AAARRRGGGHHH! I hate insurance! BCBS of AL

[sknyinside 99]

Long, ranting post to follow:

Since March, I have been jumping through insurance hoops. Have done anything and everything necessary to get this done. Have made sure my nutritionist visits and MD visits were spaced just so... Finally, after having GI clearance complete with EGD and all the other stuff, my surgeon's office has everything ready to submit to insurance. Everything submitted and the waiting begins.

A little back story here: We have had our current insurance for 15 years. 15 years. My husband has had to make a job change after being with his current employer, for - yep, you got it - 15 years. The change could not wait another month or two. Opportunity came knocking and it waits for no one.

So, were hoping since the insurance deductible has been met for this year, that I might be able to have the surgery done before his long-term job were to end and along with it the deductible-met insurance. That would have been convenient. I am already out around $2000 for all of the co-pays and deductibles. Would still have 20% of the charges to pay for. Not a small chunk of change. In order for this to occur, I would have to have my surgery done before October ends. A tight deadline but certainly not unrealistic. Everything was submitted to the insurance company by October 7th. All we needed was approval, and then to have the surgery scheduled.

The surgeons office said that everything looked really good. They had some dealings with this insurance company. With my comorbidities, even with my roughly 38 BMI, it is obvious that my body is not tolerating this weight well and medical necessity looks promising.

Of course, the insurance company took much longer than the standard 7 to 10 days. It is my understanding, that most people are trying to get their surgeries done before the end of the year due to deductibles creating a bit of a backlog. Still, I should be able to have my surgery done before the end of the month.

Then I find out, horror of horrors, I have been denied! Why? My sleep study which is a new titration, as I have been using a cpap since 2006, states moderate to severe sleep apnea. The sleep study from 2006 states severe. The one from this year shows that an increase in pressure was needed to keep my Apnea at bay. But because of the wording, it is deemed that my comorbidities are not severe enough.

Okkaaaayyyy. So now, after all the wait, the hoops, the expense, all of it, insurance will NOT pay. There is no appeal here, no re-submission. And I forgot to mention, that the insurance we are going to be under effective November 1, does not cover bariatric surgeries at all!

I could absolutely scream, cry and pull my hair out all at the same time!

Okay. End rant.

Thanks for listening/reading.

Edited October 31, 2013 by sknyinside

[mazzers120 75]

Long' date=' ranting post to follow:

Since March, I have been jumping through insurance hoops. Have done anything and everything necessary to get this done. Have made sure my nutritionist visits and MD visits were spaced just so... Finally, after having GI clearance complete with EGD and all the other stuff, my surgeon's office has everything ready to submit to insurance. Everything submitted and the waiting begins.

A little back story here: We have had our current insurance for 15 years. 15 years. My husband has had to make a job change after being with his current employer, for - yep, you got it - 15 years. The change could not wait another month or two. Opportunity came knocking and it waits for no one.

So, were hoping since the insurance deductible has been met for this year, that I might be able to have the surgery done before his long-term job were to end and along with it the deductible-met insurance. That would have been convenient. I am already out around 2000 for all of the co-pays and deductibles. Would still have 20% of the charges to pay for. Not a small chunk of change. In order for this to occur, I would have to have my surgery done before October ends. A tight deadline but certainly not unrealistic. Everything was submitted to the insurance company by October 7th. All we needed was approval, and then to have the surgery scheduled.

The surgeons office said that everything looked really good. They had some dealings with this insurance company. With my comorbidities, even with my roughly 38 BMI, it is obvious that my body is not tolerating this weight well and medical necessity looks promising.

Of course, the insurance company took much longer than the standard 7 to 10 days. It is my understanding, that most people are trying to get their surgeries done before the end of the year due to deductibles creating a bit of a backlog. Still, I should be able to have my surgery done before the end of the month.

Then I find out, horror of horrors, I have been denied! Why? My sleep study which is a new titration, as I have been using a cpap since 2006, states moderate to severe sleep apnea. The sleep study from 2006 states severe. The one from this year shows that an increase in pressure was needed to keep my Apnea at bay. But because of the wording, it is deemed that my comorbidities are not severe enough.

Okkaaaayyyy. So now, after all the wait, the hoops, the expense, all of it, insurance will NOT pay. There is no appeal here, no re-submission. And I forgot to mention, that the insurance we are going to be under effective November 1, does not cover bariatric surgeries at all!

I could absolutely scream, cry and pull my hair out all at the same time!

Okay. End rant.

Thanks for listening/reading.[/quote']

I'm sorry I'm dealing with denial too, it sucks

[sknyinside 99]

Yeah, it does. And the most frustrating thing, I think,is I now have no recourse. There is no possible way that it will now be covered by insurance. So it's cash pay or nothing. Had I been denied 7 months ago, when I started this journey, it likely wouldn't be quite so bitter.

I hope all goes well with you and you are able to appeal or to provide the information you need to have it done. I feel better having vented a bit. Thank you.

[mazzers120 75]

Yeah' date=' it does. And the most frustrating thing, I think,is I now have no recourse. There is no possible way that it will now be covered by insurance. So it's cash pay or nothing. Had I been denied 7 months ago, when I started this journey, it likely wouldn't be quite so bitter.

I hope all goes well with you and you are able to appeal or to provide the information you need to have it done. I feel better having vented a bit. Thank you.[/quote']

I'm gonna look into Mexico

[sknyinside 99]

Wow, have talked about it with my husband. He said he's a little uncomfortable with it. I'll keep researching and try to decide what to do. He's ready to just cash pay here in the States, but I don't want to go into debt for this. May just save up for a while and try to have it done. Am concerned though that delaying it is so not a good idea. Willl have to wait and see for a while. So disheartening. Good luck to you. Let me/us know what you decide and how it goes. I've definitely not ruled Mexico out.

[mazzers120 75]

Wow' date=' have talked about it with my husband. He said he's a little uncomfortable with it. I'll keep researching and try to decide what to do. He's ready to just cash pay here in the States, but I don't want to go into debt for this. May just save up for a while and try to have it done. Am concerned though that delaying it is so not a good idea. Willl have to wait and see for a while. So disheartening. Good luck to you. Let me/us know what you decide and how it goes. I've definitely not ruled Mexico out.[/quote']

Yep I hate the waiting game. I'll keep u posted

[jgibb 1]

Long' date=' ranting post to follow:

Since March, I have been jumping through insurance hoops. Have done anything and everything necessary to get this done. Have made sure my nutritionist visits and MD visits were spaced just so... Finally, after having GI clearance complete with EGD and all the other stuff, my surgeon's office has everything ready to submit to insurance. Everything submitted and the waiting begins.

A little back story here: We have had our current insurance for 15 years. 15 years. My husband has had to make a job change after being with his current employer, for - yep, you got it - 15 years. The change could not wait another month or two. Opportunity came knocking and it waits for no one.

So, were hoping since the insurance deductible has been met for this year, that I might be able to have the surgery done before his long-term job were to end and along with it the deductible-met insurance. That would have been convenient. I am already out around 2000 for all of the co-pays and deductibles. Would still have 20% of the charges to pay for. Not a small chunk of change. In order for this to occur, I would have to have my surgery done before October ends. A tight deadline but certainly not unrealistic. Everything was submitted to the insurance company by October 7th. All we needed was approval, and then to have the surgery scheduled.

The surgeons office said that everything looked really good. They had some dealings with this insurance company. With my comorbidities, even with my roughly 38 BMI, it is obvious that my body is not tolerating this weight well and medical necessity looks promising.

Of course, the insurance company took much longer than the standard 7 to 10 days. It is my understanding, that most people are trying to get their surgeries done before the end of the year due to deductibles creating a bit of a backlog. Still, I should be able to have my surgery done before the end of the month.

Then I find out, horror of horrors, I have been denied! Why? My sleep study which is a new titration, as I have been using a cpap since 2006, states moderate to severe sleep apnea. The sleep study from 2006 states severe. The one from this year shows that an increase in pressure was needed to keep my Apnea at bay. But because of the wording, it is deemed that my comorbidities are not severe enough.

Okkaaaayyyy. So now, after all the wait, the hoops, the expense, all of it, insurance will NOT pay. There is no appeal here, no re-submission. And I forgot to mention, that the insurance we are going to be under effective November 1, does not cover bariatric surgeries at all!

I could absolutely scream, cry and pull my hair out all at the same time!

Okay. End rant.

Thanks for listening/reading.[/quote']

Just reading your quote made me cry for you. This waiting is crazy roller coaster ride

[sknyinside 99]

Aawww. That's so sweet. Thank you. It's all good. Insurance won't pay for it. But my husband, God love him, said to book it. We'll do cash pay if we have to. I'm booked now for December 9th! It'll take a while to pay for it and I hate having this extra expense. But It's necessary whether my insurance thinks so or not. My body is yelling at me. If it doesn't happen soon, I'm afraid there will be irreversible health issues. So, bless his heart. We are now joining the party. An expensive party, but a party none the less.

[mazzers120 75]

Aawww. That's so sweet. Thank you. It's all good. Insurance won't pay for it. But my husband' date=' God love him, said to book it. We'll do cash pay if we have to. I'm booked now for December 9th! It'll take a while to pay for it and I hate having this extra expense. But It's necessary whether my insurance thinks so or not. My body is yelling at me. If it doesn't happen soon, I'm afraid there will be irreversible health issues. So, bless his heart. We are now joining the party. An expensive party, but a party none the less.[/quote']

Congradulation!

[sknyinside 99]

Thank you! Excited. Scared. Really thankful for a wonderful husband who is so supportive.

[BellaHugz 331]

You are one lucky lady, good luck!

[sknyinside 99]

You are one lucky lady' date=' good luck![/quote']

Yes. I am lucky. I count my blessings every single day. My husband is my rock and I am so thankful for his support.