Just so unbelievably mad...long post.

I know I'm new here, but I needed to vent and I also want to alert anyone with the same insurance.

...So today was a total derail.  I didn't realize that was how it was going until it was too late.  I crashed hard.  See today was 3 weeks since my psych eval, so I decided to call the center and see if they had got any notes on it yet. 

Marie tells me that "yes, we got them! And we submitted everything to your insurance company on Augusta 4th.  We should be hearing back soon."  YAY!!, Right? 
So I pull up my Harvard Pilgrim website and click on authorizations.  Yep!
There is the request!  There's Dr. Trieu's name...can you feel the excitement starting to build??... I click into it...
status: Denied.

WTH??

So I pull out my trusty insurance card and call them to see what mistake they have made.  I mean...I did all the steps.  I jumped through the hoops.  They already told me that this procedure is something they cover and Dr. Trieu is in network. It's gotta be a mistake, right?

The lady that answered put me on hold...twice...trying to figure out why it was saying denied. She couldn't figure it out either.  Then, finally, she comes back on the line to say that the hospital (the only one that Dr. Trieu has privileges at) does not meet the criteria. 

...

WHAT?  I called in April.  You knew it was a bariatric procedure.  You knew I was seeing Dr. Trieu for that procedure.  How could it possibly have escaped your attention to mention to me that hospital he is affiliated with would not qualify for this procedure?????

...

She did say she was sorry that no one had informed me.  Isn't that great?  $3000 out of pocket,  4 months of jumping through hoops -eagerly-, not to mention half way through my out of pocket expenses and now they're telling me I have to start all over. 
Not only is it unlikely that I will get through every thing in time to have the surgery done this year...do you want to know the real kicker???
I've lost so much weight that my BMI will no longer qualify if I walk into another consult at what I weigh today.  How freaking sad is that?  I'd need to gain weight to get approved now.

I am just so mad that I don't think I can begin to process where to go with this.  I called one of the "qualifying" hospitals and sure enough she said "the first step is the seminar and then we'd get you scheduled for a consult"....ah deja vu!  I started crying.  I couldn't help it.  I was so mad and frustrated.
...
So...deep breaths.  I did not buy any chips. :)  I am going to wait until tomorrow and see if Marie has any luck at all when she calls Harvard Pilgrim to try and argue with them.  I am going to walk tonight.  And then tomorrow I will start figuring out how to fight this.  There has to be away.

I always say things happen for a reason.  I am having a really hard time seeing the message today.  But that's ok.  That's why there's tomorrow. 

Mikki I'm so sorry !!!  things will work out.... I'd be freaking out and fuming also....but it will get better think positive!!! :-)

♡ Kelly

Thank you so much Kelly!

I am so sorry, truly a frustrating experience. May I make a suggestion? The insurance requirements are usually so many months of medically supervised diet, which you probably had to pay for separately as it was likely not covered. No where (I would imagine) is there the stipulation that you use the same surgeon for all aspects so.......from an insurance standpoint it shouldn't matter that your supervised diet, etc takes place with surgeon number 1's office and the procedure itself with number 2. They already have the information, so......I would look at doing the seminar with surgeon # 2 and ask them at that time if what you have done already will suffice. If they tell you know I would pursue that further...

Thank you Beth! one of the reason I come here is for the vast knowledge everyone has and the amazing support that is given. 

So...went for a two mile walk...feeling better...brought down my blood pressure and the splitting headache. Tomorrow my first step is going to be to go through all my correspondence from HP and see if they listed ANYWHERE the need for the hospital to be "circle of excellence" qualified. I love having documentation on my side. We will see where it goes from there...but hey...worse case scenario...even if I do have to repeat a few step and cost a bit more and that takes a few months...I've been fat for 20 years...this is just a bump in the road...I'll get through it.

I would actually encourage you to insist on a center of excellence qualification.

Thanks, I get that...the only reason our hospital is not is because it is a brand new state of the art hospital.  They just haven't been around long enough to have the stats to qualify.  However Dr. Trieu has fantastic stats, he extended his study specifically on the sleeve an extra year...and I've met about a dozen of his post surgery patients that have had wonderful success.  

Mikki, I don't even know what to say. I'd be pissed. I hope that the person who calls tomorrow on your behalf gets this all straightened out. Hang in there and I hope it all works out for you.

Thank you Dawn 

I switched surgeons after my approval (which came after a protracted denial appeal) and there were no issues at all. Granted, denial was in hand, but the point is that you should be able to transfer your files. Hopefully.

laurie