Anxiety through the roof

[jesstea2 13]

When my surgeon first submitted to my insurance they denied because they didn't get "sufficient information" so my office sent an appeal and resubmitted all of my paperwork. It could take up to 60 days to approve. If they decide to wait the full 60 days I'll either get my surgery the week of Christmas or wait until the new year and pay my $1700 deductible all over again.

That's stressful and not to mention my whole life is scheduled around my current November 12th surgery date

All this unnecessary anxiety when all my insurance needs to say is yes or no. I feel like it was such an easy approval ride for everyone else going through surgery.

Feeling down, thanks for letting me vent.

[The Candidate 3,215]

You have cause to feel anxious so vent away. Sure hope you get good news soon!

[AllisonK1986 68]

I'm in the same situation as you. They are resubmitting to my insurance on nov 2 for my nov 24 surgery date. I have a 3000$ deductible and I can't even imagine having to wait until next year or even being just flat out denied 100%. None of us would be in this situation if it was not medically necessary!

[Dub 9,922]

"An easy ride" ?????

It was easy all right. Easy to the point where I told UHC to kiss my large arse and simply self funded the procedure.

After that action it was a simple process of scheduling things......and quickly.

Insurance shenanigans piss me off. I work hard at my job and it's part of my benefit package. Go and try to use it, though, and the bullcrap starts.

Don't let it get you down.

If the worse case scenario is that you have to get pushed back to January....and pay the $1,700.......then so be it. It's a small price to pay for what you will gain by having this surgery. Keep focused on the goal.....to lose weight. Stick to a healthy diet and exercise program right now and you'll benefit regardless.

Hang in there. You are in the worst part of the deal right now.

[2goldengirl 2,076]

You didn't say what state you're in, nor what kid of health plan you have, but generally speaking, the timeframe a health plan has to process an appeal gives them the time to do a through job of gathering data, including sending records out to a third party MD for review. All this actually works in your favor.

In truth, health plans far prefer to resolve appeals in the shortest time possible. Nobody wants a huge queue of work to plow through. Part of the timeframe will be determined by how clear the plan's requirements are for the surgery, and how well the documentation submitted meets those guidelines. This is much simpler for bariatric surgery than many other kinds of procedures with less-specific guidelines. Another factor will be how many appeals your plan is dealing with at the same time.

Do what you can to focus on taking care of yourself since the timeframe isn't something you can control. I'm pretty sure you won't be waiting 60 days for an answer. Let us know when you hear back from your health plan, OK?

Edited October 21, 2015 by 2goldengirl