Disappointed doesn't even begin to describe what I currently feel...

[sassyfrass23 525]

I posted this awhile back and later felt that the issue had resolved itself and wasn't what I thought it to be. Looks like I may have been wrong.

So here goes..

I've received conflicting answers from UHC regarding my requirements. There are the typical; BMI, 6 month supervised diet and psych eval. All of which I have completed and my file is in the process of being submitted. I'm this close!!! And boom....I hit a big @ss brick wall that has knocked me off my feet this afternoon.

I called insurance to see if they'd received my file. While on the phone we discussed my requirements, etc. The rep then mentioned receiving authorization 6 months PRIOR to surgery. Curious of his answer, I asked him to convey his perception of that statement. Which he did, and I did not like. I then asked him that IF I were to be approved, let's say next Wednesday, does that mean I have to wait an ADDITIONAL 6 months before I can actually have surgery? So, like...August??? His response was yes. This whole scenario makes absolutely no sense to me. Why? Why make a patient bust their rump for 6 months to prove that they CAN follow guidelines set by their provider/nut but receive little to no result? Why have a patient see a psychiatrist, get the go ahead and then wait an additional 6 months? I'm not saying it will, but there is a lot that can happen in a 6 month period. I can honestly say that when my father passed away in 2012, I would not have been emotionally stable if you will, to follow protocol after surgery.

Up until today, I have been under the impression/hopes of having surgery in early March. I have put in my time and done what has been asked of me. And this news has rocked my world. No it's not the worst case scenario. Yes, I can put on my big girl panties and wait the required time. Yes I am even lucky for the fact that my insurance actually covers this. But I simply do not want to. And that is okay. Please do not ridicule me for being upset over this. I guarantee most of you would be just as disappointed if you were almost there and had the carpet ripped right out from under you.

And yes- when I first started this process I did inform my benefits coordinator at the office of what I was told. She said it did not sound correct and she thought the rep had misunderstood what they were reading to me. I spoke with another rep a couple of months later, and she told me that I did NOT have to wait 6 months. However, I will be calling my coordinator tomorrow to request that she call UHC and discuss this with them. When she initially called to verify my benefits, they never mentioned this to her either.

I'm just having a pity party, okay? And in an effort to avoid a bad habit I have almost broken...I am trying not to resort to emotional eating. I just want a big friggin donut right now!!!!!! Maybe a cupcake too..

Edited February 1, 2016 by sassyfrass23

[Nurse_Lenora 903]

At this point, don't stress!

Your surgeons office does this all the time and all the time with your insurance.

I would talk to your coordinator and insurance person in your surgeons office tomorrow.

After my paperwork was submitted I called insurance and they said yes they received etc and 1-2 weeks until I would hear about approval. Then she says " your surgery is Feburary 23rd so you will definitely have an answer before then"

I flipped out! My surgery date is early Feb and I have had to have so many things align that it needs to be that day!

Called surgeons office and they said no worries, I'm on for early Feb and once surgery is approved they just call and change date of surgery. Takes a 30 second phone call.

So, although I wasn't aware of this my coordinator was because they deal with my insurance so frequently.

It really sounds like the insurance guy you spoke to really had no idea what he was saying. I have never heard of an approval 6 months prior to surgery.

Oh and (hugs) I totally understand because when I had my issue I almost had a damn panic attack!

[James Marusek 5,244]

Let your surgeon's office chase this down for you. It doesn't sound right nor typical. You went through a 6 month medically monitored weight loss and exercise program, that is where there may be a mix up. So take a deep breath and relax. See what tomorrow brings.

[SHOTzY* 114]

Hey sassyfrass....you just go on and have that pity party! ????. I can't imagine how your feeling, but I know I would have exploded in a temper tantrum and dissolved in to tears. So, I'm assuming since you made your post, we are all invited to your party?!?!! ????

I admire your willpower; you don't need that donut (and we all have been at that place), you did the best thing by coming here! As everyone has said, make your dr and clinic earn their money and get this solved. Keeping you on my mind!! ????

[sassyfrass23 525]

Thanks, @@Nurse_Lenora and @@James Marusek !

I.....being the persistent individual I am, called my insurance company back after posting the statement above and spoke with a different rep. She only created more confusion. She first said that the prior authorization should have been sent in at my initial visit. I had already asked my surgeon's office about that and they said no, that it was pointless since I would automatically be denied without having my other requirements met. So this lady from UHC was basically saying it was my surgeon's office's fault for not submitting sooner. The call ended up lasting roughly around an hour. I asked to have the information she was seeing on her screen emailed to me since I have yet to locate that exact verbiage on the website under my policy. She couldn't get it emailed to me and because it was so late and her supervisor had already left. So I'll be calling back for that tomorrow. I'll also be calling my surgeon's office like I originally stated to have Tonya look into this. Like James said, I need to let them chase this down. I'm somewhat in higher spirits, but still a bit discouraged. I originally thought I only had to worry about being denied or approved at this point, but now this.

Time to practice some patience which I so incredibly suck at!!

[Nurse_Lenora 903]

Girl, I completely understand! I am so not patient at all! But this does not sound right so I would be on that phone to your surgeons office the minute the office opens tomorrow.

Let us know how it goes! Good luck!

[sassyfrass23 525]

Yes, @@SHOTzY* !! You're all invited to this party! I promise to have lots of Protein and Water for all to enjoy

Thank you for sympathizing with me and my current emotional state! I don't want everyone to pity me, but it's nice to be reassured that what I'm feeling, how badly I am disappointed, is normal and rational. And thank you for acknowledging my self-control. It took everything I had not to hop in my car and run to the store for a sugar fix. I'm so grateful to have a place like this to come to and vent my feelings. My husband is a great supporter and has been on board from day one. But bless his heart...he's just so easy-going that when I presented this tragedy this evening, he brushed it off like it wasn't that big of a deal when it was the end of the world for me at that very moment!! lol

[sassyfrass23 525]

Oh...and just to help you all better understand. This is exactly how they all read the requirements to me:

1- Patient must have a BMI of 40 or 35-39.9 with one comorbidity such as diabetes or sleep apnea.

2- Patient must complete 6 months of motivated weight loss attempt that is supervised by a physician or licensed nutritionist

3- Patient must complete a psyche exam

After all of that, they then go on to read:

Please remember, prior authorizations must be received 6 months prior to surgery.

Some of my words may be off, but that is almost word for word what they all say/read to me EVERY time I call.

[Nurse_Lenora 903]

That is so odd ! I can't wait to hear wheat the surgeons office says tomorrow

[sassyfrass23 525]

That is so odd ! I can't wait to hear wheat the surgeons office says tomorrow

Me too!!! I am praying that I've freaked out over absolutely nothing and March is still a possibility. I'll definitely update as soon as I know more!

[Sajijoma 1,324]

So sounds to me that everyone isn't talking to each other. When you went to your first initial appt, your surgeon's office should have sent in something to the insurance stating that you plan to pursue surgical options for weightloss and then they'd gather from insurance a list of what they want you to do to qualify. After that, you should have started whichever program your insurance expects. For my insurance, and because I went to a Bariatric center of excellence, I did a 90 day program with 3 NUT visits and a psych eval to get approved. Had I had a different insurance plan, I would have been required to go on the 6 months supervised weightloss, psych eval plan and to know which one to put me on meant they contacted insurance to find out. So the fact you've been on a 6 month plan means someone somewhere had to contact your insurance to find out what your requirements would be and that would have been your pre authorization. Now that you've completed the program, your packet and all the notes about your weightloss are submitted for authorization to perform the surgery. So maybe it's just that they aren't understanding what you mean by pre authorization? I hope for your sake. The idea of waiting and having to be on supervised weightloss for a year to get surgery seems beyond cruel.

[Pinkgirl1234 761]

Stop calling the insurance company.Let the dr office handle the submission process.Too many calls to insurance sends a red flag...Let the coordinator who does this for a living handle it.

[Inner Surfer Girl 12,015]

Stop calling the insurance company.Let the dr office handle the submission process.Too many calls to insurance sends a red flag...Let the coordinator who does this for a living handle it.

This!

[sassyfrass23 525]

Hey, @@Pinkgirl1234 and @@Inner Surfer Girl !

I know that my coordinator at the surgeon's office will definitely need to be involved in this. I just called and left her a voicemail to get back with me ASAP. However- if there is one thing I have learned during my research on Bariatric surgery, it's this:

1- The patient is ultimately responsible for knowing and understanding their benefits and coverage.

2- Surgeon's offices have made a multitude of mistakes leaving the patient with large amounts of monies owed

I do not want to be the patient stuck with a $70,000 bill because we didn't follow the guidelines set by my policy. I'm done calling insurance after last night as I feel that I have received enough information to pass along to my coordinator to investigate. Although- I would like to call back to get a copy of the guidelines they continue to read to me but I have yet to locate. Hopefully Tonya (coordinator) will be able to get that information today. Hopefully..

[Nurse_Lenora 903]

I'm sure you already did this but, did you scour your insurance companies website for the info??