So I got my approval letter....

[simplyseahorse]

from Blue Cross/Blue Shield, but my surgeon does not have any openings through the end of the year. As expected.

Get to start over in January with United Healthcare. My policy at work says it is covered, but I don't know if they will require 3 months of classes (which I have), 6 months (which I don't know if the 3 month will count as part of) or if they will want documentation of obesity for the past 5 years from primary care physician (easy enough). All of my reading has led me to believe one of the three will be my requirements. Just so frustrated that I did my part and the "patient advocate" dropped the ball for 3 weeks with one of my clearances. When this is over and she can't screw up anything else, I am going to write a detailed not so nice letter explaining what "advocate" means to me and just how far below the bar she fell.

GRRRRRRRR

[Stacey03]

Oh that's a shame. it is such a hard process there in the states, i really feel for you guys. I wonder if they can put you on a cancellation list if the surgeon has no spots. surgeries are sometimes cancelled for all sorts of reasons. You will get there in the end but I know it must feel frustrating XX

[Christie13]

Booo. I am so sorry. That really stinks. It is hard when going through insurance because there are hoops. And I agree with Edie about getting possibly getting on standby. Maybe someone will cancel? Does your surgeon know your situation?? Worth a shot.

[simplyseahorse]

Thanks guys - yes, unlike the UN-helpful patient advocate, the medical assistant at my surgeon's office is awesome, and she said that I am first to call if there is a cancellation. They both know that I wanted to get this done before the end of the year. She is going to try to find out if the 3 months of classes I had will count in case I have to go with a total of 6. We will see.......Appreciate the kind words

[sraebaer]

If you have records of everything you've done so far, hopefully that will count for the new insurance company. It would be no fun starting the hoops all over again. Good luck! Let's hope you get that cancellation for Christmas!

[simplyseahorse]

Here's hoping!

[Pam G]

from Blue Cross/Blue Shield, but my surgeon does not have any openings through the end of the year. As expected.

Get to start over in January with United Healthcare. My policy at work says it is covered, but I don't know if they will require 3 months of classes (which I have), 6 months (which I don't know if the 3 month will count as part of) or if they will want documentation of obesity for the past 5 years from primary care physician (easy enough). All of my reading has led me to believe one of the three will be my requirements. Just so frustrated that I did my part and the "patient advocate" dropped the ball for 3 weeks with one of my clearances. When this is over and she can't screw up anything else, I am going to write a detailed not so nice letter explaining what "advocate" means to me and just how far below the bar she fell.

GRRRRRRRR

can you use a different surgeon?

[simplyseahorse]

Well, I thought about that, but the only other one I am familiar with in that group is already gone for a month (he did my mother's surgery). As irritating as it is, I guess there is a reason I am supposed to wait (or get called in at the last minute). I wish I could tell my work more - my boss knows I am having the surgery but trying to arrange coverage is hard when you don't know when the surgery is going to be.....and I am trying to do the pre-op diet but if I have to do 3 more months of classes I am not doing the strict no carbs at all. Maybe I am supposed to have more time to mentally prepare.

[simplyseahorse]

Well, there was no cancellation before the end of the year, so I got my brand new shiny United Healthcare card and faxed it to my surgeon's office on Tuesday morning - and I got an email from the before-mentioned patient advocate saying that she received it. If I have not heard anything from her by Monday regarding additional requirements, I am going to call the insurance company myself. I am not relying on her to get things in order this time. The 3 months' worth of classes I did should count for something, and I went ahead and joined Weight Watchers before the end of December so that I would be doing something continuously every month. I am not really losing weight, but I guess considering the setback which upset me and the holidays (I went on a cruise),it is good that I am pretty much maintaining rather than gaining........

[DHB]

Well, there was no cancellation before the end of the year, so I got my brand new shiny United Healthcare card and faxed it to my surgeon's office on Tuesday morning - and I got an email from the before-mentioned patient advocate saying that she received it. If I have not heard anything from her by Monday regarding additional requirements, I am going to call the insurance company myself. I am not relying on her to get things in order this time. The 3 months' worth of classes I did should count for something, and I went ahead and joined Weight Watchers before the end of December so that I would be doing something continuously every month. I am not really losing weight, but I guess considering the setback which upset me and the holidays (I went on a cruise),it is good that I am pretty much maintaining rather than gaining........

I'm so sorry for your experience but I think I mentioned just some of the problems I had with my coordinator as well. If I hadn't managed things myself I'd still be waiting. And I ended up in the recovery room for 12+ hours bc she hadn't scheduled a hospital room for me! In any case, you're wise to get involved at every step yourself. I was in regular contact with my insurance company and they seemed to be fine with that.

[simplyseahorse]

Yes you did, and I am not going to let it go this time. We have a "bariatric services" office that does the nutrition visits, verifies insurance and requirements and coordinates classes, all of that stuff, but then our surgeons in the practice also have their own medical assistants who are involved with the scheduling and making sure all of the testing is done before surgery. The medical assistant is great - the advocate, nah. I know it is the beginning of the year and everybody is calling insurance to check on coverage, so I am giving it until the end of the week for her to let me know something. I guess they figure you have already paid the fee (the bariatric services part was not covered by my previous insurance), so what do they care about whether you get the surgery. The surgeon's office, on the other hand, is a little more responsive. I am just ready to be done with it - I know you understand how that feels haha.

[simplyseahorse]

Did I ever send an update? I know you ALL were on pins and needles lol.....

Well, I was correct....of course there are additional requirements - 3 more months' worth of classes but the first 3 did count. I have done January's already. So February and March, and as long as nothing is out of date by then, I should be able to be scheduled in April.

[mandyjdc]

I hope everything goes smoothly from now on for you.

I had to wait almost a year between hoops I had to jump through for insurance and scheduling. There were a few times I almost gave up because my insurance was so strict - I had to schedule my monthly doctor appointments in a window between 28-30 days. If he didn't happen to have a time for me in those few days, I'd have to do the 6 months all over again. Luckily, my doctor is sweet and would stay late to fit me in so that I could get an appointment in that 28-30 day window.

I hope you are able to get your surgery in April!

[simplyseahorse]

OMG I would have a complete meltdown if I had to start all over again! I think they will squeeze me in for that pre-op appointment to get me on the books after these last 3 months - because the medical assistant to my surgeon has called to check in a couple of times - she has been pretty helpful. But you better believe that February 1st or whatever the first working day is, I will be calling to ask about my class for that month and the same with March. I am not leaving anything to another person. I guess you just have to push through all of the red tape. You made it, though, so that gives me hope!