beth H.
I have wanted to have this surgery for 5 years, but since my insurance company did not cover it, I thought I never would be able to do the gastric bypass. But this year is different. My insurance company is Aetna BCBS and they have been wonderful. And it is just in time. Although I have been on every diet there is, I have no luck keeping off the weight. And as most everyone knows, that is so depressing. My husband has been retired for 6 years and we decided that I would retire at age 55. But I wanted to be healthy and be able to do things with my husband and grandchildren. My last attempt at weight loss was nutrisystem. The food was fine, and I lost 30 lbs. But the food became monotonous and I drifted off the diet around the holidays. Then at an insurance meeting, they said gastric bypass would be covered. This begins my jouney to get the surgery.
First, I made an appointment to see the doctor who I thought was in the plan. After about three weeks, a nurse from my insurance company, Theresa, called me and said that I needed to switch doctors. I talked to Theresa for quite awhile asking questions about what I had done so far (psych eval, nutrionalist) and she said that was all I needed. I was so excited. So I made an appointment with a different doctor - Dr. Beall. This was the first part of May and I got the apointment for May 24. Everyone was so kind. I met with Dr. Beall, and he explained what he would do. I met with the nurse, Debbie, and she was great. She has had the surgery so she can talk from experience. During my visit, Dr. Jereb faxed my psych eval in and they had everything they needed. Then I met with the person who did the insurance, Teresa. She was very re-assuring and had dealt with Aetna before. She recommended that I contact the insurance company in about 3 weeks, just to nudge them. When I contacted Theresa at the insurance company, she did not have any information. So I called Teresa at Dr. Beall's office and learned that Joni was now doing the insurance. I left a message for Joni to call me. She did not. I called again and again and finally on June 25, she returned my call. She told me that Teresa had quit and left all the files in terrible shape and it took her a long time to find mine. She said that they had just received Dr. Jereb's report and everything looked fine. I told her that Dr. Jereb had sent his report the previous month and that I couldn't understand why nothing had been sent to the insurance company yet. She apologized and said she would send it that week. I spoke with Theresa with Aetna and told her what was going on. Theresa tried to call Joni, but Joni did not return her calls either. The bottom line is, today is Aug 19th, and I still don't have a date. Yes, I needed to get some extra blood work, but a friend of mine, who had her appointment 3 weeks after me, is scheduled for surgery tomorrow -- perhaps. Joni called her Friday night and said that she had sent pre-approval letters to the wrong insurance company, and now she is not approved. She and her husband are to meet with Joni tomorrow at 7 a.m. to see if they can fix this mess. Long story short, sometimes it isn't the insurance company who holds up everything.
I hope to hear something tomorrow to schedule my surgery.
