Frustration!!
I am about to seriously go POSTAL!! Why is that AmeriChoice (TennCare) offers to pay for gastric bypass surgery but you have NO surgeons in network that will take the insurance. I just don't understand the rationale of the decisions of some things. I've been going back and forth and back and forth between insurance company, doctor, surgeon, insurance company and no one seems to know ANYTHING ABOUT ANYTHING. I'm getting to the point where I don't even care if I have the surgery or not because if you can't coordinate who pays for what and when I don't think I need to have you cutting on my precious body. I just don't get it, I'm so frustrated that I'm at work in my cubical right now crying because this is so difficult. No one understands how hard this is because everyone else has had their journey be a walk in park. No one else has had to struggle. No one else has had to jump through hoops, no one else has had to drive hours and hours away from their home over and over again to be told months later that they no longer accept your insurance. I'm just at the end of my rope.....
k9ophile
on 6/21/12 3:45 am
on 6/21/12 3:45 am
It does sound like you're very frustrated, yet I do have a few comments that might put things in perspective. AmeriChoice may pay for WLS surgery, but what they pay physicians may not be worth the doctor's time. Why should a doctor have to take a deeply discounted rate when he/she has expenses like everyone else. I don't like it when I have my hours (income) cut, yet my expenses remain the same.
As for everyone else having it so easy, it may just seem that way right now. I was initially denied because even though my employer covered WLS, they did not follow their own criteria. When I asked about coverage, I was told something quite different from what I was told when I actually tried to get approved. It was three years before I finally got approved. And I work for a hospital that says its employees are the most important part of their services. (Don't ask for decent health care for yourself, but smile when you take care of others.) I'm not the only one who has had to fight for their WLS. This site is full of people who wanted to give up, but kept at it until they got their surgery. People have been known to go out of state or the country to get their surgery.
Take a deep breath, regroup, and keep going for what you want.
As for everyone else having it so easy, it may just seem that way right now. I was initially denied because even though my employer covered WLS, they did not follow their own criteria. When I asked about coverage, I was told something quite different from what I was told when I actually tried to get approved. It was three years before I finally got approved. And I work for a hospital that says its employees are the most important part of their services. (Don't ask for decent health care for yourself, but smile when you take care of others.) I'm not the only one who has had to fight for their WLS. This site is full of people who wanted to give up, but kept at it until they got their surgery. People have been known to go out of state or the country to get their surgery.
Take a deep breath, regroup, and keep going for what you want.
"Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us." Stephen Covey
Don't litter! Spay or neuter your pet
This journey is not easy on anyone. It takes patience, preparation, and fortitude. You are not alone and you are not the only one who has had to struggle. In the end only your insurance company can tell you what you will need to do to get what coverage exists. Whether or not a doctor is in network with a particular insurer is up to the doctor and/or hospital. They have to agree to take whatever the insurer pays and follow the insurers guidelines. It may be that AmeriChoice is forcing either rates or care policies that the doctors find to obtrusive to deal with. TennCare has some really obnoxious rules.
If you opt for out-of-network care you always have a couple of options. You could get a third party insurer or self pay. In the end, it is your body and its your responsibility to make sure you can pay for your surgery - not the surgeons. They offer services like insurance coordinators to try and make it easier, but not taking TennCare is their choice - just like your favorite store deciding which Credit Cards to accept.
Feel your frustration, have your cry, and then try to re-evaluate your options. You probably have more than it feels like right now. The results of this surgery are well worth ANY ammount of frustration.
If you opt for out-of-network care you always have a couple of options. You could get a third party insurer or self pay. In the end, it is your body and its your responsibility to make sure you can pay for your surgery - not the surgeons. They offer services like insurance coordinators to try and make it easier, but not taking TennCare is their choice - just like your favorite store deciding which Credit Cards to accept.
Feel your frustration, have your cry, and then try to re-evaluate your options. You probably have more than it feels like right now. The results of this surgery are well worth ANY ammount of frustration.
_____________________________________________________________________
160 lbs lost. Surgeons Goal Reached in 33 weeks. My Goal in 37 Weeks.
VSG: 11/2/2011; LBL+Thigh Lift+BL: 10/3/2012; Brach+Mastopexy: 7/22/2013
Glad you are feeling better and just so you know it COULD be worse.
My insurance has a total exclusion for WLS and DH and I saved for months and sold an antique car and some relatives chipped in and I went to Mexico for my surgery.
There are ways to make it happen but I hope you are successful in your journey to WLS. It was the best money we ever spent.
GL
My insurance has a total exclusion for WLS and DH and I saved for months and sold an antique car and some relatives chipped in and I went to Mexico for my surgery.
There are ways to make it happen but I hope you are successful in your journey to WLS. It was the best money we ever spent.
GL
Just a quick question? Does your company that parks you in a cube not offer insurance?
Also, I have heard of patients being approved by Americhoice , maybe check into a smaller and lesser known surgery group. Sometimes the larger outfits such as Centennial have so many patients that they can pick and choose which insurances to deal with. I have insurance that I pay out the yazoo for and it is and has always been an exclusion. So I opted to go to baptist and pay the 12K cash option and just get it done.
Have you tried calling the TnCare solutions number for help ?
Good luck.
Also, I have heard of patients being approved by Americhoice , maybe check into a smaller and lesser known surgery group. Sometimes the larger outfits such as Centennial have so many patients that they can pick and choose which insurances to deal with. I have insurance that I pay out the yazoo for and it is and has always been an exclusion. So I opted to go to baptist and pay the 12K cash option and just get it done.
Have you tried calling the TnCare solutions number for help ?
Good luck.
Most Active
Recent Topics
