Sorry I've been MIA with the comments. I have been following but have been too depressed to say much about anything. Just thought I'd post a little update. The peer to peer never took place. They're trying to build a case and are having a hard time. I'm one of those healthy fat people that didn't feel the need to go to a doctor about my back or joint pain because I knew the doc would be like "right...you're fat...lose weight and the pain will go away." I also never went for my..ahem...urinary issues as I blamed childbirth for those. So documentation of problems is scarce. So my surgeon is going to set up a sleep study to determine if I have sleep apnea which I doubt but some very helpful bloggers have advised of a way to make it more likely. Also, remember that tailbone issue I had awhile back? Well, it still comes and goes but I never went to the pain specialist because, well...the idea of pain meds or a shot in the rear didn't sound all that appealing to me. And, again, based on what some others have experienced, I really believe it's partially weight related and that if I could get these extra lbs off, the situation would RECTify itself (bad pun...I know). Turns out this tailbone thing might be a good way to get approved. So I made an appointment with the pain specialist Wednesday to see what can be done. We'll see when we can schedule to the sleep study. I REALLY wish I could afford to self pay as these insurance companies are going to be the death of me. To add insult to injury, a RN from the insurance company called last week to "check in." Supposedly, they do this from "time to time to remind you of your benefits and answer any health related questions you might have." Funny, the only time they've called was after my babies were born. Seriously? You deny my request and then you're going to call to see if I have health related issues?!?! What a load! So this was the conversation:
Her: “we like to check in from time to time to remind you of your benefits and answer any health related questions you might have. I see you’re trying to get a surgery approved.”
Me: “Yes..y’all told me no.”
Her: “Did you get a letter or something?”
Me: “No. My surgeon’s office informed me of the denial and my doctor is supposed to have a peer to peer call with the medical director to see what can be done.
Her: “yes..I see that was requested. A lot of these conversations can often clarify for your doctor what other documentation may be required or for our medical director why the surgery is necessary.”
Me: “OK”
Her: “Along with the denial, your surgeon should have also received instructions on how to appeal so that’s another avenue you could go down.”
Me: “OK”
Her: “So is the expectation that you’ll be in contact with your doctor next week?”
Me: “I was told I’d hear something after the conversation to see what the next steps are.”
Her: “Good. It’s good that you’re staying involved with your doctor. I’ll check in with you next Friday to see how I might be able to assist at that point. I can facilitate conference calls between your doctor and our staff if necessary and just help coordinate the communication between all parties.”
Me: “OK”
Her: “Do you have any other general health questions or anything I could maybe help you with?”
Me: “No”
What an utter waste of my time. Yeah...I have a question: "Are you aware that you work for the devil? You love collecting our premiums every freakin' paycheck but don't want to pay when we actually need you to you-piece-of-poop-insurance lady?!?!?!" So I'm hoping she doesn't call back Friday as I'm not sure I can be so nice then. Otherwise, it's another manic monday...wish it were sunday...that's my fun day... (sigh). Hope y'all are all doing well.
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5 comments:
I am so sorry you have to go through this. I'm still waiting to see if I'm going to get my approval. I'm also one of those fat healthy chics, so i am a little worried.
Do you have any sort of family history of co-morbidities? I'm also a 'healthy fat chick' and showing that I have a strong family history of diabetes, stroke, heart disease, etc. really helped my case with insurance.
Oh, sweetie. I'm so sorry. You are allowed to be sad. You do what you need to do. I had to meet the minimum BMI of 40 and I gained weight to do it. Just to ensure that I would meet the requirement I planned on putting bags of change in my bra cups. You would be amazed at how much quarters weigh. Not my finest moment but you do what you have to do.
I am so sorry to hear that you are struggling with the insurance approval. I had to jump through alot of hoops and I am 40 and had several co-morbidity issues... I think that your doctor's office just needs to get whatever paperwork or tests that are missing together and you will be approved. I am part of a survey group who fill out questionaires once a month to show the benefits of lapband surgeries so that more people can be approved by insurance. *Maria*-Blogger from "This one time at Band Camp..."
Oh I am so sorry...I don;t get the insurance in the USso can't be of much help...perhaps you should bombard you Dr with yoru complaints and tehn the RN too....see how much she cares!!!!
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