Insurance approval - what if they say no?
I have posted here several months ago about my frustration with getting insurance approval (Capital BC). It seemed as if every time I thought I had submitted everything needed, they came up with new requirements. My initial consult with Dr. Pupkova was December 2007, and I have been working on this ever since.
So...this morning I faxed everything to Barix including:
Cardiac clearance
stress echocardiogram (which the cariologist only ordered because of the chance BC may want it)
Pulmonary clearance (Which the pulmonologist saw no reason for)
Sleep study (which I passed)
Psyncological eval
Primary care dr. letter and notes
Evidence of 6 month nutritionist led diet
Verification of consult with surgeon
Statement that I have attended support groups (although this was not on Barix letterhead - jus****ch - they will tell me I need something "official")
Lab work for endocrine functioning and H Pylori
Along the way, I actually talked to Blue Cross (which they did not want to do) - to get the full list of requirements. The irony is, I do not have a lot of comorbidities...however, in the 18 months since my initial consult with dr. P. - I have actually gained weight and now am under treatment for high blood pressure, which has never happened before.
My fear today is that somehow the insurance company will say no. I can't allow myself to get truly excited about surgery and my future - it feels as if I'm in suspended animation. I feel much more on edge emotionally than I have in the past, knowing that this is all in the hopper now and completely out of my control. I am a little angry that all of these things were required, taking a tremendous amount of time, energy, and co-pays. I'm angry that the surgery couldn't have happened a year ago, when my work load was lighter. I try to view the good side - that through this time, I have been able to solidify my decision to have surgery, and know for sure now that I am healthy and a good candidate for surgery. I know that the waiting game is said to be one of the hardest parts - but it's beyond being a game to me.
But it is very, very difficult to read the message boards (which I've essentially stopped doing) and read about those who got very quickk approvals with very little documentation. I resent it. I wi**** had been easier for me. I feel I am worse off for the time lag...not better.
Just venting I guess. Thanks for listening.
Lynn
So...this morning I faxed everything to Barix including:
Cardiac clearance
stress echocardiogram (which the cariologist only ordered because of the chance BC may want it)
Pulmonary clearance (Which the pulmonologist saw no reason for)
Sleep study (which I passed)
Psyncological eval
Primary care dr. letter and notes
Evidence of 6 month nutritionist led diet
Verification of consult with surgeon
Statement that I have attended support groups (although this was not on Barix letterhead - jus****ch - they will tell me I need something "official")
Lab work for endocrine functioning and H Pylori
Along the way, I actually talked to Blue Cross (which they did not want to do) - to get the full list of requirements. The irony is, I do not have a lot of comorbidities...however, in the 18 months since my initial consult with dr. P. - I have actually gained weight and now am under treatment for high blood pressure, which has never happened before.
My fear today is that somehow the insurance company will say no. I can't allow myself to get truly excited about surgery and my future - it feels as if I'm in suspended animation. I feel much more on edge emotionally than I have in the past, knowing that this is all in the hopper now and completely out of my control. I am a little angry that all of these things were required, taking a tremendous amount of time, energy, and co-pays. I'm angry that the surgery couldn't have happened a year ago, when my work load was lighter. I try to view the good side - that through this time, I have been able to solidify my decision to have surgery, and know for sure now that I am healthy and a good candidate for surgery. I know that the waiting game is said to be one of the hardest parts - but it's beyond being a game to me.
But it is very, very difficult to read the message boards (which I've essentially stopped doing) and read about those who got very quickk approvals with very little documentation. I resent it. I wi**** had been easier for me. I feel I am worse off for the time lag...not better.
Just venting I guess. Thanks for listening.
Lynn
Insurance companies can be extremely frustrating to deal with, especially when it comes to bariatric surgery. I have Aetna and the first person I talked to didn't give me much information, so I called back a day or so later and got another very helpful person who actually mailed me the entire packet of information relating to gastric bypass surgery - every insurance company has one, so insist that they send you the information for their requirements, etc., so you don't keep getting the run around.
Good luck - keep us posted on how it goes, but INSIST that they provide you with written information on their policy regarding weight loss surgery - trust me, they have one, and as a patient they must provide that information to you - FREE of charge.
Kathy
Good luck - keep us posted on how it goes, but INSIST that they provide you with written information on their policy regarding weight loss surgery - trust me, they have one, and as a patient they must provide that information to you - FREE of charge.
Kathy
'One shoe can change your life'...Cinderella
Hi your not alone.I had a date for 5-12 and on 5-8 was told cap blue cross denied me due to me taking methadone for pain.I just got my letter to start the appeal.I feel for you and for all those LUCKY people who were approved right away(like the 2 girls in my office who were approved 3 days b4 me)have no clue the disappointment and the letdown.GOOD LUCK!!!
Well I heard from Barix's insurance dept. today with this news:
Cap. BC is questioning 2 things. My stress test report says I have a "diminished capacity for exercise."
Well no jive Jack!
But they are now considering whether I need a VASCULAR CONSULT. When I spoke to the BC rep, she clearly stated that a vascular consult was only required if there were indications that would lead to thrombosis.
And...
My H Pylori had been positive at the beginning of all of this. I went on the full regimen of antibiotics (with lovely side effects). My primary care doc says once you are positive, you may get a positive result in the future as well even after treatment. He did not recommend a follow up test.
But...BC says they "may want" a GI evaluation by a gastroenterologist.
You know, I have two reactions to this. One is to just plow through it all, knowing that they'll think of something else next. Probably another 6 month diet.
The other is to take this all as a "sign" that it just isn't the right path for me to take. I'm feeling frustrated and kind of kicked in the teeth.
On June 4 it will be 18 months since my initial consult.
Cap. BC is questioning 2 things. My stress test report says I have a "diminished capacity for exercise."
Well no jive Jack!
But they are now considering whether I need a VASCULAR CONSULT. When I spoke to the BC rep, she clearly stated that a vascular consult was only required if there were indications that would lead to thrombosis.
And...
My H Pylori had been positive at the beginning of all of this. I went on the full regimen of antibiotics (with lovely side effects). My primary care doc says once you are positive, you may get a positive result in the future as well even after treatment. He did not recommend a follow up test.
But...BC says they "may want" a GI evaluation by a gastroenterologist.
You know, I have two reactions to this. One is to just plow through it all, knowing that they'll think of something else next. Probably another 6 month diet.
The other is to take this all as a "sign" that it just isn't the right path for me to take. I'm feeling frustrated and kind of kicked in the teeth.
On June 4 it will be 18 months since my initial consult.
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