Approved.. I think
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Hi all! I've been reading all ya'lls words of wisdom, and I've learned a lot. I figured it was time to introduce myself and give some background.
I screwed up my knee last year, and it's not much better after one surgery. The ortho keeps telling me it's arthritis and it won't get any better. I'm only 44. The only thing that will help me (until eventual knee replacement) is to lose weight. I found myself angry with the ortho, so I scheduled an appt with my PCP to get referred to another ortho. I had to wait a few days to get in with PCP, but while I was waiting, I did some soul searching and decided that I should try to lose weight first.
Sounds good until you know that I can't exercise much because of the knee. So my weight just kept going up. I decided to discuss lap band with my PCP (3/2). He agreed that it was worth a shot and gave me a referral to a bariatric surgeon.
Got in to see the surgeon a couple of weeks later (3/19). He looked at my stats - declared that I'm not heavy enough - BMI was not 40. Dammit. Lucky for me I took my insurance papers with me (along with 5 years of medical records), so I showed him insurance allows for BMI of 35 with co-morbity (knee is comorbidity). He didn't think it was going to work, but he was willing to try. He told me the rest of the requirements and sent me on my way. He billed insurance for over $900 for this 5 minute consult.
Scheduled myself to see the psychologist the following week (3/23). She agreed that I was ideal candidate, so I checked off another block. Now I just needed the letter of medical necessity from PCP. I called them, they whipped out a letter and sent it to the bariatric guy. Now they have everything they need to submit it (4/6). I had been in constant contact with insurance company (Heath Net) and knew they processed stuff quickly. I called the doc's office to find out submittal date. ARGH - they don't submit to the insurance company, they submit to another company that prepares the submittal (4/13)(with a 6-8 week lead time).
Depressed now, because knee hurts and walking is getting harder every day - and now they expect me to wait another 6 weeks?:sad:. Eat more, gain more weight, knee hurts worse. You get the picture. I was totally deflated inside.
Today, the doc's office calls me and tells me that the third party company has made the submittal to insurance. Right away, I called insurance and she said she has an authorization with an admit date of 5/13.
Now to me, this felt like at least a year's wait. Now that I'm typing it, I realize it was less than one month from consult to approval. Now I have to get that admit date changed, hopefully sooner. I leave for Mexico on 5/16 and I'm sure it's a bad idea to leave the country 3 days after surgery.
That's my story up till now! Hopefully I can move to the post-op forum soon! Good luck to you all in your journey!