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Depressed/anxious

CherylA

630 views

I have so much going on right now and I am waiting on so many answers..... My paperwork has been turned in for the 2nd time because they needed more info before they could approve or deny. My 2nd insurance has approved and now we are just waiting on the primary......

 

Now here is the kicker...I need to have this surgery done before May, which is not a problem for my doctor, but we are waiting on the insurance company.

 

My husband and I are also waiting to find out about a job for him in Dubai. If he gets it which I am sure he has it he will be leaving in May! Same company he works for now, so he will have the same insurance. I just need his help with the kids while I recover!

 

There is just too much going on and we have to wait for too many answers! My body hurts from all the walking and weight lifting that I have been doing. The soreness does not help with my emotions at all. I feel like a huge ball of raw emotions and like I am going to cry at any time.

 

This is the first time in a while that I have logged in here because I have been trying not to think about it at all.



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I would talk to the person in the surgeons office that handles filing and communicating with the insurance company. Explain your situation just as you explained it here. Maybe they can somehow make you a priority whenever communication is slow. The week after my surgery I lounged around for a couple of days and took things easy but I ended up looking for things to reorganize and clean. It was surreal. Be strong and think positive. Is there anyone else that can possibly help you if your husband is out of town? Make a back up plan with them just in case your husband has to leave for Dubai. I would suggest make ahead meals that you can freeze for the kids. I don't know how old they are but even if you contact your circle of friends and family to make a back up plan for each day after your surgery, that could ease your mind. Other school moms to arrange transportation, etc. I think once you explore any possible opportunities that will take the worrying away and help you to see clearly that everything will be okay. If you live near me(Windber, Pa) I would be glad to help you!! Good luck! Keep us updated.

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Thank you, you are so kind. I live in Louisiana. I have talked to the nurse in my doc's office. She is wonderful and is trying her best to help me out! Most of my circle of family and friends work and the kids can take the bus to and from school. For me it is mainly just the wait of finding out that is driving me insane!

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I am pre-op, approved and waiting, chugging down liquid protein shakes. Can't offer much in the way of experience talking, but I wanted you to know that others are thinking of you and wanting this journey for you to be successful.

Think positive. How much easier it is going to be to walk, take care of the kids, and just move around in general. I can understand the tension. Have you tried the breathing techniques for relaxation? Have you been able to do anything just fun and relaxing for yourself? I took up knitting so that I would have something new to concentrate on, and that also keeps my hands busy.

You are in my thoughts, La mom!

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Where do you live in Louisiana. I live in Lafayette after living in New Orleans my entire life. Katrina pushed us here.

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My primary insurance resisted for a LONG time. Honey, do what I did. Take that bull by the balls. Call the Insurance Company and ask for either the Medical Director or their Nurse. These are the actual people who rubber stamp the approval. Don't hang up til you get them. If you hit a brick wall, tell them you expect a call back by 5 pm today or you will be contacting both your Congressman and the local news media outlet.

When you get the MD or their Nurse on the phone, tell them what you need done. Tell them, "i believe i have been patient enough waiting for your company to do your job on my surgical request. my secondary approved it long ago. In a perfect world, I would be able to schedule surgery as soon as I hang up this phone. But I know this isn't a perfect world. So, YOU tell ME when the authorization will be approved. I NEED this surgery no later than May XX." Pick the date that works best for you.

Don't say 'approved or denied.'. In your brain, denial IS NOT an option. Lay it out. Remind them of what THEIR rules are for approval. Go over each rule step-by-step confirming you have completed each task. Then, hold their feet to the fire on getting the approval in the next 24 hours.

It's quite simple. Its THEIR game. And, if YOU have played it by THEIR RULES, you WILL WIN because they HAVE to play by their rules, too.

Everyone where I work told me our insurance doesn't cover it. I got approval (cuz I can be a bit of a b***h... With documentation to support my bitchiness.) and had my surgery last Wednesday.

Don't be discouraged if you find you have to do Nutritional Counseling for 6 months or a year. Even if your husband is not there to help with the kids, YOU can line up the support you need. I am the caregiver to my severely disabled sister who is at home with me on life-support. If I can line up people to take care of her for a couple of weeks, ANYONE can. You just have to find the burning desire in your heart to demand doing something FOR YOU. In the long run, it's for them too. And, I believe your husband can still play a big role in the support you need even from halfway around the world. ((HUGS)) to you. Please stay in touch. I am here to help you find the words you need.

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I live in Anacoco and that is about 5 hours from New Orleans. There is one that I have not met and that is to loose 10% of my body weight. I have heard that they will approve even without that one being met. Thank you all for the prayers and the thoughts. It means so much knowing that I can come here and have a support group any time! You guys are amazing!

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My prayers are with you during this very stressful time for you. you could start caling your insurance co every few days. Some one on this site had recommended that to me when I had a crunch time date due to my work. It did help. Always talk to them with the utmost respect. Use a lot of please and thank yous....even explain the situation. Use their names while you talk. and.....follow up with another call. When you do get the approval, ask them to fax it to your surgeons office instead of mailing it. Good luck!

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Oh, I agree with cbd that you get more with honey than with vinegar (my grandma used to say), however, I have also experienced being LIED to by the insurance company repeatedly in the beginning of this quest. When I got them to FINALLY admit that - under certain circumstances they will cover it, I asked for a printed out list of guidelines to follow. For example,

100+ lbs overweight

80+ lbs overweight with 2 or more qualifying medical conditions that will improve or be eliminated through this surgery

And then the rules I must follow to get it all approved, such as,

6 months Nutritional Counseling

Maintain a food journal

Psych Evaluation by a Psychiatrist, etc .....

They refused to give me anything in writing to use as a checklist to make sure I did everything ACCORDING TO THEIR RULES.

It's at this point that being nice, saying ma'am, and thank you are NOT enough. They have been trained to NOT be cooperative with the 'nice' people. They figure if they resist enough, the nice ones will give up and stop calling.

I documented every call, email, etc. After 2 months, I called again, and was told they had no record I had ever contacted them on this subject - EVER. When I sent my DETAILED documentation of every contact made, including their name, date, and time of contact, they FINALLY started cooperating with me.

If you can get there with kindness, GREAT! But, make it clear that they shouldn't confuse a kindness with weakness.

Good luck!

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