not looking good for me...

Hello all. I just introduced myself last night. I dont know if my March 4th date will stand anymore. My insurance still has not responded. Uggh. I probably lost my date but will hopefully still have surgury in March...so dont kick me out yet! I am 26 yr old married, mother of 2. From Illinois. BMI 46 with several co-morbids including... Obstructive Sleep Apnea, Pre-Diabetes with hyperinsulnemia insulin resistance, hypertension (high blood pressure), Polycystic Ovarian Syndrome, Fatty infiltration of the Liver, & Gastro Esophageal Reflux Disease, and many many weight related conditions. I am still waiting for insurance approval (big long letter in my profile to the insurance. If they cant approve me now, I doubt they ever will). I did not have to file a formal appeal. I was just asked to submitt additional information. I treated it like an appeal. I bombed them with info and records. I was supposed to know last Friday. I called again today...still nothing. Uggh. I am just disgusted today. I feel like they will never come through. I know my March 4th date is probably no longer possible (unless I get an "approved" call today). My biggest concern is getting approved, not the month in which the surgury takes place. BUT when your looking forward to your surgury date for so long and the ins. cant get their *%$# together it's just depressing! Well thanks for listening anyway. Pray for me. I really want to be a Marcher but more than that I NEED APPROVAL! Julia pre-op open RNY

Awwhhhhhh Julia, I'm hearing ya and feeling for ya as I'm in about in the same boat, I have my Cardio cath on this Thursday, and if they find anything or have to do anything, my surgery date of the 16th will be rescheduled. But you know, we'll always be Marchers, dey won kick us out!!! Keep a positive attitude and keep praying, I will be praying for you also. Da Judge of dem Marchers

Julia, here's what worked for me: call the insurance company every day. Make sure you get to talk to a precert nurse (nurse analyst, or whatever the insurance company calls them). The squeaky wheel get the grease, it's true. It worked for me at Humana insurance! If I hadn't called and bugged them, I would probably still be waiting for a decision (that I originally sent 1/21/04). HTH. Please let us know what you find out. Hugs, -Marcie

Have you called your insurance company? I'd be on that phone with them every day!!! Joy

Thanks everyone. Yes, I call constantly. I have one of their customer service specialists on my side. She does all she can for me. Today she contacted the person who knows whats up and she will call me as soon as she knows anything at all. That will most likely be later this week from my experience. I have done everything I can. I dont call "every day" but I would get the same person and I know she is doing what she can. My ins. co. uses an "outside consulting firm" to determine medical necessity...then it sits before the review board for a final decision. This was supposed to have happened (for the second time) last week. She has recieved all of the reviews on the other cases that were seen last week...but mine was not among them. She called someone on it before I even called (she has an eye out for my case). But she has not heard anything yet. I am hoping it didnt get misplaced or something and not go before the board this time or something. It's enough to drive me crazy. I am so depressed over this whole thing. I just want to go to bed & sleep it all away (not an option with 2 small children). It makes me crabby & worthless (as far as the household goes). My mom says "take the kids up there and sit in someones office letting Frankie (2 yr old) tear the place up until you have an answer!" Sounds fun. BUT the ins. co. is like 2 hours away and the person I would need to see would most likely not be in OR if he/she is in they could not make a decision without consulting the "board" I am sure. So I ruled going up there out. I dont have much else to do but wait. Thanks for understanding. Julia pre-op Open RNY

Julia, hang in there. I agree - these ins. companies can make ya crazy. They don't realize what a simple phone call can do, like "Hi, we're still working on this, but didn't want you to think we forgot you...". Don't anticipate the end result. No one can ever know what goes thru their minds. I figured I'd have to fight like I've never fought before in order to get approval, and much to my SHOCK, it was approved after the first letter (with submission of "additional info" I didn't have when the letter had been written). Most insurance companies now use a 3rd party detemination for stuff like this - mine did. It's pretty common. But don't give up. Kimmer Queen of the Niners, Instigator to All Marchers, High Priestess of Giggles Zero-minus-15 dayz 'n countin'!

Julia, Once a Marcher always a Marcher, even if ya have to change the date. Hugs, Mo (doin' the 28 day boogie )

Julia, I am sorry about all this trouble with your insurance. They can be a pain sometimes. Like some of these wonderful ladies on here said..I would call everyday..ask to speak to the nurse herself. By chance, did the surgeons office, or whoever submitted the information to the insurance company write the date of March 4th?? If so they should have definently reviewed your case. I pray you get a response today and that you will NOT have to postpone your surgery ! Bethany

JULIA, I KNOW YOU HAVE CALLED THEM BUT YOU MUST KEEP AT IT. I HAVE WORKED ALOT WITH INS COS THRU MY JOB AND YOU HAVE TO PESTER THEM. CALL AND DEMAND YOU TALK TO A SUPERVISOR. CALL EVERY HALF HOUR IF YOU HAVE TO. WHEN YOU GET THE SUPERVISOR LET HER KNOW THIS IS NOT ACCEPTABLE AND YOU WANT SOME ANSWERS NOW! ASK HER HOW LONG THIS WILL TAKE AND THAT YOU HAVE SCHEDULED TIME OFF WORK, SURGERY AND DAYCARE AND MAKE UP WHATEVER ELSE YOU HAVE TO. GET HER TO DO SOMETHING. AND IF SHE DOESNT BUGDE CALL HER ALL THE TIME. YOU WILL BUG HER INTO GETTING YOUR WORK DONE. HOPE THIS HELPS. GOOD LUCK LADONNA 3/2

Hi Julia, You're a Marcher forever now.. Don't give up and don't stop calling and don't be afraid to go over people's heads... I can't say I was the most POPULAR caller at my insurance company but I won my appeal... I also had my PCP Referral Coordinator calling for me and checking with "those people" we aren't allowed to speak with.... Hang in there....