Question:
Writting the insurance company
My husband and I just moved from Colo. to NM so we have new insurance, I have stomach problems so they sent me to a G.I. doctor. I was told it could take up to two year to have this surgery appoved. I'm 38, I'm 312 lbs., I have acid refux, depression and now have diabiets. I feel like I'm 100!!! I've missed so many things in childrens lives, and now that I really want to move on WHY does it take so long?? I would like to address the insurance company myself any helpful tips, exept that I feel like I'm doing down hill to fast to wait that long. P.S. I'm not afraid of the surgery, just any complications after. — angel-kisses (posted on October 22, 2007)
October 22, 2007
The best advice I can give is to be proactive and organized! Make sure you
go to all your appts, have all the info you need, fill out the right forms,
etc. I was approved in about 2 weeks but yes, sometimes it takes longer.
The insurance co. kinda runs the show since they're paying so just be
patient. Call them to see how long your required diet will be - it's
usually 6 months. I've never heard of anyone getting around the supervised
diet. And then there's the testing. But while you're waiting, you can
start your exercise program (however small), start eating healthier and
prepare you and your family for this huge change. Do you see someone for
your depression? It would be really helpful to have someone to talk to.
Good luck going through the process - you'll be on the "losing
side" before you know it! ~Sarah in VA
— platypus
October 22, 2007
Hi Linda - I saw my surgeon on 8/30 and had insurance approval and surgery
on 9/28. I had Anthem and my insurance was running out so my surgeon's
office pushed everything through. They stayed on top of everything. I
also contacted the insurance company and the surgeon's office to stay a
priority to get the approval. It was close and I was stressed, but it
happened. Not to say you will get it accomplished that quick because I
don't know who your insurance carrier is, but contact them and ask them why
it will take that long. My family doctor submitted a letter about my
health as well. I am diabetic, high blood pressure, weighed 339 pounds,
walked with a cane, parked in handicap, could not shop alone and am only 46
years old! I too felt like I was 100! My surgery was 9/28 and I have
down 38 pounds in 3 weeks. I feel great, I went from over 300 units of
insulin a day down to less than 40, I don't use a cane, I don't park in
handicap. I am taking it one day at a time and I am getting my life back.
Good luck and bug the crap out of your insurance company!!!!!!
— jinamos
October 22, 2007
When I began this process, I had insurance. I was told it would take up to
one year and my out of pocket expense would still be $4K. I no longer have
insurance, but began the surgical pursuit again anyway on the basis of
self-pay. I found a surgeon in Hermosillo Mexico who conducted the
procedure for a flat $10,500, and best of all, once I agreed to proceed, my
surgery date occurred two weeks later.
— Tom Y.
October 22, 2007
Well I will tell you I called my insurance company and asked what all was
needed, for them to appove my surgery, after I got my answer I had my
personal doctor, to write a letter to the insurance company, he told them
had tried diets on and off but they did not work. and he told them I was
very motivated. So when i did go see my surgeon and he sent all the
information that they always send, my surgery was approved in 2 days.
— dapoohster38
October 22, 2007
I agree with Brad...contact your insurance carrier directly..find exactly
what they require and complete each step. Also you said you has some
stomach issues. I know that some issues need to be cleared prior to
surgery, like ulcers etc. My insurance required me to be on a medically
susupervised diet for 6 consecutive months, psy evaluation and a few other
things..it took me about 8 months to finish it all, and once it was turned
in to them they approve me in one day.
— nsh4991
October 22, 2007
Hello
My name is Lisa and I had surgery on June 21 of this year. I was going
through some insurance problems before I had the surgery. There is a lot of
prep before going through the surgery. But believe me it is all worth it.
It is going to take a while with the surgery. Certain letters have to go
through to the insurance comp for them to approve.. I was denied about 5
times. I felt that I would never have it. It was a long wait. So just relax
and it will happen for you. See u on the loosing side good luck...
— LisaPellegrino2006
October 22, 2007
You didn't say where in New Mexico you lived but, if it is in the
Albuquerque area, there is an excellent support group (free of charge) that
meets twice a month. They really helped me when I was looking into the
surgery and there was no question too off the wall for them. I am now just
short of two years out (as of January) and have gone from size 26/28 to
wearing size 10 pants!! I truly think that I could not have done it
without them. If you go to the individual state forums and post on the New
Mexico one, you can find out more details about the meetings and chat with
a great bunch of people. They can even give you a lot of great suggestions
on how to approach the pesky insurance people.
Mary-Margaret
— Mary-Margaret
October 23, 2007
What was the reason behind the two years? I am guessing but I would assume
that this is a new policy and they have a waiting period of 1 year. Here is
something most outside of the medical field do not know. If you had
insurance BEFORE this policy and you did not go without insurance for MORE
than 63 days they can not put a waiting period nor a rider for anything.
You will need to contact your previous insurance carrier (look on the old
card or paperwork for the number) ask for a certifcate of continued
coverage from them then call your insurance carrier get a fax number and
fax it to them, HIPAA laws are not just for privaicy they are for
portability of insurance coverage. God bless you if you need more info call
me 713-960-7989
— DonnaB.
October 23, 2007
If you have the resources or even credit card availability, it is sometimes
worthwhile looking into medical tourism, especially if time is important to
you. Pat S
— catcat
October 31, 2007
have your doctors send in letters to the insurance co. sometimes that can
help.
— cindywho
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