Feel like quitting ! Please help

[samantha614 12]

I had my lap band in 2008. I lost weight, but gained back a ton after I had my son.

I found a surgeon who was willing to do my revision. I had the consultation, I started doing my surgical clearances. My insurance (HealthPlus Amerigroup) changed to BCBS HealthPlus. Everyone was made aware of this change happening. I was scheduled to have my lap band out on 10/27. On 10/05 I called the office to ask a question, and they informed me that they no longer take my insurance. I was floored that no one even bothered contacting me to let me know I wouldn't be having surgery in two weeks.

So for a couple weeks I sat depressed, until I found an awesome

Surgeon willing to do my revision, and who accepts my new insurance. So now I've been doing the 6 month diet because I've been headed towards this surgery for a while. I was at month 5!! I went into my PCPs office for a visit, only to be told he doesn't work there anymore!!!! They wouldn't give me any info, where he went, why he left, nothing. Finally I tracked him down and I'm going to see him this week. Idk what happened, but now I missed my weigh in for the month of October. Idk if my new insurance even requires this 6 month diet because when I call, they tell me they won't know the requirements until the surgeon submits paperwork for the surgery. Is that the most ridiculous thing you've ever heard??

Does anyone know if they require it? Does anyone know if my insurance will somehow accept that my dr went MIA in the middle of my diet? Maybe I can convince my doctor to add a weight in my chart for the month of October

I can't start over! I cannot wait until May! I only have my psychiatrist and nutritionist left to do. I've been doing this diet and it was ruined by this fucking doctor. I'm so pissed.

Idk if I'm even asking a question, just venting I suppose :/

I'm not even sure if I technically have BCBS or healthplus now. I'm so upset.

[Tobeornottobe 89]

they tell me they won't know the requirements until the surgeon submits paperwork for the surgery. Is that the most ridiculous thing you've ever heard??

This is the most ridiculous I've ever heard. You have the right to know what your insurance policy states. I have a feeling it probably the same across the board for the Blues. I would continue to call and if I don't get an answer, I would ask for a supervisor.

What ever you do, DO NOT GIVE UP!!!!

Another quick note: for the October weigh in, you could have taken a video of yourself weighing in at home on your scale for documentation.

Hang in there.

[BLERDgirl 6,417]

Who provides your insurance, your employer? If so contact HR. find out coverage dates for both insurance companies. Then request you medical records in writing from both doctors. Use all of that documentation in the event you need to submit an appeal.

[samantha614 12]

Idk my insurance because I don't know if it's technically considered healthplus, or if it's technically considered BCBS. I didn't apply for this change, the insurance company just did it and all the members rolled over onto the new plan. Now it's called BCBS HealthPlus, so I'm unsure if their policies now go by BCBS or by Healthplus.

I called my insurance and now they've stated that as long as the Doctor states it's medically necessary, it's approved. She said there is nothing written about a diet beforehand. So then I called the surgeon's office and spoke to the woman who works with the insurance companies, and she told me that they do require it. I feel like no one knows what they're talking about. (At the insurance company)

The woman from my surgeon's office told me to get a note from my doctor and that he was out of the office and I will just have to weigh in one extra month instead of starting over. Fingers crossed that it works.

PS- I don't appreciate the condescending attitude of "how do you not know what insurance you have." I don't walk around oblivious to the world. The insurance company changed and merged their names, but are still separate entities, so it's a little confusing to figure out which policy they're technically now following. Thanks for your insightful input, though.

[samantha614 12]

And no, I'm in nursing school full time, so I have insurance provided through the city.

[Miss Mac 6,261]

The worst part of this whole process of getting bariatric surgery is the aggravating hoops you have to jump through with the insurance company and doctors. Getting to the place of an actual appointment date for the operation is a full-time job by itself. Hang in there, kiddo.

[IncredibleShrinkingMan 437]

Please, please, do not quit. I can't stand to see people demoralized by bureaucracy. Call me petty, but years down the road I would like to see you send after pictures to everybody that gave you the run-around. For once, though, it seems that insurance isn't the primary antagonist.

And please don't let any of it undo any of the work you've done on the diet, or worry, as some people do on this site, that they will slim themselves out of qualification. I think you need to write an addendum saying what happened at the October weigh-in. Forging a weigh-in date could cost your doctor his license (maybe that's what you want, but that doesn't help you out much, and will probably ultimately make it more likely to have to start over with someone else), and could also disqualify you from coverage for fraud. None of that is worth it, no matter how eager you are for surgery.

[samantha614 12]

You're right. It's not worth it. I'm going to go to him and ask him to write a letter that he was out of the office like the woman suggested. Thanks!

[BLERDgirl 6,417]

Regardless they still have to provide you with effective and ending dates. My suggestion would be to call them back and ask them to provide you in writing with when the Healthplus policy ended and when BCBS Healthplus went into effect. If they give you grieve, then keep requesting a supervisor until you get to one who will. This may sound petty but make sure you get the name and note the time when you speak to each individual. In the event you need to appeal, this sort of detailed documentation will be invaluable. If you have a wallet card on the back is likely an address where you can write to and request this information as well.

[samantha614 12]

I know when the new policy took effect. This isn't my issue. Thank you.

[Inner Surfer Girl 12,015]

Another note, even if your PCP wasn't available for any reason, you could at least get a weigh-in by whoever is there to add to your records.

As others have recommended, document everything, and don't give up!

[Nora82 11]

I work as an insurance coordinator and we just had a patient who missed one month weigh in. She still got approved. The best thing to do is get a letter from PCP as to why you were unable to weigh in that month, that it was not because you just didn't go that month. Insurance companies are usually lenient on that if you have documentation as to why you missed a month. For our patient I sent in her paperwork, the insurance called to ask about the missed month, I explained to them why she missed a month and they approved.