18 Months to Approval, No Wait Maybe Not, Yes Approved

Yes, its been 18 months since I started this path towards insurance approval and in May was given a letter of approval from the insurance company.  I then attended the full-day pre-op session, had a July 11 surgery date set and then got a letter from the insurance company saying "oops, we made a mistake and shouldn't have approved you."  Another three stress-full weeks as I petitioned our insurance committee (my company is self-insured) and explained to them how inept the insurance company they hired to administer their plan was and that the surgery had been deemed medically necessary by them after I jumped through 18 months of hoops, followed a six-month doctor supervised diet, and that they'd already paid for numerous medical tests for the pre-authorization.  A week later I got a letter saying that they had approved my surgery and in fact where even amending our companies plan to specifically allow gastric bypass when deemed medically necessary.  A definite win-win but at my stress-expense. When my surgeon got the "ooops" letter and since I couldn't get it resolved swiftly I lost my July 11 surgery date.  I'm now on a waiting list for an opening hopefully in August.  You've all been in my shoes and can understand the highs and lows that come with not having control of when this surgery is going to happen.  I'm ready, call me and I'd be in my car driving to the hospital in a heartbeat.  Anyone who has a July date with De la Torre that wants to swap for an August date just let me know :) hehehe Now that I'm really, really on the path towards surgery I'm glad to have joined the message board and look forward to getting to know you all better. 

Miss TJ we are more than glad to have you but you could have joined long time ago and could have been sharing all of this grief with lots of other people and maybe it wouldnt have seemed quite as bad. That up and down yes, no time was awful and i hope all will go smoothly now for you. I think i would have been ready to go chock someone, dont know who but someone. lol  Come on in and tell us about yourself and hopefully your surgery date will be here soon.

*hugs*  So sorry bout your struggle.....that's just terrible. But, glad you're finally on the right path...and I hope you'll get a date very very soon.... Glad to see ya on our board, I'll look forward to getting to know ya as well :-)  This board is just chocked full of the most wonderful caring people you'll ever meet! Congrats and Good Luck on your journey!

Sorry to hear about all that, Im with you, it woul;dve stressed me wayyyyy out. But in the end it was approved and its just a waiting game, which is hard to do..but since I joined here, I have also met alot of nice, caring people--so time will fly!!! Good luck and I wish you all the best!!! Amber

Miss TJ I'm so proud of you for not giving up and for getting approval and apparently a major change for others from your company who apply in the future.  That's a huge WOW and you should feel really good about yourself.  Your date will be here before you know it.  Keep coming to this wonderful board and getting the advice and support we all need so badly. Hugs  Lana

Thanks everyone for the welcome.  I was shocked when they told me they didn't just make an decision for me, but made a change to the plan.  When I talked to our HR people after the denial they told me there had been another person a year earlier who went to the committee and was turned down and not to bother petitioning them.   This is proof it pays to use all the options afforded you and not let anyone try to tell you otherwise.  Because of privacy issues I don't know who the first person to get denied was but sure hope HR has the guts to tell them of the change so they can proceed.  I can imagine them not doing so and the person having to wait until next February or March when the new plan booklet comes out to find out.  As for joining the boards earlier -  I'm the type of person who doesn't like to jump in until its a sure thing.  My way of protecting myself from getting my hopes up so far it would be a bigger fall had I not gotten approval.  I'm just now starting to tell people of my surgery.  Its not so much that I'm a private person as I don't want to hear their concerns about the surgery - I only want positive support.  In fact, I haven't even told my mother about the surgery since she is the worrier type and will be overly dramatic about the risk.  I don't need that voice in the back of my head nagging me right up until surgery day.   I did start attending the DePaul monthly support meetings after the first surgery approval, and appreciate the positive energy and good information. Got my ticker built, now I need to find the fattest before picture I can find to upload ;) 

Miss TJ Welcome to the board. I am so glad you came in and shared our story with us. I hope that you will keep coming back and sharing with us. We have a great bunch of people here. I have never had a better support group than I do right here. I hope eveything goes well for you. Your date will be here before you know it. Another thing that you probably already know. You have to keep a fire lit under Columbias rumps. I would call them every couple days and see if they can help you with a date. They will grow tired of you calling and eventually give you a date. I think it was Carrie that gave me my date. Have you already went to the pre-op class??  Good luck and feel free to come in and ask questions. Hugs

I will put it on my calendar to call Nancy at the DePaul office every few days as you suggested to pester them for a date.  You just reminded me that they do surgery in both cities, dang I do need to light a fire under them that I don't mind going to either hospital for the surgery. I attended the pre-op class on May 25th so I'm set.   Cross your fingers.

Whoa-- talk about being yanked around!! You give a lot of hope to people who are about to start the process or those in the middle of it and losing hope. Welcome to the Message Board!