Insurance case manager

So I have a case manager from my insurance to help me get through my lap band. I filled out a 24 page personal health assessment and faxed it to her last week. I'm an RN, plus I work in medical records, so, if there's one thing I know how to do it's how to fill out a medical form. Anyway, today I got my plan of care by e-mail. Imagine my surprise when the second paragraph says, "You mentioned being worried about your alcohol consumption. Be aware that, once food is removed, this may become a bigger problem. We suggest a referral to..." A few paragraphs after that it say, "since you are a diabetic, you will need special protein powder that..."

I was shocked as I am NOT a diabetic and I had said on the form that I drink alcohol about 4 times a YEAR and never have more than one drink at a time. I stayed calm and wrote her asking if I had filed out the form wrong or something. I told her I wanted my insurance record to be RIGHT. She wrote back after a few hours and said it was her mistake and she had corrected it.

It was a little bit funny, but also irritating. I'm known as a kill joy at work as my idea of a wild weekend is quilting with my friends. I don't go to the work office parties since there are so many drunks there. I kept telling people at work today that our insurance thinks I drink too much and need alcohol counselling. I got several sarcastic comments about the kind of counselling THEY think I need. Sigh.....

So my case manager and I are NOT off to a great start, but I'm trying to give her the benefit of the doubt. My first interaction with her she informed me I had only lost 18 lbs and needed to lose more. I told her I had lost 37 lbs, not 18. She eventually agreed with me. Anyway this is the lady who is going to educate me  and help me be successful........Just ventilating here. Having a case manager is optional and I'm thinking I don't need this aggravation.

Do you all have case managers? Do they DO anything for you? 

I know this must be aggravating for you, so I apologize for chuckling all the way through your post. 

I don't have a case manager as I'm self-pay, so I can't speak to any personal experience.  But, my guess is that this case manager is an employee of the insurance company.  Is that right?

Call me crazy, but I've never trusted anyone who claims to be working for me when they're being paid by the person who doesn't want to give me services.  Know what I mean?

Ronda, If having a case manager is optional I say DUMP THIS LOSER!  You say you want to "give her the benefit of the doubt" but you already did twice!  First, she held up your surgery by saying you only lost 18 when you had lost 37, which was required by the insurance company for you to get the surgery.  Now she is putting out documentation that you may be an alcoholic and are diabetic.  Don't let this B**ch totally wreck havoc with your medical record.  Honestly, don't be so nice, you have given this woman enough chances to do her job correctly.  She is an incompetent moron and I don't see how in the world anything she does in the future could help you, but her misdocumentation of your health could hurt you!  You say she acknowledge to you she made mistakes, do you know for a fact she wrote some kind of documentation into your permanent record retracting those other documents that were incorrect that no doubt are?  I would call someone in your insurance company who is above her and report her incompetence.  If you want to work with a case manager, I would suggest they get you a new one and send you an official letter stating that her erroneous information has been deleted from your insurance record.  Stop being so darn nice, this woman is incompetent! 

Donna, you're right, of course. One of my big problems in life is that I give everyone else unlimited chances and I'm hard on myself. She sounds OK on the phone, but I am certainly NOT impressed with her work. I have an excellent surgical team and an involved primary doc, so I don't really think I need a case manager to "help" me. Yes, I'm VERY concerned about accurate records in my insurance file. These folks control my future payments!!! 

Brandy, thanks for chuckling at my post. It certainly was an ODD sensation to read about my problem drinking and the people at work were amused. They said, "oh she probably just saw where you worked and assumed alcoholism." We ARE a hard drinking, smoking, partying kind of group, but I'm the freakin exception!! My v ices are FOOD, FOOD and FOOD.

Sweetie i dont think you need her if you have to keep uncovering her mistakes..
Good luck and if you keep her stay on  her tail..

I agree - dump her.  Fast.

I didn't have one, but I think a good, thorough case manager would be a blessing.

Maybe there wouldn't have been a 3-month delay in my surgery because I couldn't get scheduled for a treadmill test. (I later learned that the medical group cardiologist who does them is totally anti-WLS.)
Then the time before that, when I had one my ovaries removed due to a dermoid cyst, I spent so much time dealing with insurance garbage. The final straw (being emotional about the reduced chance of having children, surgeon with no bedside manner, surgeon's office staff totally unhelpful) --  I had a meltdown when I got the paperwork from my insurance about my hysterectomy being approved! (Diagnosed in July/August -- surgery in January.)

But in your case, it sounds like she is more trouble that she is worth.

She sounds a lot like the nitwit Healthy Roads 'counselor' Cigna had calling me to talk about making healthy changes to my life when I was trying to get approved for the surgery through them. This one couldn't handle me going off script or trying to be funny. She messed stuff up in my files. She quit or got fired after I'd done it for about 2 months. Then they changed their policy about Healthy Roads. (And my plan dropped bariatric procedures.)

Insurance companies are all so different yet so much alike..I had almost the same thing happen.. they had all my information wrong.. almost a complete opposite of what I had told them.. and right up to the last week the councelor on the phone that I ahd to contend with for 3 months kept insisting I was having a lap band.  when I had said repeatedly I was having a lap RNY.. everytime she said oh I will correct tht right now yet the very next phone conversaiton she waould say I was having lap band again.. It is so aggrivatiing dealing with insurance..  take a deep breath.. it will all work out just fine.. don;t let them get you upset or aggrivated.. just keep on looking at that goal of the surgery date and don't worry what they think.. hey  ...now you can tell people at work that you officially qualify as a party animal..lol...

 Hi all,

I have a bmi over 50 and I'm planning on applying through my insurance co for surgery on Jan 1st, 2010.  I've heard that either or both insurance co's and surgeons require your  bmi to be down below 50 before they'll approve surgery.  Does anyone have any experience or knowledge of that practice?

thanks

I am gettting a lap band on the 15th of Dec with a BMI of 53. My group of surgeons will operate as long as your BMI is less than 60. My insurance required a 10% loss to prove that I'm serious about this,  not so much to help the surgery although everything you can lose by whatever means is good.