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10-31-2008, 01:45 AM
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#1 (permalink)
| | Guru In Training
Join Date: Oct 2008 Location: Back in my home state.
Posts: 327
Weight Statistics September 26, 2008 Start Date:
November 19, 2008 Surgery Date:
5' 3"
Height:
356 lb Start Weight:
250 lb Current Weight:
140 lb Goal Weight:
106 lb Weight Loss:
110 lb Lb Left to Lose:
29.7752808989 % % Lost:
October 31, 2011 Goal Date:
Body Mass Index63.0556815319 BMI Start:
44.2806752331 BMI Current:
24.7971781305 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
 |  I thought I had qualified, but apparently not
I had some shocking news today. My surgeon's office called me with terrible news. The insurance company has decided not to pay for the surgery! WHAT?!? But I had a date! I've already put in for the time off for my employer and feverishly working on lesson plans for the sub!  I called them and they said I hadn't provided enough documentation! Why are they doing this, they've been paying for EVERYTHING until now, why would they wait until after my pre-op testing to tell me they're not paying for it after all? I just don't understand I thought I had the green light. Tonight has been a real let down. I had a date for surgery, now I don't know what to do.
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10-31-2008, 02:17 AM
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#2 (permalink)
| | Super Moderator
Join Date: Nov 2005 Location: Tokyo, Japan
Posts: 24,703
5' 5"
Height:
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Awww (((((HUGS))))))
First off, find out EXACTLY what the reason is for the denial, then go from there. It just may be only the lack of some data, and once that's in, they will give you the green light, or if it's a complete denial, then you need to appeal.
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10-31-2008, 04:37 AM
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#3 (permalink)
| | Seasoned Veteran
Join Date: Jun 2007 Location: North Texas
Posts: 5,236
Weight Statistics I've lost/gained my whole life!!! Start Date:
Aug 1, 2007 Surgery Date:
5' 8"
Height:
280 lb Start Weight:
154 lb Current Weight:
150 lb Goal Weight:
126 lb Weight Loss:
4 lb Lb Left to Lose:
45 % % Lost:
Summer 2008 Goal Date:
Body Mass Index42.5692041522 BMI Start:
23.4130622837 BMI Current:
22.8049307958 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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SCREAM & HOLLER till you get someone on the phone who can provide some answers...if the person you are talking to can;t help, ask for their supervisor..keep going up the food chain until you get a YES....something's wrong if you had a date and everything...then all the sudden, you aren't having surgery...
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10-31-2008, 06:11 AM
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#4 (permalink)
| | WLS Master Guru
Join Date: Dec 2007 Location: Rochester, NY
Posts: 809
Weight Statistics August 4, 2008 Surgery Date:
5' 4"
Height:
271 lb Start Weight:
138 lb Current Weight:
150 lb Goal Weight:
133 lb Weight Loss:
-12 lb Lb Left to Lose:
49.0774907749 % % Lost:
Body Mass Index46.5119628906 BMI Start:
23.6850585938 BMI Current:
25.7446289062 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I agree sounds like an error. I would challenge it ASAP. Good luck.
__________________ Cheryl  | |
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10-31-2008, 06:15 AM
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#5 (permalink)
| | Seasoned Veteran
Join Date: Jan 2007 Location: Davenport, IA
Posts: 1,848
Weight Statistics 12/28/06 Start Date:
May 14, 2007 Surgery Date:
5' 5"
Height:
253 lb Start Weight:
191 lb Current Weight:
150 lb Goal Weight:
62 lb Weight Loss:
41 lb Lb Left to Lose:
24.5059288538 % % Lost:
Body Mass Index42.0968047337 BMI Start:
31.780591716 BMI Current:
24.9585798817 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I agree, don't let it go. Call until you get an answer. Sounds to me like some of your paperwork got lost. You may just have to send it again.
__________________ Jeanne   | |
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10-31-2008, 06:55 AM
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#6 (permalink)
| | Guru In Training
Join Date: Oct 2008 Location: Back in my home state.
Posts: 327
Weight Statistics September 26, 2008 Start Date:
November 19, 2008 Surgery Date:
5' 3"
Height:
356 lb Start Weight:
250 lb Current Weight:
140 lb Goal Weight:
106 lb Weight Loss:
110 lb Lb Left to Lose:
29.7752808989 % % Lost:
October 31, 2011 Goal Date:
Body Mass Index63.0556815319 BMI Start:
44.2806752331 BMI Current:
24.7971781305 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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I made some phone calls and found out the records from my principal care provider were never received. The surgeon's receptionist then told me over the phone they're lying I sent them 31 pages. I called my current doctor and found out they only sent one page of my records where we discussed surgery and he made the referral. Ugh! I asked them to send everything. Then I contacted my old GP in Michigan and for some reason even though her office was closed she answered the phone. Holy Cow! I had the surgeon fax her the release and her receptionist is supposed to fax my records from Michigan this morning, but I am going to call them when they open and make sure.
I was so shocked. I've been diagnosed with PCOS, been referred to an endocrinologist, prescribed phentermine for pete's sake, and my GP in Idaho has done nothing for the past two years since the first day I saw him but bark at me about losing weight, even suggesting surgery last year but I said no. I don't undestand insurance companies.
I also found out my GP in Idaho never sent for my Michigan records! I went down there before they closed and signed a new release and they said they would send for them. Good grief what a mess.
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10-31-2008, 07:51 AM
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#7 (permalink)
| | WLS Mentor
Join Date: Oct 2008 Location: Rochester NY
Posts: 1,003
Weight Statistics 1/13/08 Start Date:
11/17/08 Surgery Date:
5' 4"
Height:
288 lb Start Weight:
165 lb Current Weight:
160 lb Goal Weight:
123 lb Weight Loss:
5 lb Lb Left to Lose:
42.7083333333 % % Lost:
11/2010 Goal Date:
Body Mass Index49.4296875 BMI Start:
28.3190917969 BMI Current:
27.4609375 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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It does sound like a mess but you're doing everything right to clean it up. Don't let it go!
__________________ Sarah Lost 15 lbs before surgery
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10-31-2008, 07:58 AM
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#8 (permalink)
| | WLS Mentor
Join Date: Jan 2008 Location: Northern VA
Posts: 1,496
Weight Statistics 02/07/2008 Start Date:
02/07/2008 Surgery Date:
5' 7"
Height:
310 lb Start Weight:
146 lb Current Weight:
159 lb Goal Weight:
164 lb Weight Loss:
-13 lb Lb Left to Lose:
52.9032258065 % % Lost:
Summer 09' Goal Date:
Body Mass Index48.5475607039 BMI Start:
22.8643350412 BMI Current:
24.9002004901 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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That is a mess but....your hard work will pay off!! Keep on everyone to get it done asap and hopefully you can keep your date.
__________________ Shannon   | |
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10-31-2008, 09:09 AM
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#9 (permalink)
| | WLS Master Guru
Join Date: Feb 2008 Location: Mira Loma, CA 91752
Posts: 589
Weight Statistics April 15, 2006 Start Date:
May 10, 2006 Surgery Date:
6' 3"
Height:
365 lb Start Weight:
200 lb Current Weight:
200 lb Goal Weight:
165 lb Weight Loss:
45.2054794521 % % Lost:
anytime Goal Date:
Body Mass Index45.6168888889 BMI Start:
24.9955555556 BMI Current:
24.9955555556 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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If you PCP office can't provide the documentation properly, I'd take action myself. It may delay surgery, but it may be your only solution. YOU are entitled to copies of the documentation. Check with your isurance company to see if they will accept copies of your records if you send them. IF SO, go to your PCP, and ask for the copies of your records. You are entitled to them. Then YOU send them OR TAKE THEM to your insuance carrier office. If your insurance company only wants the records from your PCP's office, then "I'd be up their tailpipe" to make sure it got done. Personally, I called my doctor's office more than one time to check on status of paperwork in my surgery pre operative time, just to make sure there were no "issues". I even had a written authorization from my insurance co. prior to surgery, to assure that the surgeon and hospital would be properly paid. Make sure your doctor supplies any documented attempts at wt loss, if that is required by your insurance. Just a suggestion, as this is a common requirement where some patients are delayed some 6 months because they have to attend nutritional classes for not having a documented wt loss program. DAVE
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10-31-2008, 12:35 PM
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#10 (permalink)
| | Seasoned Veteran
Join Date: Jan 2008 Location: Troy,ny
Posts: 2,799
Weight Statistics Since birth:) Start Date:
August 5, 2009 Surgery Date:
5' 6"
Height:
319 lb Start Weight:
189 lb Current Weight:
150 lb Goal Weight:
130 lb Weight Loss:
39 lb Lb Left to Lose:
40.7523510972 % % Lost:
sometime in 2010 Goal Date:
Body Mass Index51.4823232323 BMI Start:
30.5020661157 BMI Current:
24.2079889807 BMI Goal:
Weight Loss MethodRoux en Y Gastric Bypass
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Fight, Fight,Fight. I can't believe after going through all the steps they pull a fast one so close to surgery. Be strong everything will happen in it's own time.((HUGS))
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