Submitted to Insurance!!!
Just found out today that my case was finally submitted to the insurance after many issues. The insurance was trying to change the length of supervised diet. Luckily they had a contract with my husbands company to not change benefits til next year. SO, I'm submitted for approval and I can't wait to find out!
After all of this crap, if I'm denied, I will be heart broken.
BUT, I'm keeping my hopes up. That's all you can do right?
After all of this crap, if I'm denied, I will be heart broken.
BUT, I'm keeping my hopes up. That's all you can do right?
Hi kelly.
I went through the same thing (sorta) with my insruance company. You mentioned that you will be heartbroken if they do not accept you. Please don't be. Just talk with the case manager, ask specifically what you need, talk with your PCP and get it all together.
I went thru the whole pre-op program at a local hospital (best in MI). I even had a surgery date and everything. I was 3 days away from starting the liquid diet. I got a call from the bariatric department telling me taht my insurance now requires that the hospital doing the surgery must be a Center or Excellence and that my request was denied. My heart sank but instead of giving up, i drilled the case manager on which hospitals ARE covered by insurance and I called several. Everyone that I called, I explained my situation and told them that i did NOT want to stat from scratch since I was so close. Luckily I found one, made an appointment and within 2 weeks they submitted to the insurance company for approval. I JUST NOW got the approval message back from the bariatric department. The surgery department will call me any moment to give me an actual surgery date, so I am so relieved. But PLEASE don't feel down. It's not a sign that you aren't meant to do this. It's just red tape. Find the paperwork you need, the notes, whatever from all docs and when you resubmit, be 100% ready and don't back down. I drilled them (BCBS) on their policy since I had alreday done my homework. I requested a printed copy of their coverage benefits way before hand. I called them numerous times to ask for them to clarify things. Don't be afraid of them, they don't control your life. I pray that you will be approved this time and you can move forward. Just stay strong. If I hadn't.. and I had given up, I wouldn't be clebrating right now!
I went through the same thing (sorta) with my insruance company. You mentioned that you will be heartbroken if they do not accept you. Please don't be. Just talk with the case manager, ask specifically what you need, talk with your PCP and get it all together.
I went thru the whole pre-op program at a local hospital (best in MI). I even had a surgery date and everything. I was 3 days away from starting the liquid diet. I got a call from the bariatric department telling me taht my insurance now requires that the hospital doing the surgery must be a Center or Excellence and that my request was denied. My heart sank but instead of giving up, i drilled the case manager on which hospitals ARE covered by insurance and I called several. Everyone that I called, I explained my situation and told them that i did NOT want to stat from scratch since I was so close. Luckily I found one, made an appointment and within 2 weeks they submitted to the insurance company for approval. I JUST NOW got the approval message back from the bariatric department. The surgery department will call me any moment to give me an actual surgery date, so I am so relieved. But PLEASE don't feel down. It's not a sign that you aren't meant to do this. It's just red tape. Find the paperwork you need, the notes, whatever from all docs and when you resubmit, be 100% ready and don't back down. I drilled them (BCBS) on their policy since I had alreday done my homework. I requested a printed copy of their coverage benefits way before hand. I called them numerous times to ask for them to clarify things. Don't be afraid of them, they don't control your life. I pray that you will be approved this time and you can move forward. Just stay strong. If I hadn't.. and I had given up, I wouldn't be clebrating right now!
Actually, mine is BCBS of Ohio, but probably same thing. If you meet the requirements:
1. BMI > 40 (or BMI > 35 with 2 comorbidities)
2. Mental Eval
3. Dieticial Eval
4. Certain "releases" signed by your PCP
5. Your supervised diet plan (mine was 6 months)
.... then don't keep yourself up at night. The only REAL problem could be that one or more pieces of info is missing in your paperwork, or that the hospital's bariatric program is not a certified COE. So, please please take it from me, don't get yourself worked up. If the hospital is not a COE, then all you do is find another program. Easy. It might take a few weeks to get back where you were, but you finally will. If it's paperwork missing, bother the POOH hout of your PCP until he provides it, or types it up or signs it, etc. But in the end, once you have it, you should be ready to resubmit.
I'm so lucky because They submitted ofr insurance approval this past MONDAY and I got the "authorization" yesterday (THURSDAY)!. I think, tho, that I may have had a fast track since the case manager said she'd be looking out for my new submission since she said she felt so bad after calling me to tell me I wasn't denied at the other hospital. So your next waiting period may be a bit longer.
If you really want to ensure you are ready, I'd do this. I'd call your insurance company, see if you have a case manager. If so, ask to speak with him/her. If not, talk to C.S. Then I would verify (Twice - and write it down) that not only is the hospital a VALID COE for YOUR insurance, but also triple check that your surgeon is 'in-network' and that the bariatric program is also 'in-network'. Calling and asking won't hurt. Remember you (your husband) pays for that insurance. It's a product you purchase. They are there to serve you, not the other way around. If you feel silly on the phone demanding info.. just remember, you won't ever meet this person on the phone and tomorrow they won't remember you called.
Good luck. I should be getting my surgery date TODAY. I also wrote a blog yesterday about what I went thru. Maybe it can give you some emotional support :)
Heather
1. BMI > 40 (or BMI > 35 with 2 comorbidities)
2. Mental Eval
3. Dieticial Eval
4. Certain "releases" signed by your PCP
5. Your supervised diet plan (mine was 6 months)
.... then don't keep yourself up at night. The only REAL problem could be that one or more pieces of info is missing in your paperwork, or that the hospital's bariatric program is not a certified COE. So, please please take it from me, don't get yourself worked up. If the hospital is not a COE, then all you do is find another program. Easy. It might take a few weeks to get back where you were, but you finally will. If it's paperwork missing, bother the POOH hout of your PCP until he provides it, or types it up or signs it, etc. But in the end, once you have it, you should be ready to resubmit.
I'm so lucky because They submitted ofr insurance approval this past MONDAY and I got the "authorization" yesterday (THURSDAY)!. I think, tho, that I may have had a fast track since the case manager said she'd be looking out for my new submission since she said she felt so bad after calling me to tell me I wasn't denied at the other hospital. So your next waiting period may be a bit longer.
If you really want to ensure you are ready, I'd do this. I'd call your insurance company, see if you have a case manager. If so, ask to speak with him/her. If not, talk to C.S. Then I would verify (Twice - and write it down) that not only is the hospital a VALID COE for YOUR insurance, but also triple check that your surgeon is 'in-network' and that the bariatric program is also 'in-network'. Calling and asking won't hurt. Remember you (your husband) pays for that insurance. It's a product you purchase. They are there to serve you, not the other way around. If you feel silly on the phone demanding info.. just remember, you won't ever meet this person on the phone and tomorrow they won't remember you called.
Good luck. I should be getting my surgery date TODAY. I also wrote a blog yesterday about what I went thru. Maybe it can give you some emotional support :)
Heather
I went thru all of the same feelings and fears. Hang in there. I have Anthem Blue Cross thru GE. I never did figure out how the different Blue Cross plans compared. Mine was approved in 12 days with no questions or problems. I hope yours will be smooth sailing. Since I started this journey in January I knew I had put all of my eggs in one basket and would be devastated if not approved. Let us know when you hear back. And... just know whatever there objections you can overcome them, it will just take a little longer.
Sheryl 
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