Bad MPlan, Bad!!

Background: Back in April, Indiana decided to change the law regarding bariatric surgery. No longer are insurance companies allowed to force an 18 month MD supervised program prior to approval. Only 6 months. This goes into effect TODAY July 1st. I was told by dietician to stop all the things I was doing...monthly MD visits, monthly nutritionist visits, weekly group sessions, food diary, etc, because I am approved as of July 1st! I was told to schedule my psych eval, schedule my surgical eval! I did both and now I have my pre-op testing scheduled and my pre-op class and my surgery!! My date is August 24th. Why am I pissed?? I got a letter in the mail yesterday when I got home from work from the head of the Nutrition Services department that coordinates all the pre-op crap that my insurance company requires. The letter starts out "It is with great regret that I give you the following information. We need to change your agreement for bariatric surgery preparation to reflect the latest information from MPlan." It goes on to say that the new law was recently 'clarified' and that even though the law goes into effect on July 1, it doesn't affect insurance coverage until the plans are renewed with the employers. Mine is renewed in January. This says that I have to reactivate the 18 month program and successfully complete all requirements to be eligible for surgery EVALUATION. I have already done it all and been evaluated!! I already have a date!! I would think this is an error except that it is not a form letter. It is addressed directly to me and names my dietician and is signed by the director. However, I cannot find out until Wednesday (!) what this means exactly since this letter dated June 26 didn't arrive until (conveniently) June 30th. I am so frustrated because I feel like they purposely sent the letter so that it would arrive Friday or Saturday on a long holiday weekend so no one could call until later next week. Maybe I'm paranoid but I don't think so. Also, my 18 months would have been up in October. Since I haven't done any of the requirements since then, do I have to wait until December to fulfill the 18 month requirement? Is my letter that says "congratulations, you are approved" null and void now? I am gonna call 6 for help! That is our ABC news program here in Indy that helps people who have been wronged! I am gonna start a class-action or something. I am so mad!!!! I already have the time scheduled off work, my Angel, husband, Momma,2 of my sisters, and my daughter have all requested that day off work. I have my 'magic bullet', my protein powder samples to get me started, my first 2 months worth of vitamins are bought. Good Lord!! I could kick a hole in the wall right now!! Sorry so long but I had to let it out. Thanks for listening!!

AJ, Im so sorry to hear that. I would also be crushed if I got postponed on my date. I was told a month ago or so and had posted it that insurance companys didnt have to change on July first. This came straight from Dr. Cacucci's office but no one believed me when I posted it. I really do hope u get somewhere with channel 6. Also I would suggest that u start back with your dr suppervised visits and and come oct turn it in. Maybe they wont notice that u missed one month or two. Maybe u can give your dr some wts for the ones they are missing and they can fill it in for you on their print out. Only a suggestions. Mariah

Mariah, You are so right! I read your post back then. I might even have responded, I'm not sure. I didn't understand that it meant this! I just wish my people would have figured it out as soon as yours did. I am hoping they won't penalize me for the 2 months missed but it will not be a surprise if they do. I have gone to some support group meetings so maybe that will cover 1 of the months. Oh well, it will happen. Just not when I thought it was going to happen. Thanks for your suggestions. Have a great 4th!

ggggr this sucks......i would tell them i never got the letter>>>>>>>>>>>> sure would be tempting...have u been to any dr in the last 2 months that weighed you? keep us posted on this....sure am gonna pray for you it is an error, and try to call monday alot of places are open and working..

I sure was weighed in the last 2 months! I didn't even think of that...thanks! My surgeon weighed me at my surgical eval appointment. I also have a bladder disease and had to have an outpatient procedure done April 28th and was weighed that day. And at the follow-up appointment for that procedure. I am going to call on Monday but I just have this funny feeling that everyone will be out. I did get some advice on the main board that was good too. My approval letter came from MPlan. The letter telling me I had to start up the 18 months again came from the Nutritionist/bariatric program. Maybe they have their info wrong? I'm praying that it all gets straightened out. Thanks for your prayers, Johnnie

Crossing my fingers and my toes that they will accept the letter they sent you first saying you were approved... Linda

I am in the same boat as you and I feel really awful. To my understanding they are giving us two months credit for the months we lost, but we still have to finish our contract of 18 months. I feel like they should not have got our hopes up by sending us an approval to see the surgeon and then pull the rug out from under us. The only thing we can do is finish the contract, but I sure would like to write a letter or sign any petition you would like to start. I didn't have a date yet , but was told it would probably be mid July. I did have my surgeon consult and psych consult. I have been fighting for 3 years to have this surgery and them doing this to us just goes to show you that most of the world still does not see obesity as a disease and insurance companies do not see us at a person. Just my thoughts.

Hi Christi, I found out today that I am still a go for my date of August 24. I was almost finished with my 18 months and since they give 2 months credit, I only have 2 dietician appointments to complete and all my requirements are finished. Make sure you know exactly how many MD, RD, and groups you need to finish your requirements. The way I see it, the people whose 18 months are not up before the end of December will be eligible January 1st if they have the 6 month requirement effective January 1st met. I am so sorry if this throws you really far behind. What month are you on? Did you have to do the 12 week psych group? Did you get the approval letter from MPlan already? I am always available if you need to talk. Just drop me an email.

So sorry to hear of your "insurance night-mare" MPlan may be correct in that the law does not affect current contracts on insurance plans and become effective upon renewal. I have a friend who is going to fight her insurance company with a medical need aspect-her policy has an outright exclusion....so she is going to fight with the long appeal battle. Perhaps if you have a medical necessity you can appeal and get them to waive the 18 month provision. Good luck and happy journey to you!!!! Hope it all gets better for you soon!!!!