I want to share this with others so they will not get discouraged by insurance games and to speak up if they feel slighted. Silence does nothing…phone calls mean very little, writing letters makes people take you seriously. Once you have their attention, you can get answers and ultimately results.

My insurance company approved my surgery with no problem. However, because I did not meet all of the criteria health wise I was going to be stuck paying $1000.00 to my surgeon and up to 20% of all of the costs for surgery. However, I could be moved from the “Standard” coverage to the “Choice” if my physician wrote a letter waiving the requirement. Of course my doctor wrote the letter right away. Then my insurance company tried to say my cholesterol was a problem too, it is 182 (anything below 200 is GOOD) and my LDL (the bad cholesterol) is 126 and my doctor says under 130 is good. My insurance company stated that because I have problems with my heart (DUE TO MY WEIGHT!) that they needed my LDL to be 100 or less and they wanted me to lose an additional 18 pounds before my surgery on June 23!

So I got mad, really mad. I sent a letter to the President of my Priority Health and gave him the details of my situation in bullet points and ended the letter with a formal request to meet with him. In less than 5 days I got a call from the customer service senior liaison that reports directly to him. Ms. N was very helpful and she told me what was needed specifically from my physician to get moved to the Choice program. It certainly felt like jumping through hoops and thankfully it was just an additional letter to my doctor and a visit to her office to have her make changes on my form. I don’t agree with the additional hoops, and the war on words but in the end it worked. My physician said what was necessary from the start, she just didn’t use the exact works PH wanted on the form. Had I not fought this…it would have been thousands of needless dollars spent. Now they are going back three months and making adjustments. I am now 100% covered for my surgery and all of the tests with my cardiologist, physician, sleep apnea doctor and bariatric surgeon will be reviewed and updated! Yay me!

Now I can focus on surgery on June23, 2014 and not insurance company hassles. I am glad I stayed vigilant and didn’t give up. Yes, it took time, letters and follow up to make it happen, but it was worth it in the end. So if you are facing similar challenges, my advice to you…start writing letters, making calls to get names and addresses of decision-makers, do not take no for an answer. Document EVERY conversation! Get the names and extensions of the people that you talk to every single call. Have a note pad handy and take notes on all conversations.

I created a three ring binder for my surgical journey with tabs:

Primary Care Doctor
Bariatric Center and Surgeon
Testing and Results
Insurance Company
Letters
Surgical Pre Information
List’s of things needed at hospital and after surgery

All have come in handy and it has been a great to have everything in one place! 38 days until surgery.