rubblefeet

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I am post op 11 months.

I paid for my surgery out of pocket.

I am happy with my results so far.

I have 40 lbs to my goal weight

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......................

the saga continues-
so- I go to the Dr.s office cause I got no response from the Financial Coordinator about my appeal.
I hand deliver the denial letter- I  mean it was like God- was on my side, cause i have never seen the lady in person. So I get of the elevator and she is like standing at the desk, and the receptionist is like who are you here to see, and I say the lady's name, and she is like "that is me" "what can I do for you?"
It was so meant for me to meet her so that she can put a face to the case you know!

So there is good news and bad news, the bad news is that i got a denial letter, the good news is that the reason for denial was not the major reasons - like lack of documentation for the 10 months of dr supervised weightloss- 
So- she is supposedly calling the lady to see what it is that they need.
Turns out that they did not do my Hpylori- and one of my comorbidities is GERD. While i was there I stopped at the lab and had them call in an order since they obviously forget to get it with my initial lab draws.
They have 15 days to get back with me about the denial, and hopefully they can get me the approval that I am seeking,
Only people that I have shared all of this with you you guys, I just do not want any haters F-ing with my mood right now- So I am keeping all of this info in house where I have got support.
I know that everything is in Gods hands and in His time.
i am trying to be patient.
I just have a good feeling, I am trying to stay focused and positive. I just want to have this surgery in the winter while i am more seditary.
I read this one profile where thisyoung lady was denied twice, and finally got approval, and that really meant alot that she shared that experience.  Being able to read others experiences makes you not feel alone.


Till next time-
Love
Shawn

Goodmorning,
I am just getting off of work, and although I have been bumbed out, I decided that it is important for me to keep blogging so that I may possibly help someone else who may find themselves in a similar situation.
I have the letter that Caresourse sent, I am taking it to Cleveland Clinic tomorrow. I will let them do all the rest. 
I will keep you all posted no matter how this thing ends up.
I am keeping myself motivated.
I look at the profiles of others, and remain thankful for what I have at this moment.- I would like to have WLS- but I know it has to be in on Gods terms- perhaps it is just not in the cards for me. I don't want to fall apart if that is the case.
I will give it a fair shot, and keep it moving.
well- I will post soon.
Love-
Shawn

OK-
I have been officially denied. I am bumbed, but glad that I got some feedback. So here I go to the appeals process. The good thing is that my financial councelor advised me in advance that thisis the way that Caresource operates, she said that they usually will deny- and before you get to file you apeal they will approve.
Keep you fingers crossed.

This is quite a roller coaster ride, I am holding on tighlty. School is in, and I am trucking right through, I am glad that I have something to distract me. Cassie (my friend) is down over 40 pounds!!!!!!!!!!!!!!!
She lives in Akron, so we have not seen eachother. I am going to get out there to see her soon, she is on regular foods now.

She says that it is not joke.

I am going to try not to get depressed, it is all part of the process right?
Feels like I am on the other side of the street watching everyone else having a great time, and my insurance company is the only thing keeping me from joining the party-

I am so thankful for all that I have, and know that God is in control.
Thanks for reading.....................


Love 
Shawn

ok-
so here it is-
these people are playing with my emotions.
I called my insurance company and they say that they did not get anything from my dr.
so of course i have to call in the morning and figure out why is it that they have not gotten it.
I hate this part, it is like you have to followup with everyone to make sure that they do their jobs.
if they did not send it in I am going to be super pissed off. enough to perhaps go somewhere else with my grip.
I am more than ready- I am past ready.
Ok Ok .....focus, focus..................I know that God is in control and will manifest all things that I need in divine time.
whew! 
I am going to try not to get upset- need to be more patient.


keep me in your prayers.

Shawn