I want to cry

HI everyone, I know I'musually pretty quiet, but I need to share this. And I'm looking for some help and advice. I've been working with Dr Giles since Feb of this year. I have BCBS of Northeast Pa through a COBRA program. I made Dr Giles office aware that I'm working on a COBRA program and that I had until Feb of 2005 on that policy. Dr Giles's office worked with me and got all my tests done in a relatively quick manner and everything was sent into the insurance company at the beginning of July. The insurance co. kicked it back to me for a test that none of Dr Giles patients have had to do, an MMPI psych evaluation. It took the insurance folks from July until the end of Sept to tell me this. I had been bugging them for an answer since we were really trying to get the surgery done before I had to go back to classes at college in the fall. Obviously that hasn't happened. Fine....I go and get the testing done and its sent in. As you all know it is now Dec. I still haven't gotten an answer from the insurance co. Since my insurance is to cancel in Feb under the COBRA plan, I called them to see about continuing my coverage as an individual. They told me that since I don't live in PA anymore that I needed to contact Anthem BCBS here in CT. Fine. I call, as soon as the word diabetes comes out of my mouth, the guy tells me that I am automatically denied coverage through them. I asked that since I've been covered by BCBS for the last 3.5 yrs with my old company and for another 4 yrs prior to that with another company, shouldn't my coverage just roll over and I pay as an individual. NOPE!! And then he got nasty with me, but I won't go there. To make a very long story short, I've been calling insurance companies until I think my ears are going to fall off. NO ONE will cover me with diabetes except for United Health or Healthnet or the state and this would be through the Health Reinsurance Program managed somehow by the state. NONE of them cover the surgery. I don't know what to do. I feel like the world has been pulled out from under me. I've been doing everything that they want, I've lost 35 lbs, started the exercise, changed eating habits ( as I sit here eating doritos! ) All I do when I think about this is cry. Not only am I overweight, I have diabetes, hi blood pressure, hi cholesterol, sleep apnea, mitral valve prolapse, arthritis, asthma, and depression. And I'm only 37. Like all of us, I've been on every diet created by man and some illegal things too. (not proud of that, but desperation is an amazing thing ). Please, Please let there be one of you guys out there that have some ideas. Or maybe have been in the same situation as I am. I'm going to call Dr Giles' office on Monday and see if they have some ideas. He's in a mess right now because he's changing hospitals. Thanks for letting me cry on your shoulders. I feel like I;ve been kicked and left bleeding. Any thoughts or help would be appreciated. Heather R.

Heather , I'm so sorry to hear about the probelm your having and unfortunatly I don't have any advice for you. I was on Cobra when I had my WLS but I had HealthNet and they gave me no problems at all. There is no reason why the Insurance company is sitting on your request. Just stay on them and call them. Have the Dr.'s office contact them too to see what the staus is. Hopefully your Dr. can get you in ASAP once approved to make sure the surgery is done before your COBRA expires. Your in my prayers. Keep your chin up and if you need to talk I'm here. I'll be up for a little bit longer and if you have AOL just IM me or email me. ~Julie~ Open RNY 8/9/04 370/283/150

Hi Heather, I think you really need to ride your doctor's office! Perhaps they are dragging because he's changing hospitals, but that's not your problem, and you could maybe try to make them understand that time is truly running out for you. Another option would be to call some different surgeons in CT and explain that you have all your tests done and need to have the surgery before your insurance expires. Be as aggressive as you possibly can be without being rude! I wish you all the best, Heather C.

Heather R, Any time you need to vent - this is the forum. ;) Can you continue to call the insurance company and ask for a supervisor? I can't STAND the runaround that you get - it drives me wild. My only advice is don't give up - don't let them get to you! Keep going - be an energizer bunny. Oh, boy, I can relate to your doritos comment too. I was a "cool ranch" girl when I was upset about anything. Hang in there! Love, Tammy

Hugs Heather. I'm sorry that you are having to deal with this. I would just keep on bugging the insurance company to get that paperwork through. Sounds to me like they are trying to ride out the end date of your policy. Don't let them do that to you. I would definetly call back BCBS of CT and speak with someone else. Seeing as you've been with them for so many years, it doesn't seem right that they can do this. Keep your chin up and keep on fighting. Hugs, Maggie

HI Heather-you don;t know me, but I understand your situation-if you are willing to change MD's the new guy at HH is great-his name is Dr Tischler, and since you have had everything done-he is starting surgeries in January-maybe he can get you in-he is very compassionate-his number is 246-2071 nad his nurse is Nina Arnold who is just as caring her number is524-2623. If you bring all your records, etc to your appointment he may be able to help you before your insurance runs out. In terms of insurance did you try CTCare-they have plans for individuals. Jeanne Ambrosio

Thank you all for your replies and sympathy. I needed it. Jeanne, I will check on CTCare, do they have a website? I'm going to hound Dr Giles office and call my insurance tomorrow morning. I've read some things about Dr Tischler and everything has been good so far. I may well give him a call, especially since he is just setting up here maybe he won;t have such a long waiting list. The final straw though will be if the insurance turns me down even with the MMPI that they made me do. Oh, they charged that entire test to me, even though they are the ones that insisted I take. Least of my worries though. Will a surgeon deal with me if he knows that my insurance is going to run out and I don;t have anything lined up. I know that there is alot of after care involved. The other big thing I;m worried about is my prescriptions. Right now, I have to spend $350 a month out of my pocket for meds. I saw the totals that insurance put toward the meds and there is no way I can afford them. Sigh...........I have myself almost sick over this. Thank you all so much again, for being here and being so understanding. Hugs Heather

Hi Heather, Sorry to hear what you are going through. I would contact the insurance commissioner and find out if the stalling is legal - since you are on Cobra, and it is going to expire. They may be able to intervene. God Bless, Kathy Bilodeau

I was going to suggest a lawyer. It usually doesn't take them long, once they know you have a lawyer they become very cooperative and only cost my girlfriend $250. Best $250 she ever spent.

Heather, I am so sorry you are having to go through this mess. I would call and ask to speak w/ a supervisor, if they don't help ask for their boss! Also call Dr Giles office and have them call. Kathy had a great suggestion about calling the insurance commissioner. If you don't have the answers by the afternoon call them. If you can afford it consider hiring an attorney who specializes in insurance and WLS situations. Good Luck! Carmen