X-Post Cancelled -pre-ops, *READ THIS*
drink deep, or taste not the Pierian spring:
there shallow draughts intoxicate the brain,
and drinking largely sobers us again."
English poet & satirist (1688 - 1744)
Because the doctor I was approved for and scheduled for did not request proper authorization, I had to cancel my thighplasty with my alternate doctor. The first doctor cancelled *me*, because I insisted on asking questions, and I'm glad they did, because they lied and said they approved Medicare (primary) insurance when they did not. I called and checked my AARP Medicare plan, alerted the doctor's office, they called and cancelled me the next day.
The second surgeon sang the same tune as the first. They do not pre-authorize Medicare prior to surgery, but bill afterwards. I had already received prior authorization from Medicaid.
No prior authorization, as most of us know, *guarantees denial from any insurance, public or private* and is a tactic used to strongarm patients out of cash who have it to pay, and weed out those of us who are less than middle-class or affluent. I was middle class before lupus and fibro took over. Not anymore. My weight loss surgery helped bring getting off disability within my grasp. Medicare is not welfare, but senior/disability health insurance that my tax dollars paid for when I was working.
I'm convinced that this tactic is used as a form of economic discrimination. I did go to college, and had a very rewarding and well-paying career, until SLE and fibro took over, so I don't fit what most doctors assume when profiling low-income patients: that they are uneducated and maladapted to life in general. It also doesn't help that I'm African-American.
That's right. Law enforcement is not the only profession engaging in this horrendous activity.
First, I am on these government plans because of disability from lupus and fibromyalgia, not because I don't want to work. I'm trying to get back to being productive. The steroid treatment for lupus helped push my weight up to 405 at its highest. I am now at 165, just five pounds away from my PCP-imposed limit of 160 pounds pre-plastics, thanks to my DS, which was approved by and paid for with the same Medicare coverage I have now. Just 20 pounds from my "chart weight" of 140.
My doctor estimated that 15 pounds of my remaining weight was skin and the uneven fat deposits clinging to it.
My surgery was reconstructive, not cosmetic. I had been referred for thigh reduction after several bouts of cellulitis, which is an infection of the fat cells just under the skin. The dermatologist that I was referred to determined that it was being caused by abrasion from the compression garment I must wear to keep my lower body skin in place, enabling me to fit into clothes and walk. Partly because my skin had been stretched out for so long, and partly due to genetics, it did not "snap back" after my massive weight loss.
Instead of empathy when I called to cancel, I got a chipper "OK, bye!" -CLICK-
I played by the rules. I put forth the extra effort to personally retrieve and deliver medical records and make sure everything was in order. ****ep a set of every lab and procedure related to my weight loss surgery, and I even have a copy of my surgical report from my DS) My Medicaid prior authorization expires June 23rd, and there simply wasn't enough time for me to do another consult and find someone who would do the prior authorization correctly. I have Medicaid because of disability.
This was a year and a half in the making. I went to four consults after I'd lost the majority of my weight. Only one surgeon said he would not do the surgery.
Perhaps if I had not exercised due diligence, and just played dumb, I would be having my surgery, recuperated during the summer and be on my way back to school in the fall.
I was seeing light at the end of the tunnel. Now all I can see is darkness once again.
Lesson: DUMMY UP WHEN NECESSARY!
HW 405/SW 397/CW 138/GW 160 Do the research! Check the stats!
The DS is *THE* solution to Severe Morbid Obesity!
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My insurance will not pay for my excess skin that hang down to my knees
Hockeymom87 · 0 replies · 611 views
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