I Just Wanna Get FREAKIN BANDED!!!!!

[xgrl 0]

Okay This is crazy so I got denied from BC/BS Alliance Select and they sent a letter saying it wasn't medically necessary I called the insurance company to get more details on why I was denied and the girl I talked to told me that my BMI wasn't documented on any of the papers that they recieved....Are you Freaking Kidding Me!?!?!?!?!?! It's on like every paper that was submitted to them on the PCP Papers on the 6 Month Diet Sheets (for EVERY month) and pretty much every other paper they got. I wonder if sometimes they just see people want to get Bariatric Surgery and they are like we'll just deny them.....ARGH so I called my Surgeon and had her circle and Highlight all the BMI's that were on the original sheet of paper that we sent them. This is so frustrating I know there are people out there in the same totally messed up situation. Let me here your F-ed up insurance stories so I won't feel like I'm david fighting goliath! Thanks Everyone!!!

[1hotchocolate 0]

You are not alone...I actually have Kaiser and they are the same way with the authorization but they also make you attend a 6 month diet and then there is still no a sure thing your going to get the lap band. I really think that the insurance companies are tighting up so that they dont have to pay out all the money...Good luck..I'm getting another insurance company next year and I hope (Finger Cross) I will start my process next year.... Good Luck...Keep your head up.

[It's_Christine 0]

Don't freak....BCBS IL tried the same sort of thing with me. They initally denied me saying I had not had a "signifigant weight loss" during my supervised diet. Well I lost 9% of my body weight during that mandatory diet so when I called them and asked what was the definition of signifigant they quickly caved and I was approved in 24 hours. Difficult to know if they are incompetent or just trying to put us off isn't it? Good luck!

[judeloren 0]

yeah i have federal blue cross and i had no problems getting aproved for the surgery but they said it was a $100 copay and then bam i get a huge hospital bill for all these supplies... then every fill costs me $100 out of pocket and every time i get a letter saying we do not cover this procedure for patients under the age of 18.... hello i am 28 years old. every time i have to call them and have them fix it. pathetic.

[CMTurner 0]

Hey xgrl

Got one better for ya. LOL I saw my surgeon for the insurance required history and physical on July 23 and they still don't have that typed up and sent downstairs (literally down the elevator and about 30 yrds to the weight loss center) so they can send in the information to the insurance so I can wait some more to find out if I am approved or have to start an appeals process. I have called the surgeon's office and the weightloss center multiple times. Surgeon's nurse said she "left the dr a note", "there is a tape on the dr's desk that needs to be typed up but she doesn't know if my visit is even on there". I was only in her office for about 10 minutes or so so I am not sure what is taking her so long. She probably could have completed it from the information provided by my pcp. I will be calling again tomorrow. I bet if the insurance needed those notes to pay the claim for the office visit they would have them done and sent off. Maybe they are waiting to be paid for the office visit before they type up the notes to send in for approval. Uggghhhhhhh!! About makes me wanna see about switching doctors at this point.

Just hope the insurance approval (hell even a denial) happens quicker than this. At this rate it will be December before I can schedule a surgery date since at the July 23rd visit she said they were currently scheduling surgeries for mid October.

:biggrin::cursing::tongue_smilie:

[Sooverit! 1]

Too funny...this is exactly how i feel I am almost too embarrased to post sometimes because people have seen me trolling here pre banded for over a year. I am in my 2nd tier level (as I'm learning it's called) of appeal from the good guys at obesitylaw.com. If I get turned down a third time from Cigna I'm packing a bag for Mexico ...just so I don't have to be obessesed obout this any longer! I am just a little jealous of those people who get approved first time. My Primary Physcian who's training to be a fill doc told me that all the insurance companies eventually "cave in" and approve if you don't give up......so just don't give up .....e

[xgrl 0]

I couldn't agree with you all any more!!! Insurance is insane but I like the comment about if you don't give up they will eventually cave in that'll keep me nagging them to tell me something I think they are getting tired of me calling them but I feel like if I don't it might never get done! I'm mean seriously Insurance stuff is total crap! I told the lady on the phone that I was between 39-40 BMI during my 6 month diet and she kinda acted like i'd be approved if that was the case hopefully they will OPEN THEIR EYES AND SEE what the paper says this time and I'll get a approval letter....until them I'm waiting I'm still watching what I eat but once again its not really getting me anywhere just like on the 6th month diet I don't think 8lbs is that much in the big picture and at 242 I don't even notice clothes or anything fitting different (not that I expected that) I feel for all of you, sometimes I wish I could just sit down with the insurance people and hand them and point out the stuff that they need to look at it would all seem so much easier.

Again thank you all for the support I seriously don't think I could do this without you guys!

[CMTurner 0]

I actually heard from the surgeon's nurse (guess she is tired of talking to me or having to return my calls every other day :biggrin2:) and she told me that the surgeon asked them to pull all the files that needed notes transcribed for insurance and she would work on them Friday afternoon. So maybe this means it will get done and maybe actually sent off to insurance sometime next week. Now just gotta pray, dance, whatever that Cigna approves so I can jump on the "Band Wagon". Good luck to you all too.

[Mamacj 0]

I am waiting for insurance approval and guess what? My WL surgeon's office calls and tells me I have to see a cardiologist before they will do anything else!! I have excellent cholesterol and lipid levels and have had clean EKG's. They are all excited about an elevated CRP level. But I guess better safe than sorry. So, I will jump through another hoop (hope this isn't just more money to pay out for nothing) and hope I get a date soon. I work for a hospital, I would think they would want to see me healthier, sooner!! Oh well, hang in there and keep us up to date.

[innwtitdtity 57]

I deal with insruance companies for a living ( I am the director of hospital admissions/scheduling/pre-certification and billing) and I can say that this is ALL a game of delaying payment. IMHO, if a PCP has approved the care you are seeking (which is his job) then no claims should be denied for "medically necessity". Obviously it is necessary if he/she approved it. I see this at least 10 times a day. I feel the pain of every patient that calls to complain "why are you billing me" when all I can tell them is that their insurance company has told me to bill them. It is very frustrating on the end of the provider as well.

All I can tell everyone is know your benefits as every plan is different and appeal any denial to every level you can.

Good luck to everyone!

[2big4U 0]

PS: if you think THIS system is a nightmare, wait until we have truly government-run health care.

YUP.. I'm a proud Canadian, with government funded universal health care. In Alberta your surgery and aftercare are completely funded and covered. This year the program is taking 25 new patients in the Calgary Health region, a population of over 1,000,000.

Because it is "medically necessary" it can not be done privately in Alberta. There are some great docs who are trying to remedy this and open a self pay clinic but so far no luck...

so.....

I am going to Mexico on Monday to get my band.:thumbup:

[CMTurner 0]

I called my surgeon's office again on Tuesday (just to make sure it had my history and physical (that are needed for insurance approval) were done) like her nurse informed me she would be transcribing on Friday, Aug. 15. Well the THINK it was transcribed but now it needs to be typed up. I am about to offer to do that for them. If it does not get done this week, it will have been a MONTH since my little 15 min visit with the surgeon. I mean really! How hard is it to dictate? It's not like it was some big involved process and she even noted at the time of the visit that with my insurance being Cigna she would try and "get it done that week" so they could get everything sent off. SHEESH! At this rate, even if I am approved fairly quickly, it will probably be November before I can schedule surgery. :smile2::cursing: I was hoping to be recovered and doing well way before my birthday and the holidays. I guess I am just gonna have to call a couple of times a day and make them get it done just so they won't have to hear from me.

I bet they are not gonna be happy that we just got hosed on some auto insurance thing because they kept taking their time and nothing got done until I got onto them and had to do THEIR (the auto insurance's) work and did all the document gathering for them and then since the year was about up had to settle for WAY under or go through added expense of getting & paying for a lawyer and the adjuster's "threat" of dragging that out for a couple of years in court. That made me a little agitated and resolved to not let others just take their own sweet time with matters that concern my health and welfare.

BTW ....do NOT use Progressive auto insurance!

[xgrl 0]

I feel for ya, they should definatly get on it, I feel like I've never wanted to know something more than if I'm actually approved by the insurance I had to have them resubmit my whole thing AGAIN and this time we Stared and circled the BMI since apparently it wasn't on the last ones *yeah freakin right :cursing: Here's hoping both us hear something soon!!!!!

[CMTurner 0]

Well when I checked my voicemail this afternoon, I had 2 messages from the surgeon's nurse. The first one was similar to past ones....waiting on dr,blah blah, pretty sure it is on tape to be typed up, blah blah. The second was just before noon and they were "happy to tell me (quit callin and buggin us) that my history and physical was typed up and they had faxed it to the weight loss center (remember this is just down the elevator to the 1st floor and about 30-40 steps down the hall). So now if I haven't heard from weight loss center by Monday saying they sent it all off to insurance, I start calling them every day. Ain't life fun???

I about to ask if they wanna hire ME to do all this follow up/get information job since I am the one doing it anyways.

[CMTurner 0]

Ok. I finally get a call today from the WLC advising me they did finally get the history and physical and got everything off to the insurance for approval. I am gonna give it until Monday to contact insurance to see if they got it. I guess my "new lot in life" is to be on the phone daily doing the follow up to make sure others are doing their job. Grrrrrr

Oh well.

Hope everyone else is having more luck getting paperwork done and turned in and actually approved.