Discouraged and drained.

[mollydeez 25]

I set off on this journey on June 20th. That's when I got all instructions of labs I needed to get, specialists I needed to see, doctors I needed approval from, tests I had to get etc. I had everything completed by August 22nd. I had that date in my head as the date I would have my surgery scheduled.

August 22nd I met with my final dietician. She's in the same office as the surgeon. When I went to schedule my surgery, they had me pump the brakes. Turns out my health insurance (Amerihealth) needs 2 records from doctors I've seen in 2014 and 2015 showing I had gone to them and discussed weight and exercise. Why hadn't they told me this in the first place?? I was furious. I worked so hard to get everything done in a timely manner and they pulled this shit on me. I had a mini panic attack until my mom reassured me that we had this. It was a tiny road block that we had to go over. Don't worry molly.

My 2015 records were obtained within a week. Easy. Brought them over to the doctor and they were approved. 2014 I was kind of struggling. I retrieved records from my old endocrinologist. The records were basically irrelevant. All the times we discussed weight and eating right and me trying victoria were nowhere to be found. The 2014 records did nothing for me.

I scheduled an appointment with her to see if she would sign some papers and post date them to make it seem like they were from 2014. She said she would do that and more. Also write a letter stating how long she had seen me for and how often weight was discussed. This appointment was on September 6th. I was beginning to regain hope.

Today is the 19th. My doctor has not faxed over anything to my surgeons office. She has not returned any of my phone calls. Or my mothers. Her receptionist is sick of hearing my sob story and is being a total bitch. She lied to me. I knew she didn't want me to get the surgery. She tried to talk me out of it. But she agreed to write me the letter and do me the favor anyway because she knew how important it was to me. This was the final piece of the puzzle. She holds the power. And she completely disappointed me.

It's been almost 2 weeks and she has not done a god damn thing. I'm heartbroken. I feel like there's no hope. I've wanted this surgery since 2008. I've been big my entire life. I have been working towards a promotion at work and feel like I don't have the confidence to fulfill the position (car sales). I feel like this surgery is holding me back. I don't know what to even do at this point. Just wondering if anyone experienced anything like this. If anyone has tips or encouragement. I'm so drained idk what to do. I've paid so many co pays. Done everything I was told to and I'm still nowhere near setting a date. I'm at a loss and could use some help. Thank you to anyone who read this. I know it was long. I'll take any help I can get

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[KristenLe 5,979]

I would call your insurance and see what exactly is required for documentation. Explain the situation. I would also ask them to look into claims submitted by your end as see what she coded as a diagnosis and visit code. If her records don't match what she billed - she could have issues. Have your surgeon's office call her.

[courtknee_luv 52]

Do they just need to track your weight? Did you see any other physicians, go to the er have dental records or anything else. I know when I checked with my insurance company they needed weights since 2014.

I understand how you feel; I relocated from cross country during 2014 and so this am when I went in the records were not received. I panicked and called all of them and finally I remembered an oral surgery and an er visit I had and fortunately they had documented my weight . I also called all my providers, both New and old, by the end of today the nurse at the surgeons office called me and told me she had what they needed to submit.

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[MemphisWLS 58]

So sorry Mollydeez. This is just another roadblock you have to deal with. Everything will work itself out. Growing up my mom always use to say " every disappointment is a blessing". Take a deep breathe and I agree with kristenle n Courtknee.....call your insurance and actually find out what your requirements are, brainstorm, maybe you saw someone that year and you forgot. All hope is not lost. It's time to go to plan b and maybe plan c too.

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[Lukeadelle 16]

Yes. This is definitely a roller coaster ride. Up one minute, down the next. Just hang in there and keep on fighting because in the end you will succeed. Maybe you could send in everything you do have and they won't notice 2014 isn't in there. And you can honestly say that your physician said she was going to submit it. I find going into the office and making them tell me to my face gets more than if I just call. I've even sat my fat a** down until someone gave me what I wanted. Yes I did. Got it though.

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[QueenOfTheTamazons 634]

I understand. I started the process in April 2015. I have medical and the only bariatric doctor they covered was over an hour away. Medical requires 6 consectutive months of doctor supervised weight loss. I worked with bariatric dr to do those monthly visits with my primary care. It took a year to get everything done. In April 2016, I ended up switching surgeons due to first dr having a $2500 management. It took my 1st dr 2 months and 7 requests to send my medical records. It then took 4 attempts to get the insurance company to approve my surgery. I kept being turned down as not medically nessisary, even though i am 380lbs, diabetic, complex sleep apnea, gout, edema, ostoarthritis and high blood pressure. They then said that i hadnt proved that i tried a non surgical approach. In the end i had to get my primary care dr to write a letter stating tbat we discussed diet and exercise in our monthly meetings (even though the chart notes said that) and a 3 page letter that discribed my family history of obesity related diseases and a 10 year history of my diet plans and outcomes.

My insurance company finally approved me... 3 days after my insurance ran out. I thought it was hopeless because I didnt think that I would qualify for medical and no insurance that I could afford would cover the surgery without a high copay.

But things all worked out for me and in 2 weeks I will be getting my sleeve. I know it will work out for you.

My advice - Is there someone above your doctor? Unless they own their own practice there likely is. Try talking the them.

You can also do what i did and write your own letter to the ins co and have tbe bari dr turn it in. You can describe you struggles, your attempts. You can talk about how your dr doesnt approve if the surgery, so is witholding the docs that would get you approved. The most you lose is a few hours of time.

My bari drs nurse said the letter I sent was the reason the ins company changed their minds. Msybe it will help you too.

[Dub 9,922]

Don't give up.

Stay after them.

You will get a break at some point.

[Nerdgrl 61]

@@mollydeez what a terrible, frustrating and discouraging ordeal you've been going through. I'm so sorry that this has been so difficult for you. While I haven't been through this type of struggle (I opted to self pay for my surgery in Mexico, in part because of the possibility of facing what you've been dealing with), I completely agree with @@Lukeadelle - you need to get in their face. Did you see the Sex and the City episode where Samantha was diagnosed with breast cancer and camped out in the oncologist's office for days until they gave her an appointment? It may sound extreme, but you can't take no for an answer. Show up at her office in the morning (and the next, and the next if that's what it takes) and just politely inform them that you're not leaving without your paperwork. Your doctor is being passive aggressive, so make her deal with you in person. Transfer the pain and suffering that you're going through to your doctor - even if she only submits the paperwork to get rid of you, I would call that success! Talk about how your doctor is putting her personal opinion over your health with other patients in the waiting room. When this starts to impact her business, she'll do anything it takes to get you out of there. Who cares if the receptionist is nasty? It's not her health or her future that is at stake!! Once you make the consequences of not responding to you worse than the consequences of responding to you, she will do it. Hang in there - be strong and out-stubborn them! Do not take no for an answer and don't stop until you get what you need!!! Best of luck!

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[The Candidate 3,215]

Don't give up whatever you do. Keep your focus on the surgery and how it is going to change your life forever. I know it's easier said than done, but you hang in there and stay on their backs night and day. Once they understand that you're not going away, things will start to move.

In the classes that we were required to take with my insurance there was one lady who had a similar problem. She fulfilled all requirements that took about a year to finish, and was only waiting for the "approval" call. They waited until then to tell her there was an issue with the insurance premiums (which came through her husband's workplace). She had to watch everyone else in the class get their surgeries in July, while she had to wait until November (2015), to get hers, while the issue was being straightened out.

They don't care if you give up, as its one less expense they'll have to cover. Let them know you have no intention of giving up!

Best wishes and I hope it's resolved soon!

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[mollydeez 25]

Wow thank you all so much for the insight and input. I actually felt better today and took "MemphisWLS" advice of brainstorming harder and thinking of doctors I might've seen in 2014. Made some calls and kept on with my day. I sometimes get caught up in the fact that nothing is overnight. Things take time and I might have to do extra work than I intended to get what I want. Thank you all so much for replying. I feel guilty for complaining after seeing what others have gone through.

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[ella37 455]

Wow thank you all so much for the insight and input. I actually felt better today and took "MemphisWLS" advice of brainstorming harder and thinking of doctors I might've seen in 2014. Made some calls and kept on with my day. I sometimes get caught up in the fact that nothing is overnight. Things take time and I might have to do extra work than I intended to get what I want. Thank you all so much for replying. I feel guilty for complaining after seeing what others have gone through.

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If all else fails, show up at her office and park yourself in the waiting room until they give you the paperwork

[MemphisWLS 58]

Mollydeez how is it going? Any progress yet?

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[Arizona❤️Texas 22]

Like the others have said.....you're so close, don't give help!!

How about any walk in clinics, urgent care, the ER, diet Drs, OB/GYN??

[Cillat4520 1]

Mollydeez my husband is thinking about having the surgery as well. He was missing a doctor visit from 2013 or 2014. They told him to find a picture that he had taken in that year and send. Thanks to Facebook we had pictures. Sent in the picture for insurance approval. It takes a little longer if you don't have 3 years of records but he was approved in about 2 weeks after sending in the picture. Check into that we got BCBS Insurance.

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