Hi Revision buddies!

Just a bit of backstory: I had a lapband placed back in fall of 2007, so almost 12 years ago. Unfortunately, I have always struggled with my band when it had fluid in it (vomited frequently, inability to eat most proteins, GERD, could not drink anything that wasn't warm or at minimum room temperature.) My band and I officially "broke up" in 2015. All of the difficulties I had been struggling with had gotten so bad that I had developed acute gastritis, and esophageal spasms due to the GERD and persistent vomiting, which resulted in me having to have all of the fluid removed. While the vomiting every time I ate and esophageal spams stopped, the GERD remained and the last 60 pounds I had managed to keep off after my initial loss, rapidly returned.

So here we are in 2019, through an unfortunate incident my husband had earlier in the year, our deductible and out of pocket maximum have been met for the year. The window of opportunity for me to finally end 12 years of GERD and struggle with this band is finally open. I found a surgeon I really am confident in and have had an EGD to check for Barret's and see what kind of shape my stomach was in. I was lucky in that my hernia had not returned and I didn't have any ulcers, but he did notice that even with no fluid in my band, that it seems tight, I'm not really sure what that means, but it would explain why I still struggle with most proteins. At my last appointment, we reviewed my EGD and he was sending the letter to the insurance company. Because my revision would be due to band complications, my insurance doesn't require the 6 months of dieting, psyh visit, etc, just a letter from the surgeon showing medical necessity for the revision. Since I have a history of GERD, we have decided that RnY is the best option. The paperwork was probably sent in sometime after July 3rd, my appointment was late afternoon on the 2nd and I can't imagine that they would be able to get the letter done and submitted the same day. And now I wait. UGH! It's the worst. I don't have any idea how long it should take. I've read the boards and for some people, it's taken as little as a single day for approval. and some waited for weeks only to be denied. It's maddening!!

Thanks for the vent!

TX2NC

Have you considered calling your insurance company to ask the status? That would be perfectly acceptable to do and you may at least be able to find out how long it should take.

We have met our deductibles for the year as well. I wasn't planning on getting surgery but when they told me I could fix my issues with a revision I am all for it. The waiting is impossible! Good luck to you!!

Totally check in with the insurance company and the patient coordinator/office manager at the Surgeon's office too.

My insurance approved it in 2 days but i got the notice in the mail a long while after.

Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? ?

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? [emoji34]

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Yep, I understand the waiting part plus a fighting component! I am on the first day of the fifth round for this revision. I might have to go through abratration in away.

The hardest part? Why do I have insurance if it doesn't pay for what is necessary?

It should be "optional" for me to have a higher quality of life? I don't think so!

On 7/25/2019 at 12:37 PM, TX2NC said:

Hello All!

I've been out of pocket the past week, but am finally back to civilization. So, taking everyone's advice, I called my surgeon's office. I chose to call them first to find out specifically what words I should use when I called the insurance company. I was afraid of calling the insurance company, and not knowing what to say and then either 1. not getting anywhere or 2. messing something up. So after leaving a message and getting a returned call to my case manager(didn't know I had one), I had a distinct impression that the surgery hadn't been sent to my insurance company at all. She wasn't able to see anything in my file, which if you've ever worked in the medical field, means that it wasn't done. She said that it had been plenty of time and I should have heard back about a week after my last appointment- it's been 3. Of course, the person in charge of sending prior-authorization request is supposed to be out until Friday. BUT today, and here's where I'm trying to be diplomatic, I got a call this morning from the person in charge of sending information to the insurance companies and she tells me that she needs the provider relations phone number off of the back of my insurance card. You mean the same phone number you called and asked me for a month ago when you got my EGD approved? That phone number? ?

So it looks like my waiting, waiting, waiting is just beginning. UGH! I know this is all just part of my journey and that things are happening as they are meant to, but dang!

Sorry ?

This is not meant to be a part of the journey.

It is not too much to ask that the job is done correctly and efficiently. Stay on top of everyone in every step of the process since you now know they are making mistakes. Don't let anyone's error cost you extra time

Good Luck ?

You’re right SeattleLady! It’s amazing to me that insurance companies basically bet that we’ll give up. That we won’t continue to fight for our health. I think that’s why I get so peeved when they try to push their “healthy lifestyle alternatives,” plans. They don’t care if we’re healthy, they just want us to pay our premiums and not file claims!
Thanks GreenTealael! I have tendencies to have very high expectations of my self regarding follow through. I can be a little hard line with it. Because I can be so stringent with myself, I somehow manage to convince myself that my expectations are probably too high when it comes to others. But you’re absolutely right. I feel like the lack of follow through has wasted the whole month of July.

It’s been a week since she called me to get the phone number. I haven’t heard anything, but again I’m worried about calling because in theory they are waiting in the insurance company. Maybe I’ll call the insurance company to make sure they’ve received the prior authorization request.

Ahhh! It’s also that whole thing of not wanting to bother people if I’m honest. It’s hard to explain. It’s like as a plus size woman, it’s been sort of constantly in my face that my size is a bother to everyone, airplanes, small office chairs, attribution of every medical problem I’ve had for 25 years being because of my weight, even if it’s completely not related. Almost like because I’m big, I should just stay happy and not raise a fuss because everyone is already being accommodating about my size. Fortunately, I have a therapist to help me work on reprogramming myself and learning to find my healthy voice.

In the meantime though, I can at least make a phone call.

I know this will all be worth it!

I completely agree with GreenTealael, I have had to call my surgeons office several times. Every time I do, things are suddenly farther along. Sometimes I feel like a pest, but I am betting if I didn't call them I might not even get my surgery this year.

So I just got off the phone with Anthem. They did receive the prior-authorization request on 7/25 and they have something like 14 days to review. So it looks like they have until about 8/13 to decide.
But at least I know where I am in the process.

Approved! I go in next Thursday to get my official pre/post diet instructions and schedule surgery. We are aiming for the 1st week of September if we can't squeeze me in the last week of August. My DH is going with me to the appointment since he'll be the one helping me post-op. He's excellent at being a caregiver, so I'm not terribly worried on that end. So here we go.?

? Congratulations ?