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!