:(

My appeal was also denied...time to move on....so, so sad!

I'm kinda in denial about my denial! Well, actually I've accepted in and feel like I'll never be approved and need to come up with another plan. I was denied due to a lack of a 2 year history of obesity and lack of 6 months worth of doctors visits. Actually based on the insurance's criteria of a BMI of 35 with comorbidities, I qualify...not understanding this at all. I submitted another doctor visit, so I should be covered as far as that goes.

I have been dreading a call to my surgeon's insurance rep but made that call today. I asked her about a peer to peer consultation. She said that she submitted an appeal 2 days ago....she thought that is what was discussed when we last spoke. I was excited to hear that. She apologized for not calling earlier to communicate that the paperwork was sent off. I was excited to hear that it was sent! She anticipated another 30-60 day wait to hear anything.

I have been considering what other options to look into as far as weight loss goes. I guess my plan for now will be to wait until I hear word about the appeal. Maybe the planets will properly align and I'll get approved! hey....a girl can dream can't she!

DENIED

Boohoo!

I called the insurance company again...denied. They said they called the surgeons office on the 10th. Ya know, the surgeon's office who assured me that they would call the minute they hear something! GRRRR! The Aetna rep couldn't tell why I was denied, but said that the surgeon's office could request a peer to peer consultation. Can I just add that it pisses me off that the insurance company can't give me a reason and the couldn't explain policies when I called earlier!?!

Still waiting!!!!

Last week, I hardly thought about surgery at all! I know that sounds like an amazing feat, but honestly, I was distracted....and not the good kind of distracted! Just as my best friend and I were finished lunch, she got a call....a bad call. A neighbor had noticed smoke ROLLING out the front door of her house! The house that she had left not even an hour earlier! (While most of their Possessions survived the fire, pretty much everything sustained sever smoke damage. They will not be able to return home for many months! :(  I'm still in shock 4 days later!) Anyways, she actually asked me if I had heard anything on Friday afternoon. I hadn't, but quickly called the insurance company before the weekend...you know, JUST in case they had made a decision. They said my claim was still pending. Ugh...that's all I have to say!

Fingers crossed!

Here's a recap of my recent events....on April 20th, I called my surgeon's insurance gal, we'll call her Jodi (because that's her name.) I called inquiring if she received all the paperwork she needed and she said that she had just received the last documents that day and would forward it along. She would call me as soon as she heard something.

I called my insurance company on the April 29 (after DAYS of worrying) just to confirm that they got everything they needed ;) She said that they JUST got everything that day. It was now in the patient management area, "sitting there" and waiting to be reviewed.

This morning I get a call from Jodi stating that insurance needed a weight from 2009. She said she called my clinic and they didn't have one, but wanted to know if I had been seen anywhere else. I haven't. She said that my 2008 weight was to light, and she would tell the insurance company that I had not been seen in 2009.

So...I sat for a few hours, questioning, wondering.....and then I had to call again. I called my insurance company to ask them a few questions. My policy requires a BMI of 40 w/o co-morbidities or 35 with. I, do have high blood pressure. I wondered if because I do NOW, if that applies my 2008 weight because if it does, I SHOULD be ok. I knew that my BMI was over 35 then. They didn't know (insert eye roll) and suggested I call Jodi. Really? I asked if I was considered "denied" and she said that my case was considered "pending." She also added that they had the claim since the 20th. Hmmmm...a bit of conflicting info here! I felt a little better, but still had questions that needed to be answered!

So, I called Jodi and waited patiently for her to return my call. First, I asked if my high blood pressure was documented. She believed it was, but was uncertain how it would affect previous weights. I told her that I had a history with high blood pressure and was on meds with all my pregnancies. Then I fessed up and said that I hadn't been the best at yearly appts and kinda just went off the meds after delivery. She giggled and said "we call that a noncompliant patient." Yep, that's what I was!

Jodi said that she would call my clinic again and try to pull more info to help paint a picture. She said that she had the direct number of the gal handling my insurance claim and would let me know as soon as she hears anything. I had to ask, "so , does this mean that I should lose hope?" "Oh, no" she said "don't give up hope, we'll keep working on this."

And, for some reason, that made me feel better!

Getting CLOSER!!!

I called my surgeon's office today to see that all the paperwork that was supposed to get there did...AND IT DID! She said that it just got there yesterday in fact (though I've been waiting nearly 3 weeks!) She said that she would send it to insurance and she would call me when she heard their decision. She said the typical turn around is 2-3 weeks. (However, I've heard that Aetna has a fast turn around rate.)

Cross your fingers and your toes that they approve!

The Wait Begins..I mean continues!

Last week officially marked 6 months of weight checks with my doctor. The next step is waiting for the clinic to compile my records and pass them along to the surgeon. Then more waiting while the assemble the info to submit to insurance. THEN, even MORE waiting while insurance approves (or Lord forbid denies) my "claim."

Even though it has been probably 8 months since I started REALLY deciding if weight loss surgery was the route I needed to take, I think the next few weeks/months will be the hardest. I am NOT a patient person. I HATE waiting. God speed, medical records......God speed!

6 months of Appts

Tomorrow is the last of my appointments documenting 6 months of weight checks! I am so excited! The next step is waiting (impatiently) for the doctors to pull together all of the necessary paperwork and submit it to insurance for approval! YAY!

Blogger FAIL!

I would like to say that it was the weather, or the holidays, or being busy that has caused me to stall  for the last (gulp) few months, but it's not. It's me! I've been at this place many times before....when the going gets tough, I give up! I don't like to fail...nobody does, but by giving up, I am doing that exact thing!

I "know" what I need to do. I "know" that I need to start journaling, stop making excuses and exercise more frequently. I am doing many things well, and I acknowledge that, but I need to do alot more things...and do them consistantly! Now just to get my head and body working on the same team.

Just a few more weeks and it will be time to submit my paperwork! I'm excited and scared. It seems like I've been waiting for so long, but then again, it seems like I just started. At times, having WLS was all that I could think about! Then, it subsided for awhile, but I think I'm on the path to be it consuming again. I want to be prepared, but realize that I'll also have to figure some things out as I go.

My dream is becoming closer to reality!