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..

Edited February 1, 201610 yr by sassyfrass23

Gosh...even $35k is more than I could imagine spending

Idk if this makes a difference, but my surgeon will actually perform a robotic surgery on me. Maybe that's where the higher cost comes into play? I'm curious as to what the self pay price would be.

Edited February 4, 201610 yr by sassyfrass23

I just took out a loan... It was devastating when they told me my insurance excluded all Bariatric surgery. I could do nothing... I cried for days. But I had to figure out a way... Only way I could do it. Mine doesn't do robotic surgery. Just him and his partner.

I know that most of the surgeries done at The Cleveland Clinic (in Cleveland, Ohio) are done laproscopically with 5 holes in the abdomen. They only open you up if necessary. Is that what you mean by robotic? I know the laproscope looks kind of like an octopus...long arms.

@@Renkoss It's laproscopic but my surgeon sits at the robot to move/control the tools. Like this video:

Ah crap- it won't let me post the link. If you go to YouTube and type in robotic bypass surgery, I believe it's the second video.

Quick update: Dari emailed me today and said her UHC rep asked that I give them 1-2 days to investigate this whole situation. I'm very grateful that they appear to be taking this seriously and want to give me a FINAL answer rather than guessing like the customer service reps were so quick to do. My file should have been submitted today or will be tomorrow according to what Tonya said yesterday. Progress!

I appreciate all of you talking this out with me and allowing me to rant/obsess/freak out! I'm sure my husband enjoys the break

I am so sorry this is happening to you. I would have been heart broken. Prayers for you that this gets resolved very soon. Good luck with everything.

Thank you, @ ! I certainly do appreciate all the prayers I can get ????

As the initial shock has worn off...I have come to have more at peace with waiting if I have to. That may be another story if I hear later in the week that I FOR SURE have to wait until August. But I'm not allowing myself to panic just yet!

Edited February 3, 201610 yr by sassyfrass23

Gahhhh. I hope this works out okay!!!

You and me both, @@bellabloom !! I must say that patience isn't my strong suit either.

Stay strong! This will all work itself out and for now control the things you can. Be as ready for surgery mentally and physically as you can and it will happen!

I'm so sorry you have to deal with this. I know I would have been calling all the time too - mostly because my coordinator is overwhelmed and has a lot of patients so I wouldn't have gotten a fast response Oh and I'm impatient.

Thanks for all of the updates. We are all rooting for you! I hope that your surgeon can escalate the surgery so you don't have to wait another six months. Big hugs!

Stay strong! This will all work itself out and for now control the things you can. Be as ready for surgery mentally and physically as you can and it will happen!

Thank you! And yes ma'am. The more time I have to prepare mentally and physically, the better. I actually had a moment of panic last night when I thought about everything I would be giving up for this procedure. I know without a doubt that the mental challenge will be the worst, but I know it will be worth it in the end and that really is all that matters. I have to save my life.

Thanks for reassuring my obsessive phone calls, @@RNYDawn ! And to be honest, I called again last night (gasp!) to inquire about the Psych eval amount I was billed. While on the phone, I figured it was worth asking about the status of my file and if it'd been received yet. The nurse advocate also read off my dang requirements again. I almost want to join in with the reps everytime they do since I practically have them memorized. And because...well...I'm curious... I asked her how SHE perceived the additional 6 month wait. She was flabbergasted. Said that out of all the policies she reviews DAILY, that was the first she'd ever seen. She really couldn't believe it. Much like many of us. She gave me hope in saying that if it's true and required that I could have my surgeon submit an appeal to override the wait. So as the days go on...I honestly do feel a little better about everything. I didn't hear back from Dari today, but hope to by tomorrow or Friday at the latest.

Heard back from Dari and things look promising. I hope to know more tomorrow.

But hey...guess what?

I just found out that my surgery was approved! I'm in complete shock! I called UHC to get some documentation from my call back in October to send to Dari. The nurse advocate decided SHE wanted to check the status of my file herself. She came back a few minutes later with my case #!!!! I still can't wrap my head around it! I thank you all for your words of encouragement and not letting me get down over all of this insurance mess. ????