Self inflicted 16 day all liquid diet. (long)

I have an appointment with my surgeon on April 11th to go over everything and make sure it is in line to submit all the needed documents to the insurance company.  If everything is together (and we're pretty sure it is) then I'll be submitting on that day.  The insurance coordinator at my surgeon's office said it can take up to 2 weeks for an approval.  I'm nervous that it will take the entire two weeks and that at that time my parents will be here for a visit from New Mexico.  If I get denied, I do not want that to ruin their trip here.  I know it'll be depressing and I just don't want to be too down in the dumps to have a great time with them. However, on the flip side, if I get approved, it will make this trip THAT much more fun and exciting knowing it'll be the last time they come to visit their super morbidly obese daughter !!  

Ok, so on to insurance issues.  I have BCBS... I thought I was told by the hospital my husband works for that we have BCBS of FL (it's new ins. to us).... and when I called the # on the back of my card they didn't specify which ins. company we had... but they did read to me the requirements for bariatric surgery.  The only requirement having to do with BMI was the usual 35 with comorbidities or 40 without.  Never a "cap" on the BMI.  Of course they only covered the bypass and the lapband at the time I first initially checked into this with them (back in August of '10) About two months ago they started allowing for the sleeve.  Anyway, I get a bill for my portion of a dr's visit and it says in the corner that BCBS of SC paid their part and that this is my part to pay.  I was stunned.  I have BCBS of SC??  Oh boy!!  I didn't call them again but I did get online and look up their requirements for bariatric surgery.

I was SHOCKED when I read the BMI requirements.  It says the MAXIMUM BMI is 50.  I had heard another patient talking in the waiting room about her insurance capping the BMI but I didn't think I needed to worry about that since I didn't share her insurance.  Well...... looks like the assuming got me into trouble! UGH!

At the time of making this discovery on Friday of last week, my BMI sat at 53.2 (according to dr's scales).  I was mortified.  That would mean I would need to drop 21lbs in just over 2 weeks!!! The thought of having to wait another month or two in order to submit my information to the insurance company was overwhelming.  In addition to the fact they want the psych eval to be current, meaning within 8 weeks and I had it 4 weeks ago. I was really upset. So I started thinking and figured that since a lot of people have to do pre-op liquid diets for 2 weeks (my surgeon only requires 3 days however).... and that's about the amount of time I had before that next appointment, I could give it my best effort and see where it got me.... right?? 

So... here we are... morning of day 6 of all liquid diet and I'm down 10.2lbs!! I have 11 full days before that dr's appointment and I am working my tush off (literally) to get this to work. 

It's been a rough 6 days... I'll be the FIRST to admit that... but I've had a few revelations about myself and my body.  It's been good for the soul.... and I'm glad I'm down this road.

Ginger

Hang in there, Ginger. The first thing to do is get in writing the actual policy you have. Talk to your husband's HR folks and get this cleared up.

I have never seen anything that put a specific time limit on the psych eval. Plus, the BMI limit of 50 sounds strange to me. My BCBS insurance wouldn't cover the sleeve because my BMI was LESS than 50. Are you sure it's maximum and not minimum??? Usually the only upper limit on BMI for surgery is set by the doctor according to what equipment they have. Mostly I've seen it at a BMI of 60.

Get right back on the phone and stay there until you find someone who knows what they're talking about. The 4 days preceding my surgery I was on the phone tracking down the one and only person who had the answer I needed. After working for 14 months - 14 months! -  with my insurance and the doctor I was told the surgery was a covered expense but the surgeon and surgeon's assistant weren't covered and I'd have to pay that part. WHAT??!! Surgery is covered but not the surgeon? How can you have surgery without the surgeon? I finally found someone at my company's HR department who looked and researched the issue. He said that language was left over from last year when they made some changes in coverage. He assured me I was fully covered. I told him I wanted it in writing. He sent me a email and I have a printed copy of it. I didn't get it all sorted out until the evening before surgery. I was so wound up over insurance coverage I didn't have a spare second to worry about my surgery until the morning as I headed to the hospital.

So, don't accept the first answer you get. Keep at it and don't stop until there's no one left to talk to.

 BCBS has one of the highest customer complaint lists in the nation.  I used to have and eventually dropped it becuase I had to take them to the insurance commission on every charge- I mean every charge.  It damaged my credit score and and angered my doctors. Eventually I got them to pay.  But I I dropped them as a result.

I paid about $4000 for my surgery and I paid cash. 

Anyway even if they do preapprove be prepared to fight them later own as they have a tendency of reversing payments.

I pray God makes this transition smooth and easy for you.

JB

Thanks all for your comments and support.

I just got off the phone with BCBS. I called the # directly on the back of my card and the first question I asked was... do I have BCBS of FL or SC? It's kind of embarrassing not to know what insurance you have but like I said.... kind of new insurance for us.... that's actually been part hold up with this whole thing.  My husband had to employed at this new job for one year prior to having surgery.  So I've been waiting until April before I'll finally be eligible.  UGH!

Anyway, the representative cleared the whole FL vs SC thing up.  I have BCBS of FLORIDA.  She said that my policy is written and handled in FL and that the claims dept and customer service is located in SC.  AH HA!  Ok... one question down... a few more to go.

She went over with me TWICE the requirements that the customer service dept gives to the insured (and she stated when the dr calls in, he'll get a more in depth list).  They are as follows: 

*$30,000 max (lifetime) benefit with no reconstructive surgery covered (TT, LBL etc) --not too shocking there
*Must be done at an approved facility
*40 or greater BMI, 35 with 2 comorbidities
*5 years of obesity
*Physician assisted diet lasting 6 consecutive months within 3 years of request for surgery
*Psych Eval (must be current---within 90 days of submitting for surgery)
*No medically treatable cause for obesity (thyroid issues, glandular issues etc)

And that's it folks.  That's all she was able to give to me, the insured. She stressed several times that the physician will call in to pre-certify me and that at the point they will give him more information and requirements.  THAT is the part I don't like.  What do you mean? Is it a secret society of Insurance vs the Patients?  I hate that part.  

Anyway..... I'm not sure what to do know with the liquid diet concept now.  Stinks because I had just gotten past that annoying headache and body aches and EXTREME fatigue.  Grrrrrrrr Now what???

If you're doing ok on liquid, then stay with it or at least low carb. Any weight you lose before surgery is that much closer to goal. I didn't worry too much about it b/c I had a very hectic few months of travel before my surgery. I had bcbs of tx and they started covering sleeve last summer. Right before I had to make my decision on type of surgery. So glad I had the sleeve as an option!

Yes, I've decided to stick it out with the liquids since I'm feeling better today and doing ok on it.  I'm losing a good amount of weight on it (although I assume that will slow as my body figures out what I'm doing lol) and you're right... every pound gone is closer to goal. 

Honestly, I am so frustrated by the whole process (insurance junk) that I've decided to stick with the liquid diet for the remaining 11 days before the dr's appointment and let God sort it out. :)  If my BMI is below 50 when I go in and there isn't the 35-50 rule then yay!! Less weight to lose with the sleeve, right? And I go in there and my BMI is under 50 and there is the 35-50 rule then GREAT!! I did it!!  Either way, this stress is KILLING me and I just want to give it to God to handle it.  I'm officially done.  

Thanks for your kind words and encouragement, I really appreciate it

Ginger

Either way you win! Wi**** weren't so hard to turn our worries over to God. You'd think we'd know by now that He has it under control!