ObesityHelp

I have been back and forth with the BMI Clinic. They cannot even find my file. Instead of them just admitting it - first the coodinator tells me that she must not have had the correct insurance number, so I call and make sure that everything is alright with the insurance.  They say that everything was fine, and that they never got the appeal.  So finally I left a message for the director- and he tells me that she is on top of it and give her a chance....yada yada. She calls me back and tells me that she needs my 11 month diet history w/ notes, i tell her that I hand delivered them to her in January- why is she asking me for them again- (now keep in mind I have moved etc) Found the letter of necessity, but no diet history. I call her and tell her that if the insurance company denied my claim- shouldn't they already have the copies of my diet history- she claims that she has to locate my medical records and it would be faster if I gave her a copy- 
basically she don't now where my records are, I spent 11 months on that damn diet- got cleared by every dept, and you did not even really work on my appeal- Just Great. 
So the next message i left was something to the affect of "just tell me that you lost my stuff and lets keep it real" 
Tommorrow I am going to ask for a copy of my medical file. I must make sure that it is correct, i know that i have to do this in writing and that I must file it with the compliance department at the hospital.
HIPPA is supposed ensure privacy of all of my medical documents, and if they cannot find them then they cannot tell me that they are secure.
I am so hurt that this lady played me like I was slow- and to think that i trusted them to keep their word to work on my appeal-
Tomorrow is my off day, and I will gladly take all of the day to get it all done.
I am wondering do I want them to give me surgery if this is how they handle the appeal process.
I will try to have patience-
the doctor secretary called and left me a message on Tuesday and I have left her many messages and she has not called me back to tell me what she wanted..
I am frustrated.

so here i got this inclination to call and check in with the coordinator at the BMI clinic. now keep in mind when i got denied i kept calling checking on the status of my appeal, and the lady ( i use that term loosly ) treated me like I was bothering them, and they were working on my appeal yada yada yada.
well let me snap back into reality, cause i had got game ran on me- see they told me that they were working on my appeal so that I could stop calling- DO NOT STOP WORKING YOUR CASE- turns out that when I called they had nothing in my file regarding they appeal ever being worked on,  keep in mind that I had hand walked my stuff to the coordinator- so i know that she knows lightweight who I am.
she hadn't done squat- here I am thinking that I needed to get a different carrier- when they had just sat on my ish- hoping that I would never follow up. I feel like i have been snookered.-
I got the name of the director of the program, (her boss) and left a very nice message. 
he called me right back that same day, and then she called me today not even mentioning that they had not worked on my case. 
keep in mind it has been 8 months-
so now I have to resume the process,  I am so glad that i have this outlet to provide me with some type of focus. 
it has been very helpful to me to read soo many profiles with similar experiences.
What it all comes down to is that when people mention not to give up- Heck- they are really not just whistlen dixie-
they say that because it is soooo true.
also- when people say to writed down names, dates, and times, of those that you speak with- 
so now that I have their attention, the coordinator is working with me feverishly to get me approved. I am not sure if it is going to happen, but there is a good lesson in here for me in handlin business, and not only asking for what you want, but also persistance and follow thru which are not one of my strong suits. 
The Lord is working on me y'all, and it is sooo wonderful.
I have just been growing so much- it has been through, these rough times that my faith has been strengthened.
Well, i know that I am supposed to be optimistic, but i would rather be realistic with myself right now.
I will trust in Him to know what is best for me.................
I sure hope that I get approved though.....................

today is going to be a long day, i am so happy though : )

Peace-

Shawn.

I am sorry that I have not blogged in a while, I got a message from a fellow Ohioian (go buckeyes!), and I have been so busy living life that I forgot that a big part of this site is for us to share our journeys.
Well0 the last 9 months have been quite busy. I am single again officially! I have a new love interest, and even with all of these changes..............i am still pre-op. I have got a job with a different carrier, the same carrier that did my friends surgery (did I mention that my girl is a year out and down a whole 100 lbs she looks great) the carrier has a whole bunch of hoops that I have to jump through-but they actually have a structured program that is in place to make the process a bit easier.
All in His time : )
I must say that the denial of my first proposal was devastating. I mean, you go through all of those tests,  and for them to say no - cause of some ish is quite unerving. I think that I became even more depressed.
Things will work out I am sure- keep me in your prayers.
I will not stay away for long, for all that read this- God Bless and take care.
Shawn
 

Hey all,
well I am still appealing,
not much more I can say. I have been bumbed out, and selfishly I have not posted. It is important to post so that others can learn from your experience. So if not for my own sanity- I will do it for those who are trying to get approved.
Well- my financial counselor took it upon herself to change my diagnoses before submitting my paper work based on the experience she has had with Caresource and what they generally approve on.
Needless to say, they returned the request as denied because of not enough information about the new diagnoses-Note***my medical provider gave supporting documentation for only his diagnosis.
so here I am waiting on them to work my case.
It has gotten to the point were I am calling them and they know me by name. 
last time I spoke with the secretary she basically told me to stop calling cause they were doing all that they could at this time. I am trying to be optimistic but it is hard.
My friend Cassie has been real supportive, she and her sister have been telling me their stories- her sister got denied and them they called her 2 years later to have the surgery.
I mean, I am trying to come up with a plan B- but the fact is that I have been dieting for 10+ years, and I am tired of the up and down. 
It is now beginning to wear on my usually high spirits.
I am trekking on for those who may find themselves in similar situations.
I guess thinking positively will be my focus now. 
I have not been on BAF in about two weeks.
Is that some hater type sh*t? I hope not, I truly feel happy for everyone-and have to respect what they went to to get on the losing side.
I guess I have more dues to pay huh?
I know one thing. When they finally approve me- I am going to really appreciate some of the other posts that I have read more.
take care

Shawn

Just getting up-
and boy am I sleepy still.
I am feeling a bit bumbed out.
I am nervous about this appeals process, I am thinking about retaining a lawyer of the bat to atleast do the appeal letter.
I keep seeing everyones posts and profiles, and I feel like blah!
I worked really hard on completing my paper work- and including everything that I needed. 
I guess this is where my faith comes in?
i keep looking over my denial letter and thinking - Why could they have not just approved it?
Is that compulsive behavior?
I have to get ready to get to work, I want to plan for the summer.
i am just stuck I guess.
I got 90 days for the appeal-
my financial counselor is working on things for me now hopefully-
keep me in your prayers......................