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Very frustrated with my case worker

tholbert08

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tholbert08    51

tholbert08
Posted

I am 2 months away from surgery and I will basically have ZERO out of pocket due to meeting my max out of pocket. But I am now being told by my surgeons office that they won't schedule me in November but that my surgeon is not scheduled at my in network hospital FOR THE ENTIRE MONTH! I am really not happy and I feel like I have lost my voice.

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blizair09    3,250

blizair09
Posted (edited)

My patient advocate hasn't been much of an advocate for me, either. Now that my surgery has been approved, I am hoping that I don't have much interaction with her going forward. She acted like I was a problem because I INSISTED that my surgery be done at an in-network hospital and because I inquired about the anesthesiologist to insure that he/she is also in-network.

Just keep pressing the issue. That's what I have done. My experience is that customer service has been seriously lacking in this endeavor (even though the surgeon himself is really awesome).

Edited by blizair09

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IMissVegas    23

IMissVegas
Posted

My caseworker has been slow and snarky. I'm starting to realize that "I'll get right back to you" means 4 days, which doesn't cut it in any other business. I've become very persistent and vocal.

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tholbert08    51

tholbert08
Posted

I have requested a new advocate 2 weeks ago and have yet to hear back. Called twice and keep being told they are working on it but I am 45 days out from being able to submit. Very frustrated. I need a true ADVOCATE! Someone on my side.

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cherieinnv    3

cherieinnv
Posted

I feel like it's too late to request a new advocate and I've learned to go to the woman that assists him when I need help. However, I have another issue now. My paperwork was supposed to be submitted to insurance a week ago but when I called BCBS on Fri. to see if they had received it, they said no. This is so frustrating! So I called my advocate and got voicemail, as always, but didn't bother to leave a message because I don't want to wait the usual 4 days for a reply. So I emailed the assistant, who always answers promptly.

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tholbert08    51

tholbert08
Posted

THAT stinks and is exactly what I was afraid of! Stay on them. My nutritionist told me that she transmits the results of the appt within seconds of completing our visit. If that is the last thing needed for approval, it should be very simple to get a file submitted.

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cherieinnv    3

cherieinnv
Posted

Someone new from the surgeon's office contacted me this week and said the file was sent to insurance on Monday. I guess if I don't hear back from her next week I'll start checking with BCBS for a status.

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tholbert08    51

tholbert08
Posted

Someone new from the surgeon's office contacted me this week and said the file was sent to insurance on Monday. I guess if I don't hear back from her next week I'll start checking with BCBS for a status.

Any update?

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Joy@boman    151

Joy@boman
Posted

I am so lucky. I called the bariatric office and left initial message. They called me back next day and told me exactly what to do. And this whole process from 1st call to surgery has been less than 3 months. The hospital bariatric ward is so in depth. I got tons of preop testing and they personally walked me to the ultrasound, xray, bllood gas, blood work, and ekg. I never had to wonder around from the moment i walked in the door.loved it.

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Go To Topic Listing PRE-Operation Weight Loss Surgery Q&A

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    • Aunty Mamo

      Aunty Mamo

      Iʻm roughly 6 weeks post-op this morning and have begun to feel like a normal human, with a normal human body again. I started introducing solid foods and pill forms of medications/supplements a couple of weeks ago and it's really amazing to eat meals with my family again, despite the fact that my portions are so much smaller than theirs. 
      I live on the island of Oʻahu and spend a lot of time in the water- for exercise, for play,  and for spiritual & mental health. The day I had my month out appointment with my surgeon, I packed all my gear in my truck, anticipating his permission to get back in the ocean. The minute I walked out of that hospital I drove straight to the shore and got in that water. Hallelujah! My appointment was at 10 am. I didn't get home until after 5 pm. 
      I'm down 31 pounds since the day of surgery and 47 since my pre-op diet began, with that typical week long stall occurring at three weeks. I'm really starting to see some changes lately- some of my clothing is too big, some fits again. The most drastic changes I notice however are in my face. I've also noticed my endurance and flexibility increasing. I was really starting to be held up physically, and I'm so grateful that I'm seeing that turn around in such short order. 
      My general disposition lately is hopeful and motivated. The only thing that bugs me on a daily basis still is the way those supplements make my house smell. So stink! But I just bought a smell proof bag online that other people use to put their pot in. My house doesn't stink anymore. 
       
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Oh yeah, something I wanted to rant about, a billing dispute that cropped up 3 months ago.
      Surgery was in August of 2023. A bill shows up for over $7,000 in January. WTF? I asks myself. I know that I jumped through all of the insurance hoops and verified this and triple checked that, as did the surgeon's office. All was set, and I paid all of the known costs before surgery.
      A looong story short, is that an assistant surgeon that was in the process of accepting money from my insurance company touched me while I was under anesthesia. That is what the bill was for. But hey, guess what? Some federal legislation was enacted last year to help patients out when they cannot consent to being touched by someone out of their insurance network. These types of bills fall under something called, "surprise billing," and you don't have to put up with it.
      https://www.cms.gov/nosurprises
      I had to make a lot of phone calls to both the surgeon's office and the insurance company and explain my rights and what the maximum out of pocket costs were that I could be liable for. Also had to remind them that it isn't my place to be taking care of all of this and that I was going to escalate things if they could not play nice with one another.
      Quick ending is that I don't have to pay that $7,000+. Advocate, advocate, advocate for yourself no matter how long it takes and learn more about this law if you are ever hit with a surprise bill.
      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      BeanitoDiego

      Some days I feel like an infiltrator... I'm participating in society as a "thin" person. They have no idea that I haven't always been one of them! 🤣
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    • ChunkCat

      ChunkCat

      Thank you everyone for your well wishes! I totally forgot I wrote an update here... I'm one week post op today. I gained 15 lbs in water weight overnight because they had to give me tons of fluids to bring my BP up after surgery! I stayed one night in the hospital. Everything has been fine except I seem to have picked up a bug while I was there and I've been running a low grade fever, coughing, and a sore throat. So I've been hydrating well and sleeping a ton. So far the Covid tests are negative.
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      · 0 replies
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    • BeanitoDiego

      BeanitoDiego

      Still purging all of the larger clothing. This morning, a shirt that I ADORED wearing ended up on top. Hard to let it go, but it was also hard to let go of those habits that also no longer serve my highest good. Onward and upward!
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