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

[sassyfrass23 525]

@@Missy407 that's horrible! If I were 3 days away from surgery and experienced that, I would have had a complete melt down. I'm so glad it all worked out for you in the end though! The thought of delaying my surgery for another 6 months sucks but IS doable. My husband and I have been trying to conceive for 8 years. Which is part of the reason I have decided to embark on the WLS journey. I'm nearing 28, so when I do the math...I'll be 30 when/if my first child is born since I plan to wait at least 18 months before getting pregnant after RNY. I prefer not to have children into my later thirties or early forties...so my biological clock is ticking extra loud at this point. I originally wanted 3 children and would have preferred a 3 year gap between each like it was for me and my brothers. But now I'm forced to reevaluate the entire situation and reconsider my plans and how logical they are now.

Thank you so much @@jantra12 !

Edited January 30, 2016 by sassyfrass23

[Renkoss 420]

I'm just wondering here if when they told you a 6 month wait for surgery, they were not stating it from all the pre-op stuff required. So basically, you have to have 6 NUT appts, and you can only do 1 a month for 6 months. During that time you also need a Psych eval. Once you have satisfied all the requirements, then your application or file is submitted to insurance for final approval. From there you get scheduled for surgery.

I have BC/BS, and my requirements were 6 NUT visits, 1 per month, a psych eval, 2-3 appts with a Nurse Practioner or D.O. I just finished a 4 week group support for binge eating (part of psych visit). I have final psych visit in a couple weeks. I have my last NUT appt in a couple weeks. I've completed the Nurse/D.O. appointments. So, by end of February I should be submitted for final approval from the insurance. If approved, then I'm scheduled by surgeons office.

I'm just wondering if this is nothing more than a misunderstanding of the wording by the insurance. It makes no sense to have to wait 6 months after final approval is received.

BTW, I work with insurance companies all the time. They can be quite confusing.

[sassyfrass23 525]

I'm just wondering here if when they told you a 6 month wait for surgery, they were not stating it from all the pre-op stuff required. So basically, you have to have 6 NUT appts, and you can only do 1 a month for 6 months. During that time you also need a Psych eval. Once you have satisfied all the requirements, then your application or file is submitted to insurance for final approval. From there you get scheduled for surgery.

I have BC/BS, and my requirements were 6 NUT visits, 1 per month, a psych eval, 2-3 appts with a Nurse Practioner or D.O. I just finished a 4 week group support for binge eating (part of psych visit). I have final psych visit in a couple weeks. I have my last NUT appt in a couple weeks. I've completed the Nurse/D.O. appointments. So, by end of February I should be submitted for final approval from the insurance. If approved, then I'm scheduled by surgeons office.

I'm just wondering if this is nothing more than a misunderstanding of the wording by the insurance. It makes no sense to have to wait 6 months after final approval is received.

BTW, I work with insurance companies all the time. They can be quite confusing.

Honestly...I thought the same as you. That they were confusing the 6 month delay with the 6 month monitored weight loss. I'm still praying that this is the case. I had most of the same requirements as you and have completed ALL with additional requirements from my surgeon. My papers should be submitted at the beginning of next week!! Which is why this is such a bummer. To be so close...and possibly not be so close afterall is gut wrenching. I've managed to keep myself preoccupied this weekend. I am dying for Monday to get here so I can reach my surgeon's office and hear what Tonya learned yesterday. Please send all prayers/thoughts/vibes my way in hopes of this being nothing but a misunderstanding

And yes- insurance is INCREDIBLY confusing. I work in I.T for Healthcare...I wouldn't trade that to work directly with insurance if my life depended on it.

Edited January 31, 2016 by sassyfrass23

[Renkoss 420]

All thoughts and prayers going out to you sassyfrass23. Hope you hear nothing but good new Monday.

[sassyfrass23 525]

All thoughts and prayers going out to you sassyfrass23. Hope you hear nothing but good new Monday.

Thank you! I plan to call the office as soon as the doors open tomorrow. I will update soon after!! I feel much better today than I did Friday. In higher hopes I suppose. Trying to keep the "positive thoughts equals positive results" mindset. That really works, right??

[sassyfrass23 525]

I was so badly hoping that I would be writing the happiest post this morning after talking with Tonya. It's not a terrible update...but more of a confused one, I suppose.

Apparently Tonya spoke with 4 different reps on Friday. One from the Precert Department and the others from the Customer Service department. Tonya explained that neither she or I have been able to locate the 6 month waiting period that is being read off to us on each phone call and are wanting to see it in writing. And of course- no one could provide it for her. So they told her to have me get with my husband's HR department and request a Certificate of Coverage (CC) or Summary Plan Description, which I have done as of a few minutes ago. According to UHC, this "CC" will list the EXACT requirements based off of my specific plan. Tonya went on to say that once they submit my file, if they receive approval on Friday for example, she will call back in with the authorization number and ask if she can go ahead and schedule the surgery or if she has to wait until Summer.

So...still no clear answers. This is frustrating beyond belief. We discussed the SMALL possibility of them trying to get the waiting period waived depending on if Dr. Nguyen can send in a request for it. I'm not too hopeful for this as I don't have any life threatening or major issues going on from my weight. My biggest complaint would probably be weight bearing joint pain. My job requires a ton of walking daily and by the time I get home, my legs are stiff as a board and my ankles/feet swell up like balloons.

Let the waiting game continue...... *sigh*

[sassyfrass23 525]

Second update from today:

As stated above, I reached out to the HR department and requested a copy of the CC. Dari's response was :

"A certificate of coverage just shows that you have coverage under our plan. And you are listed so there is no reason why they would need that because you are already in their system."

Dari is great and I have known her for years and prior to my husband joining that company. I wrote her back and explained in a shorter version of what is going on and how UHC is not providing reliable/consistent answers and that we (surgeon's office & myself) have yet to locate the exact wording of my plan/requirements for Bariatric Surgery to know what is EXACTLY expected of us.

With that, she said she would go straight to her UHC rep who will have the information we are looking for and more definite answers. Dari forwarded my email directly to the rep so we'll wait and see what they have to offer. I feel much better having Dari involved and reaching out to her sources for additional information!

[Nurse_Lenora 903]

Sorry this is such a long and circuitous route to find out what your coverage is!

Has your surgeons office has any other patients with your insurance??

Good luck and hope the insurance rep can help Iron things out.

[sassyfrass23 525]

@@Nurse_Lenora yes...they have had HUNDREDS of patients with United Healthcare! But never one with a plan that specifically states this. Which is why they're just as confused as I am. It's all become kind of funny to me. Yes, still stressful and upsetting. But entertaining nonetheless. ????

Edited February 1, 2016 by sassyfrass23

[Renkoss 420]

Well, there is still hope that the 6 month waiting game has already been done with the appointments and waiting you have already done.

The UHC Rep should have the verbage of how the insurance policy is written in regards to this type of surgery. As far as the insurance telling you to contact HR and ask for CC...how ridiculous! Dari is correct; all a Certificate of Coverage is going to do is show that you do indeed have insurance, the effective date and that is is active status. Wow. Makes you wonder about UHC's customer service reps. Don't know their butts from a hole in the ground!!!

Also, just for your reference, just because other people have UHC insurance and they covered the surgery doesn't mean everyone's policy is the same. Companies work with the insurance reps and write the policy to best fit their needs, and sometimes they exclude some benefits that may be cost ineffective for them. Each plan is unique to the company it is through.

[sassyfrass23 525]

HI, @@Renkoss ! I really hope that Dari's rep will provide exactly what we need to figure everything out. Even if it's not the answer I'm wanting...I'm just ready to know and quit guessing/wondering. I believe the unknown is what bothers me most about all of this. I can't prepare myself mentally. I can't prepare my boss. I can't prepare my family who will be taking off work to stay with me in the hospital those two days and any help I may (hopefully not) need after.

As far as the difference in each patient's insurance, I completely agree! I posed that question to Tonya from the very beginning when I asked her about this waiting period, and she said that she'd never heard of it before. To which my response was "Is this something specific to my individual plan?" But because we never could find it in writing, she didn't think it was true or applied to me. I understand that most reps at insurance companies read what is on their screen with little understanding of the information they're relaying. After all- it would be almost impossible for them to learn and understand each policy. You would still think they'd have a better way of handling all of this to make it less convoluted.

OH! I forgot to mention- when I called last Thursday evening before I posted this original thread, I was told by the second rep I spoke to that night, that I didn't even have bariatric surgery coverage. Talk about your heart dropping to your stomach!!! My dead silence more than likely gave away my shock and disbelief. She basically asked if I was okay after hearing that. I pushed a little and told her that the guy I spoke to right before her confirmed my coverage so how did things change in a matter of minutes?? Which was then when I asked if she was looking at "Bariatric Resources" which is NOT covered and I was already aware of. Yes- she was looking in the wrong section and misinformed me.

Apparently they told Tonya the same thing on Friday. Two out of the four reps told her that. But she was able to confirm on both of those calls that the reps were not looking at the correct information when stating I wasn't covered. Just another example of them not knowing whether to wind their a$$ or scratch their watch

[Renkoss 420]

You'd think they would train these people better. smh.

[Inner Surfer Girl 12,015]

I hate to hear yours was denied @@jantra12 ! But so glad you can still go through with it.

Unfortunately- self pay for the bypass is not an option for me. $70,000 - $80,000 is just not a realistic expense for me

$70,000 - &80,000? Who in the world is charging $70,000 - $80,000?

[sassyfrass23 525]

I hate to hear yours was denied @@jantra12 ! But so glad you can still go through with it.

Unfortunately- self pay for the bypass is not an option for me. $70,000 - $80,000 is just not a realistic expense for me

$70,000 - &80,000? Who in the world is charging $70,000 - $80,000?

My friend had the VSG by the same surgeon at the same hospital and her hospital bill alone came out to $50k. Not including the surgeon or anesthesiologist fees. And she only stayed over night 1 night. With RNY- I'll have to stay a minimum of 2 nights. So I was kind of guessing in that figure which may have been a little more but not too much more I wouldn't imagine?

With that being said- I've wondered how some of these folks I've seen on here get/got VSG for around $11k. Maybe it's based off of location? The hospital I'll be going to was ranked #2 in the state behind mayo. Maybe that has something to do with it?

You'd think they would train these people better. smh.

Right??? One would think....

Edited February 1, 2016 by sassyfrass23

[jantra12 28]

I hate to hear yours was denied @@jantra12 ! But so glad you can still go through with it.

Unfortunately- self pay for the bypass is not an option for me. $70,000 - $80,000 is just not a realistic expense for me

$70,000 - &80,000? Who in the world is charging $70,000 - $80,000?

My friend had the VSG by the same surgeon at the same hospital and her hospital bill alone came out to $50k. Not including the surgeon or anesthesiologist fees. And she only stayed over night 1 night. With RNY- I'll have to stay a minimum of 2 nights. So I was kind of guessing in that figure which may have been a little more but not too much more I wouldn't imagine?

With that being said- I've wondered how some of these folks I've seen on here get/got VSG for around $11k. Maybe it's based off of location? The hospital I'll be going to was ranked #2 in the state behind mayo. Maybe that has something to do with it?

You'd think they would train these people better. smh.

Right??? One would think....

Mine will cost about $35,000. Including hospital, surgeon, anesthesia and 2 nights. They give a discount for cash.