So frustrated

[jhbeck 29]

I started the process in 2014, but as a single mom with a toddler still in a crib, I was moving at a snail's pace. No point until she was out of the crib, right?

Fast forward 9 months, and my kid was in a bed, so I thought I was finishing my insurance requirements. Only to find out that, in 2015, my insurance added a 6 month physician monitored diet. Ok. Changes my timeline, but nothing to do but follow the rules, right?

Well today, after jumping through every hoop, repeating the steps I did in 2014, they tell me that I will probably be denied. Because of a scheduling issue, my sept appt ended up happening in October. So I have July, August, 2 October appts, nov, and dec.

Today, TODAY, the patient navigator says "didn't you know it had to be 6 consecutive months, with no less than 4 weeks between appointments?" Beyond the magic if scheduling that must require, why the duck did you tell me this at the END of the period, and not the beginning?

So-the current plan is to get a note from my pcp explaining that his front office staff screwed up and hope that someone is actually rational at the insurance company. Otherwise I actually need 3 more appointments!

Does anyone have other ideas on how to approach this? My insurance is Anthem BCBS in VA but they are just the administrator. My employer self insures and they make the rules. I had to appeal a decision years ago and lost. So I'm feeling pretty down right now.

Jess, mom to Ysabel, 6 and Maggie, 3

[Pinkgirl1234 761]

Keep at it...start over...time will go fast...think of it as Now is the start...book your appointments now

[nicole91379 2]

Yes I had to start over as well. They have to include specifics and my visits left of some info. I'm now 3/6. Timewill fly by. It could be worst like my employer being bought out by another company only to find out in 2016 bariatric surgery is excluded ????...I'm just pushing forward with my appt and all I have left is nutrition consult. I scheduled all my appts while in the office....good luck to you!!

[Pinkgirl1234 761]

Yep..when you are scheduling your appointments,dr visits and tests and observations and referrals you will find that time goes by fast.These insurance companies make you jump through hoops.If I had the money I would just self pay...I spent 6 months starting from scratch for this revision.Finally approved.

[jhbeck 29]

I'm glad you've found time goes fast. But I already jumped through all their hoops. I did the 6 months. But due to a scheduling error by my pcp's office, they may only count the last 3 visits. I'm not annoyed they had the 6 month requirement. Im annoyed that they do this hoping we will give up and they won't have to pay. I'm annoyed that I am being penalized for something that was beyond my control. I'm annoyed at how much additional money it will cost.

I've already waited-first 9 months until my child didn't need to be lifted into a crib. Then 2 months to get into my pcp plus 6 months of visits. Not including the year of thinking before that. So yes, I'm frustrated and pissed that such a minor thing (an appt a week late) can have such a major impact.

Jess, mom to Ysabel, 6 and Maggie, 3

Edited December 25, 2015 by jhbeck

[Pinkgirl1234 761]

So yes delay until New Year.typical scumbag move on their behalf.

[jhbeck 29]

Apparently the note from my pcp explaining the scheduling error did the trick! Honestly, I'm shocked. But happy. Surgery late Jan or early Feb. and healed up by spring break when we have travel plans!

Jess, mom to Ysabel, 6 and Maggie, 3