Interesting phone call

[Melinco 1]

Today I had a voice message on my home phone from a registered nurse from my insurance company, inviting me to call to participate in a health education program. I was curious to see what had prompted the phone call.

When I returned the call, the nurse I spoke with said it was due to a recent diagnosis that was received from one of my doctors - obesity. This was from when I had my annual exam with my GYN and talked to him about WLS.

So in talking with the RN, I asked her if she could tell me anything about my actual insurance plan and she said no, I'd have to call customer service (which I knew anyway). So when I did call CS, I asked if they cover WLS and they said no (which I knew from reading my policy). However, if I do have any complications from it, they will cover that, which is good news (this wasn't addressed in the policy).

All this is just to say that now I can move forward and not have to wonder will my insurance cover it. I figure that by what I save in eating out lunch almost daily will make my monthly finance payment. I told my husband that he'd have to eat what I'm eating as I'm not cooking two different meals! Of course, he said he wouldn't do the liquid part of the diet with me. :tt1:

Now I just have to schedule the actual consultation and get going with it. If only work scheduling weren't an issue right now, I'd call and make the appointment for tomorrow!

[RestlessMonkey 7]

I swear I think my husband must be a freaking saint (and I know he's not! LOL) because while I was preop and post op liquids etc he ate what I ate AT HOME. I didn't care if he ate away from home, but while here, he ate what I did when i did. He wants me to be happy and healthy (we've been married 26 years this year and he's literally been w/me through "thick and thin", or rather "thin and thick" ) If he had refused to help me in this way, we'd be in counseling now.

HOWEVER!! I think it's sucky about your insurance, but good that you're moving ahead. :tt1:

Edited September 16, 2009 by RestlessMonkey

[bluetopaz 0]

I had a similar call from my insurance company. They called many times so I thought it had something to do with my surgery. I returned the call. The nurse said, they would do follow up calls to see how I was doing after any hospital stay. I thought to myself....that's what my hospital and doctors nurses do. She continue to as if I had time to answer a few questions for her. She said it would only take about 20 minutes....that's more than a few questions. I was making supper so I couldn't stay on the phone. She called back a few days later. I didn't answer so she left a message. I then got a letter in the mail about it.

I go to a monthly support group that my doctor's CBN and dietician hold. Just got a cookbook that was made just for bariatric patients. The meals are simple and look and sound delicious. Plus, you don't have to run to the store for a million different ingredients. I can't wait until I get off the blended foods so I can start cooking these. Your family can also eat them.

[Christy712 0]

Am I the only one that feels these calls from the insurance companies are an invasion of privacy??? I'm upset that what goes on in my doctor's office does not STAY in my doctor's office. Maybe I'm paranoid, but I don't like the insurance company (or anyone else) knowing all my business. The more you tell the insurance company reps, in conversation, the more ammunition they have to create pre-existing conditions, etc.

[GidgetGrnEyez 1]

Actually, the insurance companies cannot "create" a pre-existing condition. A pre-existing condition is something the member already has. The definition is pretty straight forward (this is from the book we use for the insurance licensing exam): "A physical condition existing prior to the effective date of the policy. Coverage may be denied if the condition required treatment within a specified period before the application date and then requires teatment within a specified time after the policy effective date."

The insurance company absolutely has the right to know what your doctor is treating you for. That's how they pay claims. They aren't just going to give you money becuase you say so. Plus, this is a PHI (Protected Health Information) requirement. If you want to know more google it.

Sorry to jack the thread, but misinformation is not good.

[Boykie 4]

Good luck to you. your stats seem similar to mine - except that you are 10 years younger. I had surgery on Good Friday (April) 2009, and am down 45 lbs.

My medical did not pay for anything, but I decided if I wanted to live beyound my 55th birthday, now was the time to start.

Good luck on your journey. Sometimes i find it frustrating (like when i yo-yo'd for 2 months - not setious, just 3 or so pound bandwidth). Other times it is so rewarding. Like, taking my belt in 5 notches -- until i got banded my belt always worked for a living, now it still works, but is in 'keeping up' not 'keeping in'. Also, wearing clothes i have nt worn since i stopped smoking 10 years ago.. this is bloody magic.

Good on ya.

[Brandy~ 2]

I would ask if there is a specific exclusion of the surgery if there is not I would request approval and fight the denials anyway.

no you don't have to cook 2 different meals and nobody in my house had to conform to what I eat... I eat whatever I cook for them just in Tiny amounts. Last night they had sandwiches and chip w/veggies since it was Friday... I cannot eat bread so I took a large leaf of lettuce and put 1 slice of bacon, 1/2 slice of Tomato, slice of cheese rolled it up.... dinner and yep it was very good.

[Melinco 1]

My policy specifically excludes all WLS. So I'm not even going to try to appeal it or file a claim in the first place.

My MIL is thinking about having this done as well but I don't think she is truly ready yet for it. While she has a couple of comorbidities, she isn't yet in the mindset to make the initial sacrafices it takes (liquid diet). I was kind of hoping she'd have it done too so we could be each other's support, but I know better than to push her into something she just isn't ready for.

By the way, most insurance companies have disease management programs that they invite their members to participate in. Members are under no obligation to participate. It doesn't create a pre-existing condition, since the only way they found out about it in the first place is when the claim was filed by the provider. These types of programs typically help members by answering questions that they might have about their condition, as well as giving the member another resource for information and support.