of yet).

He stated that there was nothing in my records indicating that I didn’t understand the process, yet there was nothing in there about bariatric surgery at all………So! With that being said, he said they were going to talk to the doctor who submitted the information and see what the reasoning behind it was, and see if they can resubmit to the insurance.

I agreed, said whatever and to call me with an update. Then, as I’m walking out to my car, the head supervisor over the establishment calls me and tells me that the one who did my evaluation is not even a registered psychiatrist with their office yet, and that’s probably why it got denied. That he just came over from another area, and they haven’t got him in the system yet….SERIOUSLY?! OKAY, so you let me see a doctor who isn’t registered there As a psychiatrist.... And let him submit the information INCOMPLETE and expect me to be chill?! Oh my god, I was sooo heated! Without totally freaking out and cussing out everyone under the sun, I asked if this was going to be resolved. She said that the psychiatrist who did the evaluation was out of the office, and that they will contact him tomorrow and have him reword the information, and send it to my surgeon’s office to see what they can do with it.

I got a call stating they need the denial letter before they can do anything...so yet again, here is to waiting......

Right now, as it stands, I will be keeping the once a week sessions for the time I have requested already, seeing as I needed to find someone I like to talk to (other than my boyfriend) for post-op anyway, might as well start early. I don’t have my hopes up; I don’t care at this point what happens- I needed a reality check. I know this surgery is not going to fix everything, but it will help me along the way.

I feel like time will help me realize a lot of things, and this psychologist appointment maybe what I need to really let this all sink in. I’ve read THOUSANDS of hour’s worth of material, seen videos, heard podcasts, and I still don’t think I realize how life changing this is and how I need to ease myself into this, and not be in such of a hurry.

I appreciate all your feedback and understanding!

[leag78 469]

Wow, what a story. I'm sorry you had to go through that. It seems like when we want something so bad, something else tries to get in the way. I applaud you for not taking any of this lying down and taking it upon yourself to look further into it. How are they gonna have someone consult and evaluate you who isn't even registered with them? What was that a practice run, lol? I would have been livid. I'm hoping everything goes better for you from here on out.

[The Candidate 3,215]

I'm so sorry that you seem to have become a victim of the approval process system. And if indeed all of this drama is simply because they allowed you be interviewed by someone who "isn't in the system" yet, I wouldn't blame you for having a major blow out.

I know it's probably something you're extremely tired of hearing, but please don't give up. I so hope this will eventually be resolved in your favor.

Good luck!