i give up

I dont know what else to do ... I called Dr. Harringtons office and they are just telling me to wait for the insurance company to get into contact with them ... THEY WILL NOT EVEN CALL FOR ME.. HELLO I NEED THIS OPERATION... My mom is thinking about taking out a loan, because she is afraid I might not make my 32 birthday.. I have NEVER IN MY LIFE MET SUCH UNCARING RUDE OFFICE WORKERS IN MY LIFE..I cant get angry because I want to not burn my bridges with them ... I got so damn angry at the insurance people that i slammed my hand down on my table and it broke... UNITED HEALTHCARE OF NEW ENGLAND is HORRIBLE.... They have no compassion what so ever.. Maybe its because its state funded medical care... I dont know.. I have been fighting this since January of 2002.. I dont know.. I wrote a total of 14 letters to my insurance and have heard NOTHING.. I am thinking about getting a lawyer and maybe suing them for something... I know its a covered proceddure because I called and asked and everytime i call they say yes its covered... I just dont get it.. I was driving home the other day planning my funeral cuz i know if it does not come soon i will possibly die.. How much more can my body take of being this heavy.. I dont eat junk and i try soooooo hard not to overeat... I pray everyday and god still does not answer my prayers.. Life for me right now is just basic survival at this point.. emily

Don't give up Emily, Things will eventually go your way. Would it be possible for you to change your insurance company? I am not liking what I hear you say about Dr. Harrington's Office. I am glad that I am not a patient in that practice. You must just keep plugging and eventually things will turn out. This is just a suggestion. When you call United Health again, why don't you ask to speak to the persons supervisor and keep going up the line until you get the answer you want. It may be worth a try. Hope things turn around for you soon. Carolyn

Emily, DONT GIVE UP!!!! I know its hard to wait for the insurance company. But it will come through. I would suggest calling the insurance company and speaking with a supervisor and if that doesnt get you anywhere then maybe the threat of hiring a lawyer might work. If its the same secretary that handles Dr. Royes patients, she is not a nice person at all!! Very rude and not compassionate at all. I dont think she understands what we have gone through in our lives. Have faith. Keep your chin up!! It WILL all happen soon. Good luck!!!

Hi Emily, I have United Health RItecare which I assume is what you have since you mentioned it is state funded. I got approved quite quickly. Here is how it went for me. I contacted my pcp and his secretary started the process with United Health. She is quite on the ball and called me constantly to let me know what she needed and to remind me of stuff I hadn't sent her yet. The first things she needed from me was a letter outlining my past dieting attempts. This really wasn't hard. I didn't have exact dates or weight losses so I basically went over my history of weight gain and the various diets I had tried over the years. The other thing she needed right away was a psyche evaluation. This was easy for me because I already see a psychiatrist for ADHD. It should not be too hard to get an appointment to see a therapist if you don't have one. From what I've heard, the evaluations are pretty easy. They just want to make sure you aren't pyschotic or delusional. At one point, it looked iffy because I didn't have any co-morbidities like diabetes or high blood pressure. But I had recently had a sleep apnea study with the wife of my pcp. I had very mild sleep apnea but it was enough of a co-morbidity with my high BMI that Kristen said it looked pretty good. I just looked through the archives to get some concrete dates and here is what I had written for May 28, "Kristen, PCP's secretary, yesterday who informed me she had only just that day been able to get the fax of his letter of referral through to United Health. The lines have been busy since early last week, apparently. I called the Dr.Pohl's office to see if they had a better idea of what kind of documentation I needed to present to United Health regarding my past weight loss attempts. I was notified that at my first appointment with Dr.Pohl he would go over that with me and then submit documentation on my behalf." I saw Dr.Pohl on August 4. His secretary insured me that they sent out letters of request by the next working day at the latest. She told me it would probably take a month with United Health as that seemed standard for them. I explained my pcp's secretary had already been working on my behalf but the secretary seemed doubtful. On August 25, Kristen, my pcp's secretary called to tell me I had been approved as long as I had all my testing done through Roger Williams Hospital where I would be having the surgery. She gave me a tentative date which is the usual procedure of the insurance companies. I called the surgeon's office to let them know I had been approved but the secretary was sceptical because she hadn't heard from them. I gave her my pcp's number and she said she would call the insurance company as well. She called me back either later that day or the next to tell me I had been approved. From there I was able to start scheduling my pre-op tests which I had all done in September. As soon as I knew the date of the last test I called to schedule the follow-up with Dr.Pohl which turned out to be October 6. On the day of the follow-up I was given the surgery date, November 11. So, the whole process once I actually saw the surgeon for the first time (that was August 4) will have taken roughly 14 weeks. I don't know what the deal is with Dr.Harrington's staff. They don't sound particularly helpful. Dr.Pohl's staff are very helpful, as is my pcp's secretary. In fact, I was told that it was not my place to contact the insurance company but theirs. The only work I did was writing the diet history and showing up for appointments. When I initially called United Health to find out if the surgery was covered I was told the request had to be made through my doctor or the surgeon and they gave me the number to give to my pcp. From there , as I said, Kristen handled everything. I would speak very firmly to Dr.Harrington's secretaries and demand that they call the insurance company, rather than hassle with them yourself. They have the expertise, that is what they are trained for and that is their job. Remind them of it. If you can, get your personal physician on board, or any other doctor you might be seeing. For instance, Dr.Kramer, the sleep apnea specialist would have gladly spoken to the insurance company on my behalf. Now, it may seem like it took a long time for me to get approval since the initial letter of referral went out on May 27. But remember, they were waiting for a letter from Dr.Pohl, the surgeon as well. Once that went out it only took three weeks from the date of my consultation. I know there are companies that approve much quicker and I'm sure part of what helped me was that my pcp was so clearly on board, as well as my sleep specialist. GOOD LUCK AND DON'T DESPAIR! Melissa

Emily, You didn't mention when the surgeon's letter of referral went out. I will just remind you that Dr.Pohl's secretaries said that United Health almost always approves once they have a surgeon's referral but it can take about a month. If you actually had your consultation on June 17, I would question whether United Health ever received the referral letter. What has been their repsonse to that question. I've read stories of secretaries forgetting to send the referral letter, or faxes not getting through, etc. For instance, if you'll recall from my previous post, my personal physician's secretary had to submit the referral several times over a period of days because the fax lines were busy. She even left a note on her day off, asking the secretary of the other physician to try the fax. Perhaps Dr.Harrington's secretary is less vigilant? In your place, knowing what I know now, I would demand that she tell you the exact date that she sent the referral letter with confirmation that it was received by United Health.