I feel like bawling!

I know people have went through this longer than I have, but then most that I've talked with it only takes them a month or two. I've been trying to get surgery for 16 months now... I am soooo fed up with no one willing to help me out. I did have medical mutual and was told they would cover it depending on their guidelines which in my case was no problem, then my hubby's company switched to Anthem I knew they were going to do this and tried and tried and tried to get people on the ball to send my papers here and there, I even told them that my insurance was switching I needed everything done ASAP I called day after day, but in the end nothing has been done, everytime I call anyone or go anywhere for help on this I get the run around no one knows what they are doing! Well, when the insurance was switched I called and asked if it was excepted and they even took my info then told me yes, well when my stuff was turned in they denied me, I called them and they told me that no the plan I was on wasn't covered! I'm sitting there thinking can't I get a break!!! Unfortunately I am also using medicaid for secondary insurance and supposedly they denied me too even though I had everything they needed, in this whole process there have been at least 3-4 people in my surgeons office handling my papers and I've been told my folder was lost, then found, then lost then found... I am stuck in this place where no one knows beans from applebutter and I'm just weary of it all! Now what you don't know is my sister has also been going through the same exact thing as me, she just called me today and finally told me after 16 months of this junk she was approved for surgery I was soooooooo happy for her! Now that I've sat and pondered over everything I'm still so excited for her yet unhappy for me because here I am still not getting anything done. This new woman who is now taking over finally got things settled for her and with luck I hope she will do the same for me, but in all with so many people having our folders, my sister and I agree that it wasn't either turned in to medicaid or it wasn't done right. All of the girls who had our folders prior to this new one was supposedly fired. Could it be a possibility they weren't doing their job right and in the process I have been wrongly put to the side or what? I'm so confused as to what I should do and just want to curl up and bawl. Someone cheer me up *sniff sniff*

I would talk to this new person and try and find out what the deal is and then maybe see about getting Walter Lindstrom or another lawyer. Sounds like you were unfairly denied because of incompetence.

Melody, Hang in there. I let the insurance people with my surgeon's office handle mine and found out earlier this week, they have NO intentions of submitting it because I do not meet the basic guidelines. However, in speaking with my husband's benefits department where they have this exclusion, as well as the insurance company itself, I was told that exceptions have and will be made depending on individual cases. EVERYONE strongly suggested I get them to submit, get denied and go through the appeal process so the "whole" picture, including letters from doctors can be reviewed. Even though I insisted they submit, they refused and with that, I said SENT ME MY PAPERWORK IMMEDIATELY! I then made a call to another surgeon and have an appointment for consult this coming Monday. I called the insurance company again and asked specifically what would help me in the appeal process to be approved, etc. They were very helpful. I then made an appointment with my PCP to "discuss" the plan of attack. I strongly suggest you "take the bull by the horns" and dig in your heels and MAKE them do as you ask or explain why. I had the run around for over 4 months, went through surgical clearances and ended up with nothing. Both my husband and I were told many insurance departments won't follow through because its just too much work-they are lazy. I decided if they didn't care enough about me, I didn't need them. You might want to post something on the board about medicaid. I've read where a couple of folks have gotten approval very quickly. They could tell you more than I on how, etc. Good luck! Beth

Also, remember that you don't have to wait on the surgeons office to do everything. I submitted the bulk of my information to my insurance comanies (Aetna and MMOH) myself because I got tired of waiting on BTC. When BTC sent it in the first time, they didn't send all that was needed and I was denied. I said the heck with them and took care of my appeal myself. Once my 6 month supervised diet was up, I was approved within a week and I think that was because of the way I sent stuff in. I documented everything in a cover letter and explained how I met each and every one of their requirements for approval and referred them to the corresponding page of medical records which I had also enclosed (I think the packet was 2 inches thick of medical records) and I hi-lited the pertinent information so they didn't have to look for it. If you don't get anywhere with them, take control and do it yourself - you can do it. Good Luck

Hi, I wish I could offer some words of wisdom. My surgeon and pcp have taken care of everything for me. I have really been blessed in that respect. I can only wish you a lot of luck and say do like others have said, "Don't give up!" I know how bad you want it because I do too. And, though I have had a lot of help it can't come fast enough! Obesity is something we live with everyday and are reminded daily of our quest. Can't get away from it. Maybe if you can think of something to give you a bit of peace and enjoyment you will get the strength you need to get going again! Hey Melody! I have a cousin named Melody. You hear Melanie but not Melody too often. Pretty name! Best of wishes to you! PJ wfad

well if you are not happy with the progress of your surgeon find another one I did and I am so glad I did when it is meant to happen it will happen test your strength and tredge on god led you to it now allow him to guide you through it god bless

Don't give up. In Dr. Curry's office we submit the insurance for all of our patients. We have found that Anthem has a very formal process that must be followed prior to the submission. If we follow their steps exactly, we are most often successful in getting approval for surgery. If you wish to come and see Dr. Curry, you can schedule an appointment by calling (513)559-2545. Linda

Thank you all for your support I'm cheered up a little, I know I will get this surgery sometime it's just a matter of when... If my insurance won't cover it I might get a bariatric lawyer, if that doesn't work then I guess I will have to pay for it myself even if I have to get a loan... No, I can't afford it, but I desperately need this surgery! Yes the benefits of looking a lot better and getting into my clothes are great, but I want to be alive for my kids to grow up and I want to have energy and to be able to walk without as much pain in my joints... I can barely breathe anymore it just keeps getting worse and no matter what I do or have done the weight just won't go away grrrr. Anyway lol I just wanted to pop on and say thanks to everyone!