My date is (tentatively) set!
I just got back from the surgeon's office and now I have 2 hours until I have to be in work and NO idea what to do with myself, so here I am! The surgeon's office scheduled me for 12/21/11 - which gives me a full year of sleeved life before the Mayans said the world will end. I'll only miss 2.5 days of work, then we're off the week between the holidays, and maybe I'll miss another day and a half after the holidays, but the surgeon said to cross that bridge when I come to it. Best part - I'll be home for Christmas!
So that had me walking on air, until I asked the coordinator if they already had my approval. Here's where the (tentatively) part of this all comes in. She said yes, and then she looked at the computer and said "uh oh." My insurance (First Priority Life/BCBS of PA) approved me already, but for the RnY. My surgeon recommended the sleeve and that's what I'm getting. The coordinator didn't seem too worried about it, especially because I documented who I talked to, when, and what they said when I called about approval - and they told me any of the 3 procedures (RnY, VSG, Band) would be covered. I will be on pins and needles until I hear back from the office that I can have my VSG, but if the insurance is being d-baggy about it, I'm going to have to think if I'd do the RnY or postpone and fight (probably the latter).
So that had me walking on air, until I asked the coordinator if they already had my approval. Here's where the (tentatively) part of this all comes in. She said yes, and then she looked at the computer and said "uh oh." My insurance (First Priority Life/BCBS of PA) approved me already, but for the RnY. My surgeon recommended the sleeve and that's what I'm getting. The coordinator didn't seem too worried about it, especially because I documented who I talked to, when, and what they said when I called about approval - and they told me any of the 3 procedures (RnY, VSG, Band) would be covered. I will be on pins and needles until I hear back from the office that I can have my VSG, but if the insurance is being d-baggy about it, I'm going to have to think if I'd do the RnY or postpone and fight (probably the latter).
-Kristi
Good luck to you with your revision, Cassandra! That's got to be so frustrating to go around with the insurance like that. I got a call as I was typing that post that they wanted my EKG before they considered the VSG for me, so thankfully my aunt is the nurse at my PCP's and she got me in this morning. I'm puzzled why the insurance would tell me I am getting the RnY when the surgeon says the VSG would work better for me... I mean, he's just the doctor. LOL
Rainsong - I only needed 1 visit with the NUT pre-op per insurance requirements... I'll actually wind up having 3 because what the heck, I get 6 covered visits per calendar year so why not use as many as I can? My insurance requires a 1 year post-op monitoring program instead. I get 6 NUT visits covered per year, so I can space them every other month, and the NUT is part of a medically supervised WL program, so it may save me on co-pays at some point. Just hoping they straighten out whatever got snafu'd. Good luck to you! :)
Rainsong - I only needed 1 visit with the NUT pre-op per insurance requirements... I'll actually wind up having 3 because what the heck, I get 6 covered visits per calendar year so why not use as many as I can? My insurance requires a 1 year post-op monitoring program instead. I get 6 NUT visits covered per year, so I can space them every other month, and the NUT is part of a medically supervised WL program, so it may save me on co-pays at some point. Just hoping they straighten out whatever got snafu'd. Good luck to you! :)
-Kristi
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