hernia repair, TT and insurance...

Donna R
on 3/26/05 6:23 am - Paducah, KY
hi all, I have lost just over 100 pounds and feel like a different person. I want to go buy new clothes but I have been waiting to get two hernias repaired, one is just under my sternum and the other is next to my belly button, this one causes the most problems because it is huge and sticks out to where I look pregnant! When I saw my surgeon about 7 weeks ago he wanted to put in to my insurance to get both fixed but he also put in to get a TT because I already have the saggy skin and once the hernia is fixed it will sag even more. I weighed 182 the day of that appointment, that was -95 pounds on his scale. I was just 5 pounds shy of losing 100 pounds. well because of problems with my insurance, they could not find the paper work, it went to the wrong person, it had the old ID on it...etc, it took a while for it to get to the right person. (it took about one whole month) I finally received the letter in the mail but it was for a denial. but it was not specific..., it stated that I had not lost 100 pounds. it had not been 18 months. 6 months of a maintained weight had not been met. I tried to call my insurance but I am having problems again, I asked if I had to have all three of those things stated because I have now lose 105 pounds. I also explained that the doctor wanted to do this along with the hernia repair to make it easier on me. plus it would save them money if it was all done together. SOMEONE is susposed to call me!!! but I have called every day the past week and I did not get anywhere, I just wanted to ask those questions so I could call my surgeon and at least document my new weight. Here is my problem, My hernia next to my belly button is huge, and the more I lose the larger it seems to get, wearing pants is now becoming painful and the stores no longer have any sweat pants out, they have all the spring stuff. I can not wait 7 more months to have the hernia fixed, so I was wondering if any of you had a hernia fixed then later had a TT?? I will call my insurance again Monday and stress that I just need that question answered, it may acually be a good thing that the insurane will make me wait for the TT, that way I can lose more weight and try to get in better shape. sorry so long Donna anyway,
Dedicated
on 3/29/05 3:21 am - Eleva, WI
Did you reach anyone at the insurance company???? How about calling your doc and getting their help with communication with insurance? Good luck!
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