freedomquest
07/20 verbally denied.
Jul 23, 2009
Okay so they called on Monday and told me that I was denied on the basis that VSG didn't have enough evidence that it was as efficacious (effective) as the other Bariatric surgeries out there. Why did they wait so long to tell me that? I asked in November, January, May and they still had me go through all that crap when I put in my letter in May the Medical Code for it and told them all along that is what I wanted.... AAAAARRRRGGGGHHH!! I railed on her for my entire lunch about how badly this was handled. That they could have told me when I asked in November. That was the Dr. & Nurse people on the East coast called Health Care Strategies who supposedly make the medical determination for my local insurance co who just takes HCS opinion/recommendation. Then I called my local provider and railed THEM for another half an hour. I was mad. Then I wrote an appeal letter, but I don't think I'll use it cause I was so mad. The Insurance GURU here on OH (Vicki) is going to send me template and I will use that as well as some suggested links of info that several other OH users gave me when I posted on a forum.
I am so thankful for all the people on this site. I'm an OH addict and I feel like it's one giant community where we are all aiming in the same direction and everyone wants you to suceed... Very few places in the world like that. LOVE OH.
Later
0 comments
I am so thankful for all the people on this site. I'm an OH addict and I feel like it's one giant community where we are all aiming in the same direction and everyone wants you to suceed... Very few places in the world like that. LOVE OH.
Later
Tests done and faxed in
Jul 18, 2009
So I finally got the lab orders from my doctor and went to the lab on Friday before work... All the stuff used to have to be sent down to the states and then back so I was suprised to be told I could pick up my results after work on friday... But I didn't have time for the Chest X-Ray so I went after work and got it done. I had to wait until this morning to pick up the results... so another trip to the big city just to pick up results...1 hour drive each way.... nice. BUT I got them all together with a letter from Dr. A (that he is a member of SAGES) and my letter explaining why I want to go out of my preferred provider area.... SO.... I've done all that. I've done all they asked of me. IF they deny me again I will be pissed. I've given them everything. If it comes from a doctor they approve in 1 week but since I'm not a doctor they have to hassle me? REALLY??? Hmmm... We shall see I suppose. I wanted to be recovered from surgery by my birthday... At this rate it looks like i may not even get to HAVE surgery by my birthday... It's August 17th. I'd like to have the surgery done by August 1st.... but I don't see that happening now that it is July 18th....wow.
Okay enough P & M for now (Pissin & Moanin)
Later
0 comments
Okay enough P & M for now (Pissin & Moanin)
Later
frustration
Jul 07, 2009
So once again on the day I was going to call the insurance they called me. They said they needed more stuff from me.
They needed the following:
A letter from the Surgeon that he is a member of the American Bariatrics Association (or the Mexican equivalent)
A Chest X-Ray
An EKG
The following Labs:
Liver
Endocrin
Lipids
CoAg(ulations)
And some others I can't remember. THey said it was because I was going self pay. My insurance company is through the local Union but the Health Strategies people back east are the ones that make the rules and requirements. These folks have a hard time with a Surgeon outside of the US and with Self Pay they gave me a bunch of hassle but my local people here that I called said it's no problem. But they say I have to meet the medical requirements placed by Health Strategies.
SO then my PCP is like why to they need an endocrin study for pre op? I'm like I have no idea. I don't even know what it is!!!
The surgeon doesn't deal with insurance and apparently the insurance company isn't used to dealing with people (vs Doctors) You know, I pay THEM to be my insurance company, they should make it easy for their members not more difficult. If I had gone to the local surgeon I would've been approved in a week.
But when I asked HS what all documentation I needed to have for a determination they said the letters from PCP, Psych eval, Nut and PCP's notes so that's what I sent them. Now it's more. SO now I gotta make an appt for some freakin lab work that could have been done. SO I also had some lab work done but that was over 30 days ago, so it's too old now... I am feeling frustrated and angry because they could have told me this when I asked. I was trying to avoid this situation.
ok. I've babbled enough for now.
later
0 comments
They needed the following:
A letter from the Surgeon that he is a member of the American Bariatrics Association (or the Mexican equivalent)
A Chest X-Ray
An EKG
The following Labs:
Liver
Endocrin
Lipids
CoAg(ulations)
And some others I can't remember. THey said it was because I was going self pay. My insurance company is through the local Union but the Health Strategies people back east are the ones that make the rules and requirements. These folks have a hard time with a Surgeon outside of the US and with Self Pay they gave me a bunch of hassle but my local people here that I called said it's no problem. But they say I have to meet the medical requirements placed by Health Strategies.
SO then my PCP is like why to they need an endocrin study for pre op? I'm like I have no idea. I don't even know what it is!!!
The surgeon doesn't deal with insurance and apparently the insurance company isn't used to dealing with people (vs Doctors) You know, I pay THEM to be my insurance company, they should make it easy for their members not more difficult. If I had gone to the local surgeon I would've been approved in a week.
But when I asked HS what all documentation I needed to have for a determination they said the letters from PCP, Psych eval, Nut and PCP's notes so that's what I sent them. Now it's more. SO now I gotta make an appt for some freakin lab work that could have been done. SO I also had some lab work done but that was over 30 days ago, so it's too old now... I am feeling frustrated and angry because they could have told me this when I asked. I was trying to avoid this situation.
ok. I've babbled enough for now.
later
NUT approval....
Jul 04, 2009
Wednesday I went to my NUT meeting... (kinda funny one NUT to another!! LOL!! ) She was a Nutrionalist and I was the nutty one!! Really, it was good to talk with her, I learned a few things I didn't know, I learned a few things that I was right about/doing and I learned a few things I was wrong about / doing... It was about 1 1/2 hour long meeting but it ended with her approval and encouragement for me to have the surgery and she gave me the orginal letter to walk out with that night. The next morning, Thursday, the 2nd of July I faxed her letter to my contact at the insurance company. I am going to give her a call on Monday to make sure she got it since a lot of places had a long weekend since the 4th fell on a Saturday.
I am hoping the insurance will come back with a quick approval and then I have to get the financing, I will use a loan from my 401K and then maybe try to get a signatue loan from my credit union for the rest. The insurance company told me that they would reimburse me as soon as they got my bills so I should be able to pay off the loan quickly and then the loan from my 401K would have a low interest rate, they take it right out of my check and the interest goes directly back into my 401K which is nice since my employer does not contribute to our 401K's...So it will benefit me to use as much as I can from my 401K and pay myself the interest....
So that is where I stand now... waiting once again. But I am still all over the OH pages looking at other peoples pages, pictures, blogs and chats... It is so helpful and so inspiring to read all this stuff from SO many other people going through the process. I really want to thank so many people for sharing what can be a very painful, private and sometimes embarrasing stories... I should go thank everyone in the VSG Forum for all they have contributed... I think I will...
Enough babble for now..
Later....
0 comments
I am hoping the insurance will come back with a quick approval and then I have to get the financing, I will use a loan from my 401K and then maybe try to get a signatue loan from my credit union for the rest. The insurance company told me that they would reimburse me as soon as they got my bills so I should be able to pay off the loan quickly and then the loan from my 401K would have a low interest rate, they take it right out of my check and the interest goes directly back into my 401K which is nice since my employer does not contribute to our 401K's...So it will benefit me to use as much as I can from my 401K and pay myself the interest....
So that is where I stand now... waiting once again. But I am still all over the OH pages looking at other peoples pages, pictures, blogs and chats... It is so helpful and so inspiring to read all this stuff from SO many other people going through the process. I really want to thank so many people for sharing what can be a very painful, private and sometimes embarrasing stories... I should go thank everyone in the VSG Forum for all they have contributed... I think I will...
Enough babble for now..
Later....
Insurance called me....
Jun 24, 2009
Well, yesterday, one week to the day, my insurance called me and said they had received my letters and they called Dr. Alvarez's office but they needed one more thing... a letter from a Nutruitionist. Well, when I first started the 6 month diet thing that doctor told me that the nurse who weighed me and went over my diet log was a nutruitionist and that those sessions would be considered my nutritional counseling. Well after 4 months I switched doctors... I never thought about the nutruitionist thing. SO, I called the office and left a message for the nutritionist. I doubt they will give me a letter since I switched doctors. SO, I called my new doctors office and they gave me a referral and a number to a nutritionist. I have an appointment for next Wednesday. IF in the meantime the original one says they will do a letter, then I'm good, if not then at least I have an appointment set up. My insurance said everything looked good and once they got the letter from the nutritionist then it looked like "we're good to go." Dr. Alvarez's office doesn't deal with insurance companies (not too many will cover this it appears) so I will be going self pay and my insurance will re-imburse. But I want to make sure I'm approved first... That was pretty quick for my insurance company to get back with me. I was going to call them just to check and make sure they had everything, but they called me first... Nice.
0 comments
Faxed in approval request to Insurance
Jun 19, 2009
Well, I faxed in my PCP letter, my Psych letter, my letter and some notes on my wieght loss attempt with that first doctor to the insurance company. Only I think I may have faxed it to the part of the company back east that determines eligility instead of to my local insurance provider. From the looks of others who have my same insurance, when it goes that far then it takes a while... I'm not sure. I faxed it in on Tuesday the 16th of June. I'm going to call next Tuesday the 23rd and try to talk to the same lady I talked to when I faxed all that stuff in. Many other people on this site who posted they have the same insurance I have stated it only took a week for approval, but I know how things can go when I get my hopes up. I quit smoking on the 1st of May and since then seem to have been gaining even more weight even though it seems my eating habits haven't changed much... oh and I also cut out my "fru-fru" coffee every morning, thinking that would cut out a bunch of calories, but apparently I've made up for the loss elsewhere, other wise I wouldn't be gaining weight again... I've been kinda cranky too, small wonder, eh?
Well, I'm doing all this because the ones before me did it and it was such an inspiration and a help to know that I am not the only one out there, so maybe my little blogging will help someone else along too.... Sometimes it feels like it is all taking forever and there is so much I want to do NOW and so much I want done NOW it is so hard to be patient, but I will try...
Enough for today I suppose.
Later
0 comments
Well, I'm doing all this because the ones before me did it and it was such an inspiration and a help to know that I am not the only one out there, so maybe my little blogging will help someone else along too.... Sometimes it feels like it is all taking forever and there is so much I want to do NOW and so much I want done NOW it is so hard to be patient, but I will try...
Enough for today I suppose.
Later
Letters
May 31, 2009
Well, I recieved my recommendation letters from my Primary Care Provider (PCP... hm sounds like a drug not a doctor!!) and one from my Psychologist (when I read everyone's posts and comments they always talked about their NUT, I was guessing they were talking about their Psychologist!!! LOL!! I'm a bit nutty so you might see where I made that connection. I now know that NUT means Nutritionist. Silly me!!! )
I also went online and used the request for approval letter format from obesityhelp.com and found it to be set up wonderfully for me to use! I took out what didn't apply, elaborated on what did and Voila! I had myself a nice professional letter! I really like what OH has done here.
Well, that's about it for now
Later.
0 comments
I also went online and used the request for approval letter format from obesityhelp.com and found it to be set up wonderfully for me to use! I took out what didn't apply, elaborated on what did and Voila! I had myself a nice professional letter! I really like what OH has done here.
Well, that's about it for now
Later.
Psych Eval. DONE!
May 23, 2009
So Thursday I was kinda worried about how my psych eval would go. The doctor was very nice explained everything very thorougly and had a warped and twisted sense of humor like me, so we got along great and it went smoothly and he told me he'd be sending me 4 copies in the mail of the letter to do with what I want...
I had a vacation scheduled from work at the end of June but the surgeon I want to go to (Dr. Alvarez) was going to be at a converence for that last week, so I changed my schedule to have vacation at the end of July. The last thing I wanted to do was move it out farther but without insurance approval in my hot little (fat) hands yet, I guess it is a better thing to have a little more time to get all my stuff done. But still, I want this now, not in 2 months from now... I feel like a spoiled little brat... "I want it and I want it NOW!!!" I scream... Oh well, I will just have to be patient as I really don't have any choice.
Just a quick note to vent a little steam here...
Later.
0 comments
I had a vacation scheduled from work at the end of June but the surgeon I want to go to (Dr. Alvarez) was going to be at a converence for that last week, so I changed my schedule to have vacation at the end of July. The last thing I wanted to do was move it out farther but without insurance approval in my hot little (fat) hands yet, I guess it is a better thing to have a little more time to get all my stuff done. But still, I want this now, not in 2 months from now... I feel like a spoiled little brat... "I want it and I want it NOW!!!" I scream... Oh well, I will just have to be patient as I really don't have any choice.
Just a quick note to vent a little steam here...
Later.
ticker
May 19, 2009
Just checking out the ticker to see how to get it on here, how it looks and how I like it... Took me a while to figure it out and the help on the ticker factory part didn't help so much as the help page on my OH was .....
0 comments
qualifying....
May 16, 2009
I had to switch doctors because the one I was going to for my 6 month supervised diet was not going to give me a referral for the surgery but a referral to only certain specific surgeons. Her husband was one of them and she certainly didn't want to refer me to a surgeon out of the country.
I switched to my parents new doctor and she is awesome. She is going to find me a psychologist to go to for my eval and once I have that done then we can turn in my paperwork for the insurance to get approval. I should hear something this week. Some doctors are unbelievable. I never heard of a doctor saying, yes you need the procedure but we will only give you the referral if it is a surgeon WE approve of. Hey, anyone tell the doctors that they work for US??? I mean I am the one paying for it so it should be MY choice, not the doctors. I would certainly listen to their opinion but I shouldn't be required to do only that... Crazy. And when their prejudices about surgeon's in other countries come into play that becomes pathetic. To be told, well, we don't know what kind of antiseptic they use so we certainly wouldn't send you to them.... OMG!! What, did I just graduate from kindergarten or something???? Whatever. Found a doctor that would listen to me and talk TO me not AT me and treat me like I am a living breathing adult human being. I mean the insurance companies and all their crap are hard enough to deal with then you throw in a holier than thou doctor that is all wrapped up in red tape and that is just mind boggling...
Okay, enough pissin' and moanin' for me for now...
Hopefully I will hear something and make an appointment this coming week. I have 2 weeks of vacation scheduled off from work at the last week of June/first week of July and I am hoping to be able to squeak in to get a surgery scheduled during the first part of my vacation so I can have a few weeks to recuperate from it without having to work... That would be nice... I'm crossing my fingers.
Later.
0 comments
I switched to my parents new doctor and she is awesome. She is going to find me a psychologist to go to for my eval and once I have that done then we can turn in my paperwork for the insurance to get approval. I should hear something this week. Some doctors are unbelievable. I never heard of a doctor saying, yes you need the procedure but we will only give you the referral if it is a surgeon WE approve of. Hey, anyone tell the doctors that they work for US??? I mean I am the one paying for it so it should be MY choice, not the doctors. I would certainly listen to their opinion but I shouldn't be required to do only that... Crazy. And when their prejudices about surgeon's in other countries come into play that becomes pathetic. To be told, well, we don't know what kind of antiseptic they use so we certainly wouldn't send you to them.... OMG!! What, did I just graduate from kindergarten or something???? Whatever. Found a doctor that would listen to me and talk TO me not AT me and treat me like I am a living breathing adult human being. I mean the insurance companies and all their crap are hard enough to deal with then you throw in a holier than thou doctor that is all wrapped up in red tape and that is just mind boggling...
Okay, enough pissin' and moanin' for me for now...
Hopefully I will hear something and make an appointment this coming week. I have 2 weeks of vacation scheduled off from work at the last week of June/first week of July and I am hoping to be able to squeak in to get a surgery scheduled during the first part of my vacation so I can have a few weeks to recuperate from it without having to work... That would be nice... I'm crossing my fingers.
Later.
About Me
AK
Location
39.0
BMI
Surgery
01/24/2011
Surgery Date
Surgeon
May 06, 2009
Member Since
