Tried to get approval for a year; finally have a date!

jdub81 · September 2, 2013

This has been a long, arduous road for me. I initially went to Beverly Hills Physicians for an informational meeting on the lap band in June 2012. I met with the doctor after the info session and he recommended the vertical sleeve for me. The staff then submitted my info to my insurance for pre-approval (Aetna). About a week later, I received a call that the surgery was pre-approved and they scheduled the upper GI EGD test which I had done in July 2012. I had to do 6 month nutrition, a sleep study, and of course the psych eval. I completed all of my requirements in November 2012.

I contacted Beverly Hills Physicians in December to see if they submitted my file for final approval and was told that they were missing something from the sleep study doctor, then it was that they were missing something from the surgery doctor. I finally made an appointment in January and they still did not have everything they needed. I kept calling every couple of weeks in February, March, April, and May...no progress.

While my husband and I were in Savannah for vacation in June 2013, I sent a text to the coordinator I had been in contact with asking for an update. To my complete surprise, she told me that the insurance company had approved the doctor to perform the surgery, but not their facility as it was out of network. I asked her some questions to ultimately discover that she knew in June 2012 that they were not in network or approved to do my surgery, but was jerking me along to try to eventually get approval for their surgery center! Seven months totally wasted! I was infuriated! She never told me that they were out of network or I would have gone elsewhere!

Long story short, I ended up going through the surgery doctor's office directly (dr. Feiz) and as of last week, I have been approved for surgery! Oh, what a relief. It was turning into a nightmare. I started feeling hopeless and depressed. Now I feel excited and hopeful again.

However, I do have to do the EGD test again!! because it was done too long ago! That will be done September 25. My surgery is scheduled for November 21.

I recently changed jobs so I have no vacation time accrued so I had to have the surgery near a holiday! My birthday is 2 weeks later, but I've heard there is a tasty birthday cake flavored Protein Shake.

I haven't told anyone, other than my husband and mom, that I am having the surgery....anyone want to exchange emails or meet up for support? I'm 31 yrs old, live in Ventura County, CA, lawyer, female.

ArnoldS · September 2, 2013

" To my complete surprise, she told me that the insurance company had approved the doctor to perform the surgery, but not their facility as it was out of network"

(I don't know how to do the quotes.) However, I knew before I even read that section that was going on.

I hope that my story turns out as successful as yours. I had my initial psych eval. Even though it's early and she didn't say anything to my face, I felt she wasn't very happy w me. I'll have a final one coming up. So, I'm following the program to the best of my ability. The surgeon's office set my date for Nov. 14.