sassyfrass23

I'm just wondering here if when they told you a 6 month wait for surgery, they were not stating it from all the pre-op stuff required. So basically, you have to have 6 NUT appts, and you can only do 1 a month for 6 months. During that time you also need a Psych eval. Once you have satisfied all the requirements, then your application or file is submitted to insurance for final approval. From there you get scheduled for surgery.

I have BC/BS, and my requirements were 6 NUT visits, 1 per month, a psych eval, 2-3 appts with a Nurse Practioner or D.O. I just finished a 4 week group support for binge eating (part of psych visit). I have final psych visit in a couple weeks. I have my last NUT appt in a couple weeks. I've completed the Nurse/D.O. appointments. So, by end of February I should be submitted for final approval from the insurance. If approved, then I'm scheduled by surgeons office.

I'm just wondering if this is nothing more than a misunderstanding of the wording by the insurance. It makes no sense to have to wait 6 months after final approval is received.

BTW, I work with insurance companies all the time. They can be quite confusing.

Honestly...I thought the same as you. That they were confusing the 6 month delay with the 6 month monitored weight loss. I'm still praying that this is the case. I had most of the same requirements as you and have completed ALL with additional requirements from my surgeon. My papers should be submitted at the beginning of next week!! Which is why this is such a bummer. To be so close...and possibly not be so close afterall is gut wrenching. I've managed to keep myself preoccupied this weekend. I am dying for Monday to get here so I can reach my surgeon's office and hear what Tonya learned yesterday. Please send all prayers/thoughts/vibes my way in hopes of this being nothing but a misunderstanding

And yes- insurance is INCREDIBLY confusing. I work in I.T for Healthcare...I wouldn't trade that to work directly with insurance if my life depended on it.

@@Cape Crooner I respect what you say and wish more men were like you. More in touch with their feelings, perhaps? But I will say this...if someone blatantly tells their S.O that they are embarrassed of their appearance or do not want a "fat" spouse..that's emotional abuse. If he's coming from the point of....I want a HEALTHY wife but chose the incorrect words...that's understandable. But if he is only concerned about how she looks and what others may think of her appearance, that's a whole different ball game.

My ex, we'll refer to him as "A"- when we began dating I was fit! Not just skinny. I'm talking, decent abs, muscular legs...i played soccer and it was obvious by my physique. "A" left for the air force & I battled with a few "demons" if you will...anxiety & depression being the biggest culprit and put on a few pounds. I was still at a healthy weight, just not as cut like HE preferred. When I went to visit him, he refused to take me on base to meet his friends. Or have them over for a cookout and beach volleyball. I finally convinced him to tell me why he was so opposed to the idea. Wanna hear what his response was?

Something along the lines of.... "I have a picture in my room of you in your bathing suit from when we first started dating. I don't know how I will explain to them how you went from that.....to this."

I didn't get flowers, candy, stuffed animals, etc in my care packages from him. I got hydroxicut. Freakin diet pills.

I honestly do try to give ppl the benefit of the doubt, but what she has shared sounds all too familiar to what I experienced. And if he is coming from the same point as "A"....then he does not mean well. He is inconvenienced by her looks and the lack of "trophy wife" material that he expects. That's abuse. Plain and simple.

I don't think I made myself clear. I'm suggesting two thoughts to the OP:

1. You're clearly fragile and he didn't say the things you needed to hear. I'm suggesting that what he actually said/meant might have been different than what you heard. No one knows this but you (certainly not a bunch of strangers on this forum).

I've been married 37 years and my wife hears me say things all the time that I don't think I said and certainly didn't intend to convey.

2. Clearly, you don't like what you're hearing him say. Have you told him loud and clear that? Have you told him what you need from him to help you get through this? Women her nuances that guys can't. Guys are thick in this area and need to be set straight.

Obviously, if you're certain that he spoke those words and meant to be hurtful and you told him as much and he doesn't give a ****, you need to move on.

I'm just saying be sure first...

How is he otherwise?

Thank you for wanting to be objective. I have told him every way I can...STOP IT! In his mind he thinks he's helping me. He also said he is frustrated that I am not the weight I was just 3 years ago when I met him, and I eat (candy, Cookies, bread) while I've been preparing for this surgery.

Unlike many others I had to gain 7 lbs to have surgery. And guess what? I have been enjoying EVERY second of it. I have been on some diet, some plan, over-excercizing and battling not eating "bad food". It has been great to eat what I want. Some people may say that means I'm not ready for this surgery....I think it means I am totally ready for this surgery...because I need it. I have gone up and down all my life. My husband thinks I "cheated the system by gaining the weight...and he feels I should have been eating all healthy these last 9 months. The problem with that is I had to stay at a certain weight to be approved. No gaining..no losing...and I did everything I had to...to be approved.

I do understand his frustration. I don't look like I did. I'm also 42, been going through peri-menapaus, and have chronic pain and health issues. And now have been thrown into surgical menopause. Sorry this may TMI...but..I'm trying to paint you a picture.

My husband other than being mean and critical about my weight...is funny, hardworking, responsible, handsome, committed to his ministry, a great friend, a good Dad (to my step-daugter), and can be loving towards me. He simply doesn't want a fat wife.

He strongly apposes surgery, and told me today...that I will just gain the weight back, and stretch my stomach back out. I hope that doesn't happen.

I'm having the surgery. That is not negotiable.

So...there you have it.

Sure- anyone can gain the weight back. We all know this going into surgery. But- your mind is made up and I believe you will be successful. No matter who's doubting you. You've got me in your corner, rooting you on!! So...you can show him better than you can tell him. And no one knows who is truly ready for this surgery. Only you know. And that's all that matters. I will keep you in my prayers and pray that God will soften your husband's heart while helping you remain steadfast in your journey. As a wife. And as a WLS patient. You've got this

@@Missy407 that's horrible! If I were 3 days away from surgery and experienced that, I would have had a complete melt down. I'm so glad it all worked out for you in the end though! The thought of delaying my surgery for another 6 months sucks but IS doable. My husband and I have been trying to conceive for 8 years. Which is part of the reason I have decided to embark on the WLS journey. I'm nearing 28, so when I do the math...I'll be 30 when/if my first child is born since I plan to wait at least 18 months before getting pregnant after RNY. I prefer not to have children into my later thirties or early forties...so my biological clock is ticking extra loud at this point. I originally wanted 3 children and would have preferred a 3 year gap between each like it was for me and my brothers. But now I'm forced to reevaluate the entire situation and reconsider my plans and how logical they are now.

Thank you so much @@jantra12 !

In the past year, I have learned to let go of a good many friendships. I've learned that it's okay for me to let go of toxic people. If someone doesn't treat you or your friendship with the same values and respect, you no longer have to entertain that relationship. You're entitled to your feelings after all you've done for her. Just out of curiosity, have you considered talking to M about your feelings on the matter?

@ your last two sentences made me giggle!

I never gave this much thought (pre-op stage). But now that it's been brought to my attention....I believe I'll have to find out what is expected of me. I do know that I won't have a cath.

I hate to hear yours was denied @@jantra12 ! But so glad you can still go through with it.

Unfortunately- self pay for the bypass is not an option for me. $70,000 - $80,000 is just not a realistic expense for me

Is it possible UHC updated its Bariatric policy on January 1st?

I don't think so. All of this came about when I began the process in 2015 :\

Hands have been tied up to prevent any cheating, @@Djmohr !! And trust me...it's taking everything I have not to cry. I'll hold the tears back until Monday. They'll either be happy or sad tears...

Here's a question for everyone:

I had my policy printout that my surgeon's office pulled when they verified my insurance on day 1. I just reread it and never found the statement about 6 additional months of waiting or the prior auth requiring 6 months.

So- how can they have my policy worded one way for me or any of us (patients) to see, but have special stipulations on their side that we're unaware of? I would think UHC would list everything out in the open and have it all written in black and white...even if it was "small text." This just sounds sneaky to me. And my obsessive/control freak side is in full swing. I have got to chill.

That's how I perceived it, @@Danita !

When I mentioned that to Tonya, she said that they never submitted before a patient had completed ALL requirements and basically proven to Dr. Nguyen that they were serious about the lifestyle changes that this surgery entails.

So...Tonya called this afternoon, but thanks to my crappy service at home, my phone didn't ring and she left me a fairly vague VM. All she said was that she spent quite a bit of time investigating this this morning and consulted with her administrator. She asked me to call her back on Monday so she could tell me what SHE (yes....she emphasized "I" when she said that last sentence...not that it may mean anything) found out.

When I spoke with UHC last night, they did say that my doctor could submit a request to escalate my status to urgent to possibly override the additional 6 month wait. But, I don't have any present "life-threatening" or critical issues that I could see him arguing to get that approved. However, if I really am required to wait 6 more months, I feel like although it was an honest mistake, it was still their mistake. And they should try whatever they can to help get this expedited. I tried to bring attention to this in the very beginning and because Tonya had never heard of it before, she thought the reps who relayed the information to me were wrong and basically said not to worry about it. So here we are 6 months later and she's finally investigating.

Grrr!!

I've always enjoyed my weekends...who doesn't? But I guess I will be eagerly awaiting this weekend to pass so I can call her first thing Monday.

Tonya called back and I shared the information with her! She was just as confused/appalled as I was. So, she said she was going to look over my policy again and then call UHC to discuss it further with them. I'm dying for her to call back and tell me that it was all a big misunderstanding. Preferably before they close today Fingers crossed!!

I'm 27 and have received a couple of comments about my age. But my surgeon hit the nail on the head and gave me the assurance I needed:

He prefers patients young. Why? Because when they lay us on those tables, our complication rates are much lower. Our risk is lower. Our secondary or comorbidity issues typically aren't as critical as a patient who is much older with more health problems that have occurred as they aged.

Like James mentioned, we yo yo diet. I have done that for a good solid 8ish years. And each time I gain the weight back, I gain a few more pounds. It adds up over time. If you're fairly healthy and mentally prepared for this, then I say go for it! That way you're not sitting here 7 years later like I am, thinking about all of the opportunities I've missed due to my weight. If I could go back to 20 and do this, I would in a heartbeat. I've lost 8 years of my life that I can never get back.

Yes ma'am! The UHC rep even tried to walk me through step by step but our screens were totally different, which was no surprise. After the call ended I continued to look but had no luck.

Hey, @@Pinkgirl1234 and @@Inner Surfer Girl !

I know that my coordinator at the surgeon's office will definitely need to be involved in this. I just called and left her a voicemail to get back with me ASAP. However- if there is one thing I have learned during my research on Bariatric surgery, it's this:

1- The patient is ultimately responsible for knowing and understanding their benefits and coverage.

2- Surgeon's offices have made a multitude of mistakes leaving the patient with large amounts of monies owed

I do not want to be the patient stuck with a $70,000 bill because we didn't follow the guidelines set by my policy. I'm done calling insurance after last night as I feel that I have received enough information to pass along to my coordinator to investigate. Although- I would like to call back to get a copy of the guidelines they continue to read to me but I have yet to locate. Hopefully Tonya (coordinator) will be able to get that information today. Hopefully..

That is so odd ! I can't wait to hear wheat the surgeons office says tomorrow

Me too!!! I am praying that I've freaked out over absolutely nothing and March is still a possibility. I'll definitely update as soon as I know more!

Oh...and just to help you all better understand. This is exactly how they all read the requirements to me:

1- Patient must have a BMI of 40 or 35-39.9 with one comorbidity such as diabetes or sleep apnea.

2- Patient must complete 6 months of motivated weight loss attempt that is supervised by a physician or licensed nutritionist

3- Patient must complete a psyche exam

After all of that, they then go on to read:

Please remember, prior authorizations must be received 6 months prior to surgery.

Some of my words may be off, but that is almost word for word what they all say/read to me EVERY time I call.

Yes, @@SHOTzY* !! You're all invited to this party! I promise to have lots of Protein and Water for all to enjoy

Thank you for sympathizing with me and my current emotional state! I don't want everyone to pity me, but it's nice to be reassured that what I'm feeling, how badly I am disappointed, is normal and rational. And thank you for acknowledging my self-control. It took everything I had not to hop in my car and run to the store for a sugar fix. I'm so grateful to have a place like this to come to and vent my feelings. My husband is a great supporter and has been on board from day one. But bless his heart...he's just so easy-going that when I presented this tragedy this evening, he brushed it off like it wasn't that big of a deal when it was the end of the world for me at that very moment!! lol

Thanks, @@Nurse_Lenora and @@James Marusek !

I.....being the persistent individual I am, called my insurance company back after posting the statement above and spoke with a different rep. She only created more confusion. She first said that the prior authorization should have been sent in at my initial visit. I had already asked my surgeon's office about that and they said no, that it was pointless since I would automatically be denied without having my other requirements met. So this lady from UHC was basically saying it was my surgeon's office's fault for not submitting sooner. The call ended up lasting roughly around an hour. I asked to have the information she was seeing on her screen emailed to me since I have yet to locate that exact verbiage on the website under my policy. She couldn't get it emailed to me and because it was so late and her supervisor had already left. So I'll be calling back for that tomorrow. I'll also be calling my surgeon's office like I originally stated to have Tonya look into this. Like James said, I need to let them chase this down. I'm somewhat in higher spirits, but still a bit discouraged. I originally thought I only had to worry about being denied or approved at this point, but now this.

Time to practice some patience which I so incredibly suck at!!

I posted this awhile back and later felt that the issue had resolved itself and wasn't what I thought it to be. Looks like I may have been wrong.

So here goes..

I've received conflicting answers from UHC regarding my requirements. There are the typical; BMI, 6 month supervised diet and psych eval. All of which I have completed and my file is in the process of being submitted. I'm this close!!! And boom....I hit a big @ss brick wall that has knocked me off my feet this afternoon.

I called insurance to see if they'd received my file. While on the phone we discussed my requirements, etc. The rep then mentioned receiving authorization 6 months PRIOR to surgery. Curious of his answer, I asked him to convey his perception of that statement. Which he did, and I did not like. I then asked him that IF I were to be approved, let's say next Wednesday, does that mean I have to wait an ADDITIONAL 6 months before I can actually have surgery? So, like...August??? His response was yes. This whole scenario makes absolutely no sense to me. Why? Why make a patient bust their rump for 6 months to prove that they CAN follow guidelines set by their provider/nut but receive little to no result? Why have a patient see a psychiatrist, get the go ahead and then wait an additional 6 months? I'm not saying it will, but there is a lot that can happen in a 6 month period. I can honestly say that when my father passed away in 2012, I would not have been emotionally stable if you will, to follow protocol after surgery.

Up until today, I have been under the impression/hopes of having surgery in early March. I have put in my time and done what has been asked of me. And this news has rocked my world. No it's not the worst case scenario. Yes, I can put on my big girl panties and wait the required time. Yes I am even lucky for the fact that my insurance actually covers this. But I simply do not want to. And that is okay. Please do not ridicule me for being upset over this. I guarantee most of you would be just as disappointed if you were almost there and had the carpet ripped right out from under you.

And yes- when I first started this process I did inform my benefits coordinator at the office of what I was told. She said it did not sound correct and she thought the rep had misunderstood what they were reading to me. I spoke with another rep a couple of months later, and she told me that I did NOT have to wait 6 months. However, I will be calling my coordinator tomorrow to request that she call UHC and discuss this with them. When she initially called to verify my benefits, they never mentioned this to her either.

I'm just having a pity party, okay? And in an effort to avoid a bad habit I have almost broken...I am trying not to resort to emotional eating. I just want a big friggin donut right now!!!!!! Maybe a cupcake too..

@@Cape Crooner I respect what you say and wish more men were like you. More in touch with their feelings, perhaps? But I will say this...if someone blatantly tells their S.O that they are embarrassed of their appearance or do not want a "fat" spouse..that's emotional abuse. If he's coming from the point of....I want a HEALTHY wife but chose the incorrect words...that's understandable. But if he is only concerned about how she looks and what others may think of her appearance, that's a whole different ball game.

My ex, we'll refer to him as "A"- when we began dating I was fit! Not just skinny. I'm talking, decent abs, muscular legs...i played soccer and it was obvious by my physique. "A" left for the air force & I battled with a few "demons" if you will...anxiety & depression being the biggest culprit and put on a few pounds. I was still at a healthy weight, just not as cut like HE preferred. When I went to visit him, he refused to take me on base to meet his friends. Or have them over for a cookout and beach volleyball. I finally convinced him to tell me why he was so opposed to the idea. Wanna hear what his response was?

Something along the lines of.... "I have a picture in my room of you in your bathing suit from when we first started dating. I don't know how I will explain to them how you went from that.....to this."

I didn't get flowers, candy, stuffed animals, etc in my care packages from him. I got hydroxicut. Freakin diet pills.

I honestly do try to give ppl the benefit of the doubt, but what she has shared sounds all too familiar to what I experienced. And if he is coming from the same point as "A"....then he does not mean well. He is inconvenienced by her looks and the lack of "trophy wife" material that he expects. That's abuse. Plain and simple.

All I ask is that you let every negative thing he says go thru one ear & out the other. Please don't let him get to you. Small minded people aren't worth beating ourselves up over. You're better than that and deserve only love & encouragement.

Ohhh @@Bluesky1 ! His behavior is far from what I would expect my preacher to exemplify. Or my husband. Or best friend. Granted- we're all human and we make mistakes. We hurt each others feelings at some point, but this is overboard. I went through a similar situation with my ex boyfriend for 2 & 1/2 years. That was nearly 10 hears ago and I am still cleaning up the mess I became after enduring the most brutal and demeaning behavior I have ever encountered. I am now happily married and have a husband who has loved me at my smallest and now my largest. And I have promised myself that I will never ALLOW another individual to treat me the way I let Jackass do for so long. We may not be able to control other people, but we can control the boundaries we set and whether we choose to accept what is or do something about it.

I hate to hear that you are stuck with this jackwagon. If there were ANY ways for you to get out, I would strongly encourage you to do so. I am a FIRM believer in the saying "If you can't accept me at my worst, you don't deserve me at my best."

Once you lose weight and begin to fit the mold that he expects from you, I can almost guarantee that he will find something new to chastise you about. This isn't about you or your appearance. This is about a man who deliberately goes out of his way to belittle a woman in order to make himself feel superior.

My heart truly hurts for you...

OH! And....tell him that according to The Book he preaches from, his obedience as a Christian is a joke. Pretty sure it touches base on not judging...treating each others with kindness...loving one another?

Thank you! Thank you! I'm having to remind myself to relax and let it be. If they deny...I can appeal. But I will cross that bridge IF I get to it. No need in worrying over something that may never take place. Hopefully the next time I'm posting a new topic...I'll be sharing my surgery date! Which I hope to be in early March..will work out perfectly with work!

Thank you @@Inner Surfer Girl !

I didn't feel like I was ever going to get to this point so I'm tickled PINK!

Had my final visit with my surgeon today! I've met all insurance requirements along with his requirements. I've lost some weight and dropped myself to a BMI of 40. He said that I have proven I'm serious about this surgery and what it will entail post op so he's given the office the go ahead to submit my file to insurance.

From what I've read with most UHC folks, they don't take too long to respond. Either way....this little lady is going to have a fun time keep herself preoccupied until we receive an answer! I cannot believe I'm this much closer!!!!

My final appointment was last Wednesday but had to be rescheduled to this Wednesday due to inclement weather. Boo!! So I am only a few days away from the last appointment I've been working towards with my surgeon. I completed my 6 months in December. And had my GB ultrasound and EGD earlier this month.

I'm curious as to about how long it took your office to submit your paperwork to insurance once all requirements were met?

I've been anxious this entire process (as most of us have been) and now I'm almost done. I'm just ready for an answer at this point. Will I have surgery? Yes or no. While the time was necessary in preparing me for surgery....the number of appointments has become exhausting. Especially with over an hour round trip each time. I hope one of you are reserving a seat for me on the loser 's bench!