ElizabethK
Hi, I never thought that I would get far enough with my journey to become a member of OH. My journey started in Oct. 2006 when I attended a wls seminar. I was so excited and ready for surgery. I found out what my insurance required and was so overwhelmed. So, I decided to try just one more time on my own. By January 2007, I knew that surgery was what I needed and wanted. My employer requires wls patients to complete a 12 week "SUCCEED" program and OF COURSE the next class didn't start until June!!! I have to admit that I actually liked the class and made some great friends too. I think the exercise trainer assigned to me thought I was a total flunky. I get tickled sometimes thinking about my weigh-ins and the same question of "what do you think is the problem Elizabeth? and I'm thinking.....yo skinny, you are clueless!!" Anyway, I finished the class on Aug. 28 and was ready for surgery!! I also had to lose 10% of my total body weight. I lost the 10% by Nov. 1 and yes, was ready for surgery! my surgeons office sent my paperwork to BCBS and was denied on Nov. 20th. My surgeons office staff turned into a nightmare!! They are the ones that should be on hidden camera. I was told that my surgeon would do a "peer to peer" review with BCBS medical director etc. They NEVER called me, so I started calling weekly by mid Dec. and I got every excuse from "someone else has your file", to "so and so takes care of that", we'll get back to you, blah blah blah. Finally, after my insistance, the peer to peer review was done, and denied on Dec. 28. I found out because I called....and called. Wow, I was devastated. So nice doesn't cut it. I got mad, then I got busy. My employer is "self funded" insurance, so I had the option to appeal directly to an appeal board at the hospital where I work. The HR person I spoke with recommended for me to do so, because she said it was my last option. I ALMOST didn't because I was tired and felt defeated. I also knew that I would hate myself in 6 months when I was struggling and had not tried. I put a packet together with supportive articles on morbid obesity, letter, dateline etc. and OMG it was approved on Mar 7, 2008!!! and yes, I was ready for surgery! Not so fast, it's now Mar 30 and I am waiting....AGAIN! But it's okay, because I know it's just a matter of time now. some red tape and "pre-determination, pre-authorization" stuff has to be done. I OF COURSE have changed who is doing my surgery. I am waiting for the call from my surgeon's office to confirm with BCBS and get my appointment date. One thing I've learned is that is you fight for something and do everything you can, whatever the outcome, you have no regrets. I have no regrets!!!
