So Worried

[Bryn Dawson 9]

So I have a surgery date scheduled, July 12th.

This morning, my surgeon's office calls me - they were getting ready to submit my file for insurance approval and my insurance told them about some program where I am supposed to call into the insurance and have phone coaching at least 5 times with each call being 2 weeks apart. This was NOT mentioned to ME when I called my insurance way back in January, nor was it mentioned to my insurance coordinator when SHE called in January AND in the months following to make sure we were on track!

So now I have to see if my insurance will back down on this requirement (ha! Because they're known to be SOO flexible, those insurance people) or lose my surgery date because they're going to deny me until I complete this stupid requirement. All it apparently is is a bunch of calls to a nutritionist to discuss the importance of following the pre- and post-op diets and exercise plans - which I have ALREADY BEEN DOING for the last 6 months with the surgeon's office!

ARGH! I'm so mad and frustrated and upset I could spit! I've already been in tears a couple times today and I'm sure there's more on the way. The insurance is supposed to call me back tonight to see if they have come up with a better next step, so at least they are considering it.

I really, really hope my date doesn't get pushed back because of this!

[carrierae 0]

What insurance co. ? If this is a new thing I want to be sure to know if it is mine so I am on top of it.

Thank!

[Bryn Dawson 9]

HealthPartners insurance.

[Wheetsin 714]

I would call and ask them when the phone calls were implemented as requirements for the procedure.

It probably won't matter that much since requirements are usually defined by what's in place on your date of approval (I've _heard_ of companies that enforce requirements based on dates of procedure, but have never encountered it, and I'm not completely sure it would be legal), and you aren't approved yet. But if it is a change since they relayed you the initial requirements, which did not include the phone calls, then you at least have grounds to file an appeal (sounds like you already have a few, but more will only help).

Are the phone calls listed in your SPD as a requirement? That, too, will help. "Someone on the phone told me..." isn't going to hold much Water IF the requirements ARE in the SPD, but if they aren't -- there you go.

(Used to work in the insurance industry - insurance companies really aren't the evil most people think they are. You just need to have the right data.)

[KellyL 173]

That would make me so mad too!! Keeping my fingers crossed that you get to keep your surgery date!

[KellyL 173]

That would make me so mad too!! Keeping my fingers crossed that you get to keep your surgery date!

[Bryn Dawson 9]

@Wheetsin - What's an SPD?

I've called the Member Services group several times and mentioned that I'm having bariatric surgery, and I've logged into the website several times, AND my insurance coordinator at the surgeon's office has called them also but neither of us found this requirement in January, so I am guessing it was newly-entered. However, the policy SAYS it's been in place since January of 2007. Grr.

[Bryn Dawson 9]

Update:

The insurance office was supposed to call me back yesterday night, but didn't. When I called them, they refused to give me to the person I had been working with and told me that it had only been a few hours and I needed to wait longer to be contacted back.

*sigh*

My pre-op is scheduled for Monday. I guess I'll keep the appointment just in case, but at this point I'm pretty sure I'm going to have to go through the preop stuff all over again. Which means another chest x-ray, another history and physical, MORE bloodwork...

I'm praying that they don't have to push my surgery date back. But this waiting and waiting is really frustrating.

[myrori 55]

ahhh, yes another game. I had this woman call me to tell me that I had to talk to her throgh out as per my insurance. She never mentioned being billed, it all presented as " part of plan" and then when I felt I no longer needed her "coaching" CABLAM! a years worth of phone calls billed! And yes it was set up by the very insurance that pays for it!

Play the game, talk sweet and take no more than the 5 required calls.

[Bryn Dawson 9]

Update:

It now looks like I am going to hopefully be able to keep my July 12th surgery date after all. They said that as long as I am enrolled in the phone coaching program, that non completion won't have an impact on whether I am approved or denied.

So now I am back to where I was - still awaiting approval but on-track and with no known hurdles in the path.

Yay!

[mnbsleeve 87]

Oh Bryn, I'm so glad things are back on track for you!!! How frustrating. It can be such a roller coaster ride. I will keep my fingers crossed for you that the rest is smooth sailing. Best of luck on you pre-op apt.

Update:

It now looks like I am going to hopefully be able to keep my July 12th surgery date after all. They said that as long as I am enrolled in the phone coaching program, that non completion won't have an impact on whether I am approved or denied.

So now I am back to where I was - still awaiting approval but on-track and with no known hurdles in the path.

Yay!

[Bryn Dawson 9]

Thanks for your support, mnbsleeve and everyone else.

[wondering1 103]

Bryn,

I'm so glad to hear your situation has turned around. I was off the grid for a couple of days or you would've heard from me sooner. I know you have all your pre-op stuff on Monday so I'll be thinking of you. I have my psyche exam on Monday and my Fitness Evaluation. Then Monday night I have a sleep study. Ugh. So now you know someone will be going through crap the same day as you

Please keep us posted. I KNOW you'll have surgery on 7/12. I feel it in my bones.

[Bryn Dawson 9]

Thank you, Debbie - I appreciate it! *hugs*

[mythreechildren2001 7]

My surgery is scheduled for the 12th as well. I hope things stay on track for you!!