I am SO bad!
And I really don't care! Oh my.. I can't believe I said that, but truly.. I don't care!
Okay - so, today I'm doing my research and I gave my insurance a call... I got the SAME lady who gave me the run around last time.. I think next time I hear her voice, I better just hang up and try again. Or maybe I should ask her to transfer me to the next avail. agent?? I hate to be rude, but I'm soooooo frustrated by her!
I asked her if she could tell me what types of weight loss surgeries they'd cover, and which they would not? I told her that I was in process of being worked up for bariatric surgery, and was wondering if I had any choices as far as the surgery, that way we could apply for the authorization appropriately. Weeeeeelllll... She doesn't know A THING.
First she tells me weight loss is not a covered benefit. And I told her yes, it is when it's medically necessary, and I have that letter from my physician the minute the logistics are worked out. I asked her if she could just tell me if there were any exclusions in the policy for certain types of WLS's and she says, yes.. we don't cover Weight loss at all! Not pills, not food, not shots, not dr.'s visits, not ANYTHING! I calmly re-explained to her what was going on, and how I knew that this was covered for me - co-morbidities, High BMI, failed WL attempts etc.. (besides, I know of at least 10 people who've used my EXACT same insurance to have the surgery - we all work at the same place!) and she proceeds to tell me there is no information, and yaddy, yadda, yadda... Finally she mentions that the best thing I can do (this is 30 minutes of going rounds later) is to have the surgeon call the provider hotline and ask them what needs to be submitted in order to get approval.
But wait!! You might be wondering.... I THOUGHT weight loss wasn't a benefit!!!!!! Rrrrgggg... so I emailed one of the surgeons that I've been working with, and didn't hear back for awhile and just got the urge to call it in myself! : idea:
Why not? So I called the providers hotline and asked what documentation would be required in order for "Katie T.." to have surgery with us.. and were there any exclusions "we" should be aware of...... he he... I didn't really learn that much more, but I FELT better!!
As far as my insurance is concerned, a note from my sugeon listing out what he's gonna do, why he thinks I need it, and what steps he's taken to determine the appropriateness of this for me specifically (EKG etc..) - will be pretty much what they want, oh and a refferal to go out of town from my PCP (IF I actually go out of town.). Go figure... isn't that what everyone says??? lol... oh well. Like I said, I feel better!
Ha.. so disregard everything the LAST lady told me.. none of them get it right. I mentioned that only my PCP had to submit.. thought it was too easy. Oh well. We'll deal. It's gonna happen, one way or another.
Katie T