Getting Closer

Hi, all! Since I didn't hear from Lois Monday, I called Dr. A's office Tuesday morning. After a lot of busy signals and redials, I finally reached Stacy. She told me that Lois was on the phone and offered to check my file. Kim Daniel's report was there, but my cardiologist's report was still missing (although it was supposed to have been faxed to them Nov. 5th). Stacy checked the papers that are waiting to be filed (which at least are in alphabetical order by patient name) and didn't see it. (So much for Lois telling me a week and a half ago not to have it refaxed to them.) I told Stacy that I'd call the cardiologist's office as soon as she and I hung up and she suggested that I call her in the afternoon to make sure that it was received. I explained to Stacy that I've heard that Healthnet may not be paying for WLS next yr. and that therefore I want to have it done before the end of Dec. About 3 hrs. later, I spoke with Stacy who told me that they received the fax, she put it in my file and handed it to Dr. A for him to sign off on it, WHICH HE DID!!!! She then went on to tell me that between my morning and afternoon telephone calls with her, they had heard that Healthnet indeed may not be paying for WLS after Dec. 31st and that Lois is now trying to get approval for Dec. dates for patients with Healthnet who've done everything required by Dr. A pre-op (like me). According to Stacy, I should be hearing from Lois on Wed. or Thurs. to discuss tentative dates. Debby

Well, okay - you are getting closer - but what a bummer about Health Net. Ugh that stinks so bad! I am hoping that they will allow for payment on those patients that have already taken care of the pre-op stuff prior to the end of the year. Good Luck Debby! Will I see you Monday night in Hamden?? Tara

Hi, Tara! Yes, I'll be at the Hamden support group meeting Monday. Will you have time for dinner after? Debby

Oh Debby What a day for you to deal with this again!!! I hope you will get the date BEFORE DEC 31st. I am very disappointment in all insurance companies about refusing to pay this surgery. That surgery saved our life and gave us second chance to stay more healthier. I will keep my eyes open for your next posting for your tentative date!!! Hugs Kathy k

Hi there Angelette- I was thinking about you yesterday. I am glad you are moving ahead...and hopefully by the end of this week you will have a surgery date! I will keep you in my prayers..and cross my fingers--toes and everything I got! I know this will work out for you! Love, Joanie

You'll get your date, I just KNOW it!!!!! Hang in there - and hint hint....do you need an angel??

Hi, Tammy! Thanks for the offer, but Joanie M. is my angel. Is there such a thing as an angel understudy? If for any reason, Joanie can't fulfill her duties as my angel, you'd step in? Hugs, Debby

Debby, I am glad you followed up and made sure everything was in order. Sometimes they get so overwhelmed a little reminder helps. Hopefully you will get your approval and you will be joining the loosers bench this month! Carmen

Glad you're squeaking through Debby. I have Healtnet to and am so thankful that I did it this year. Do you know why they are thinking of stopping benefits? Good luck and hope you get your date soon. Maggie

Hi, Maggie! I don't know what's going through the (small) minds at Healthnet other than probably saving money in the short run. Someone at the Hamden support group meeting Nov. 1st mentioned that she'd heard from a friend who works at Healthnet that they might not cover WLS after Dec. 31st. I called Healthnet customer service the next day, but all they could tell me was that they hadn't heard anything about it and that if it's medically necessary of course it would be covered. Like no one has ever had an insurance co. refuse to pay for something that's medically necessary?! They're probably playing follow the leader. With some other insurance companies refusing to pay for WLS next yr., the rest are probably starting to think that if they continue to pay, people who've been covered by the other companies will start to switch companies and only a few companies will end up paying for all the surgeries. It's so stupid. Even if they don't care about my having a healthier life or longer life expectancy, if I just calculate what they must be spending each year on my prescriptions (for diabetes, high blood pressure and high cholesterol) that I most likely won't need after WLS, and multiply that by even just 20 yrs. (without surgery would I likely live more than another 20 yrs.?) I come up with an estimated total drug expense that's greater than the cost of the surgery. But that would be savings over 20 yrs. vs. a large expense in one yr. and they seem to worry more about the current bottom line than the future. Debby