Nicki104

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So, my surgeons office submitted my pre-auth. paperwork to UHC on July 5.  Today, I called UHC to check on the progress.  I was informed that they didn't have ANY pre-auth. paperwork!  I phoned the woman at my drs. office that handles submissions.  She looked at my file, had a copy of the completed transmission page from the fax, double checked the phone numbers with me, everything looked good on her side SO she offered to call UHC to figure things out.  45 minutes later she calls me back with the following information.
      When she called UHC on July 5th to get the fax number for submitting pre-auths.  she was given the correct fax number HOWEVER was NOT told that she needed a case number.
     Apparently, UHC policy is that if a pre-auth. comes in without a case number, the pre-auth. is automatically shredded!  Wouldn't you think the BUSINESS-LIKE thing to do would to be to call the number provided on the cover page of the fax and tell them that the submission is incomplete without the case number?  SO, I have been waiting 4 weeks for nothing because UHC SHREDDED my mother humping pre-auth. ten seconds after receiving it!
    Then, the insurance handler from my drs. office had to give them my mothers maiden name and my surgery date so she could NOW get a case number.  How are we supposed to know the surgery date when UHC has been jerking me around for over a year?  So, here I sit..... waiting....... again...... for UHC.

    My personal advice to EVERYONE is that if you are EVER offered insurance through UHC ---- RUN as fast as you can.  I never had any problems with other insurance companies.  UHC is like the slimiest version of all used car salesmen imaginable.

There is a part of me that wants to make it my life mission to drive UHC out of business!

Well, I just got the phone call from the surgeon's office.  They have officially submitted me for insurance pre-authorization today!  This was done once before and the insurance TOTALLY screwed me over for five months before giving me an empty approval.  This time, I am hoping this will go quick and easy.  I would LOVE to get an approval letter in 2 weeks but because I have dealt with UHC and their shananagans for the past year I know it will probably be more like 6 weeks.  Optimistically, I am hoping for an early September surg. date -- BUT I know where optimism has gotten me in the past.  My fingers are crossed! 

First, I recieved my letter from "the team" last week.  The only requirements on it were confirm insurance, attend another support group and have TSH checked prior to surgery.  Then, I had my SMA (shared medical appt.) today.and spoke with the PA handling my case.  I told him that I would be attending support group tomorrow.  He said that I should make sure to touch base with him at group so he remembers to submit my paperwork for insurance pre-auth.  I am SO excited,  Now, I know -- I HAVE been down this road before and what was supposed to be easy turned into a mess.  I know, based on that, I shouldn't get my hopes up.  But I can't help it!!!!  Dean Health has been exceptional, so super helpful, AMAZING!  I don't want to be mean to anyone but if I had known last year what I know now -- i would have chosed Dean instead of...... well..... the other Madison option. 
So, I am doing "the math" in my head.  If my paperwork is submitted to UHC by June 1 and they take 4 weeks to respond I will be looking at a possible surg. date MAYBE the beginning of August..... I can hope right.? 
Of course, if UHC behaves the way they have over the past year --- they won't respond until the end of July, with a denial and I won't have all the crap worked out until Thanksgiving! LOL   (I wish I were kidding) Seriously, UHC is a crapbag, rip-off, that tries to deny EVERYTHING so that they can make a quick buck!
ANYWAY, I digress ---- my fingers ARE CROSSED!

Today I finally recieved my approval letter from UHC -- it only took 2 appeals and 5 months!  It is also an approval for a surgeon that will only be covered until June 30th so I have to go through this process again with my NEW surgeon.  But somehow I still feel a pile of satisfaction in that I pushed and pushed and got the approval.  I would also assume that when the new surgeon submits for approval - it will float right through.  If it doesn't  - I now have another piece of paperwork to send back to them stating that I was already approved.  I feel good anyway.

Well, I called UHC on Tuesday to find out why they hadn't called me back like they said they would.  After talking to a "lovely lady" and quite frankly verbally abusing her a little bit - I asked to speak with her supervisor.  A lovely lady named Rochelle came on as "The Supervisor".   I again explained how long I have been waiting AND the fact that my coverage for UW would indeed come to a REAL end June 30th.  So, even if they pushed this whole thing through today, surgery probably wouldn't happen until sometime in June.  That would mean having to have follow-up with a different provider.  Call me crazy, but for the six months following a major surgery -- I would like to have followup visits with the actual surgeon that did the surgery.  Rochelle listened intently and told me that it seemed that my second appeal was "dropped" for no real reason by was re-activated on the 26th.  She said she would look into something and get back to me in a few hours.  I laughed at her and informed her that her staff say they will call me back but they never do.  ROCHELLE GAVE ME HER DIRECT LINE # !!!!!!!
Rocelle, did call me back at the end of the day stating that she was still working on this, had a couple emails "out there" waiting for replys and that she would get back in touch with me when she heard back on the emails.
Then, today - Rochelle called me AGAIN!  This time she informed me that she was working on getting approval for LONGER coverage for me with UW if I decided to have the surgery there.  She also had the appeals dept. put a "rush" on the decision. SO cool!  I also reviewed with her that I have already begun the process all over with Dean/St. Mary's and I might possibly be willing to have the surgery there IF they could push the approval process through for me.  She said she would advise the "TEAM" of that as well.  So, after 5 months it looks like there is some forward progress.
THEN, just as I thought I was having a good day - I got a call from Dean/St, Marys and they have recieved a copy of my case notes from the nutritionist at UW.  This means that I probably will NOT have to go through the whole 6 month supervised diet thing at Dean.  I will find out more when I go for my appts. this week (hopefully).
So many weeks of depressing, No NEWS crap.  I finally can have a little more upbeat outlook and I am thinking that there might a chance of having surgery (One way or the other) this summer.  Is it too much to think it might happen before the 4th of July?  LOL    I remember a point in time that I thought it might happen before CHRISTMAS of last year,  WOW talk about being totally screwed over by a health insurance provider! Oh well.... life goes on.

So, I have been patiently waiting for a response to my SECOND appeal from UHC since March 8.  Today, i finally lost all patience and called them.  The response was that they need 30 days to look into it.  I informed the "lovely" phone lady  (Karin) that I have actually already waited for nearly 60 days.  (She didn't seemed entertained by my logic.)  She put me on hold for the "required" 5 minutes only to come back on to inform me that she needed a little more time and finally came back on to get my phone number so that she can look into this and call me back TOMORROW!  WTF!!!!   If ANYONE  is considering UHC as an insurance provider or company health insurance administrator -- do not walk... RUN as far in the other direction as you can get!  This company sucks!!!!!   I have had nothing but trouble for over the past year with them.  UNITED HEALTHCARE IS HORRIBLE!!!!!

So, I have recieved the insurance companies response to my appeal.  They of course talked in such babble - I am still not 100% sure of what they are saying.  I THINK they are now saying that the reason they are not covering the procedure is because the surgeon I have selected is now NOT covered by the insurance BUT I think they are saying that the actual procedure IS covered.  (The convienently reviewed the request on Jan. 2nd.....  and I am quite certain this surgeon is supposed to be covered through June. )
I am contemplating, at this point, if I should just throw in the towel - as far as "fighting" to use the origional surgeon or if I should just switch to the surgeons that are now covered.  that would mean possibly not having surgery until summer --- or maybe even later.  to think that at one time I actually thought I might have the surgery by Christmas ---- and now I am looking at the 4th of July.
If I read the appeal response correctly, I should just be so greatful to have coverage for the surgery and stop feeling sorry for myself.  At least I can have the surgery (I think).
UGH!

I got a denial letter in the mail last week from my health insurance.  This is after I was told that "There isn't bariatric coverage" and then "Sorry, there is bariatric coverage" and now "no - we don't cover that".  I obviously appealed and sent copies of all the emails I have exchanged with UHC -- all stating that there is indeed coverage.  I am trying to remain strong but I am so sick of fighting the fight.  Why can't any of this go easy for me?  First, was getting this entire process started due to the insurance.  Then it was dealing with the NUT and now.....  I know this is what I want and I am not good with being told no.  But this WAITING is so awful.  i assumed when this all started last summer/ early fall --- I would have had my surgery by now.  Instead, the time keeps dragging on and I have absolutely NO control over any of it.  Please, LORD ---- help me out here!

So, I had my FOURTH visit with the NUT this week.  She FINALLY gave me her stamp of approval.  She will now go back to "the team" and tell them that I am ready for surgery, on Monday.  Then paperwork gets submitted to insurance!  Probably another 4-6 week wait for that.  THEN we can schedule the surgery.  What a long road.... lots of hoops... lots of reading and learning.  I pray that I use this tool, that I have worked so hard for, to the best of my ability EVERY day!  (Crossed fingers for quick reply & approval from insurance!)

I made it through Thanksgiving fairly well.  My last visit with the NUT, I was told to eat when I was at a 4 (on a scale of 1-10) and to stop when I got to a 7.  I may have gone to an 8 BUT I maintained that I was much more aware of my eatting - in comparison to other years.  I continue to assess (in my head-NOT out loud) how  my family functions revolve around food.  Last night I kept thinking that THIS IS IT!  My life WILL be so very very different next Thanksgiving.
On top of that, I did my annual Black Friday shopping trip today.  I was standing outside a store, waiting for it to open for an hour.  It was cold so everything seemed a bit more miserable - but again, I found myself going back to the fact that next Black Friday my knees won't ache, my back won't hurt and I will feel so much better about myself!
I can't wait until Monday.  I see the surgeon and will hopefully get a surgery date!