Insurance - Support Woes!!

I talked to Lois on Friday and she was going to submit my info for Pre-Certification to my Insurance. I should be happy...but I am not...I am all twisted up. I need some support on this..it is really bothering me. I had talked to her a few weeks ago and she was very concerned that I would not be approved because of a requirement needed by my Ins. Co.. (Need to provide documented evidence that I failed to sustain wieght loss for a year prior to surgery - and I have 21 years of it from him). It did not ask that I go to a D. once a month to discuss weight issues, get weighed, etc. I had showed the requirements to Dr. A and got a message that he thought it might be a problem...but not something that I could not get past. She said that you just don't know what the Ins Co's want. I was so depressed. I then talked to my PCP and he told me to call my Ins Co and see what it is that they wanted. I did and sent him an email of what I needed. He wrote a letter of medical necessity and sent documents to Dr. A's office to back up what he said in the letter. She had someone call me and tell me that they did receive it, but that she did not know if it was going to be enough. I called her Friday to see if she had a chance to look it over and did I need anything else. I think she had me confused with someone else - I could be wrong - she talked about 6 months of Dr. visits specifically about weight loss. I think she may have thought I was being really pushy, and I definitely got the feeling that I am not being supported by her. I know she has to be honest with us, but I just don't get that supportive feeling from her. I don't mean to talk about her, but I SO need support on this..and I thought I would get it from her. Maybe I am just too needy...I need to know if this gets approved so I can plan for my life...I am NOT good at sitting around and waiting. I feel so out of control..and I am..but that doesn't help. I really was going to write an email to a few of you that had said you were there if I had any questions, etc...but I felt like no one could help...and I got into this place where I hate being...so I am writing it all out for the world to see ...not sure why..except I am at work and stressed out and want to cry b/c I started to think about all of this... What will I do if I don't get approved? Do I have the energy to fight? How much more time will that take from my family? I feel so guilty lately that I am trying to take care of myself - to the detriment of being with my boys. Granted they are 16 and 14 (the 20 yr old is at college), and mom's are the coolest to be around at this point... but I feel SO selfish. Then if I look at it the other way...where will I be in 10 years if I am still here if I don't do this...There is no "happy medium" to this whole process and it is making me crazy! Nancy

Nancy, You have the right to feel this way sweetie, but take it slow. Its a long and painful process for some of us with the insurance, all the testing and then the appointments and diets. You will get through this I promise you that. There are alot of members out there who were worse off than you and I put together. I thought alot of the same things you did, but I talked to alot of our fellow OH family members and they answered alot of my questions and concerns. Take it as it comes, and you will be strong enough to fight if you have to. Use all your family for your support and you make sure you take care of yourself both emotionally and physically. You wait and see pretty soon you will be on your journey to the losing side like the rest of us and you will look back and say it was all worth it. Good luck to you and God Bless to you. Take care and contact me if you would like someone to talk to. Hugs Kim C

Hi Nancy, First of all, take a long deep breath and exhale! Now, you need to get things into perspective here. Remember, Lois is just one person. She has a LOT to do for Dr A. I don't know why, but she does. Maybe she didn't have your file right in front of her the last time you spoke to her..so, I would suggest that you phone her on Tues or Wed and ask her to grab your file and see if anything is happening with it. Maybe there has been, maybe not...but remember, she's just the middle person here...I'm sure she's seen all kinds of stuff with all the different insurance companies she deals with. Maybe you just caught her on a busy day and sounded overzealous and she just wasn't into buying into it with you... I know that I felt I was bugging them a bit when I was anxious about where my file was in their office and what status it was at. I just politely said I was getting antsy and tired of waiting and would like to know the status of my file. Pat (another woman in there) is also very knowledgable on the subject and can check for you. Stacy too. Ask them if there's anything you can do by calling your insurance company, phoning your PCP, etc and maybe with a few people advocating for you (and yourself) you'll get down to whether ins is going to approve or not. Be honest, be friendly and tell them that the waiting game is killing your psyche. I did and they were always very nice and helpful to me. I go in on Tues (tomorrow/today) for my two week check up and hope that I don't have to wait for Dr A for hours...Hubby has to get back to work afterwards... Ahhh...I know this waiting is hard...but in the end if you have to appeal, there's a TON of people on this main bbs that have appeal letters they can lend to you to go off of etc. It doesn't have to end at a denial..something which you haven't even gotten yet! Hang in there and know that you can email me anytime with any of this crap...it's frustrating and I know that you wanted the surgery done last week with me! It's hard to be patient! take care, paula

Dear Nancy, have you found out if the info you were given is true for you? I had a similar experience, my doctors office did not want to submit my info because they had a few other patients with my insurance that were rejected and told they need a 6 month monitored diet first. I contacted my insurance company several times and was told it was different for each persons situation. I persisted with the office staff and told them I wanted it sent in anyhow. They sent it and two days later I was precertified. Don't give up and don't feel selfi**** is time to think of yourself. By succeding in this weight loss journey you will help yourself and your family. All the best Sher