Big day on Monday: final answer from insurance (maybe)

I'm in need of zen, prayers, crossed fingers and toes, whatever you've got!

I may be entering the final round of this appeals mess on Monday. That is the day of my husband's employer's benefits review board. One of three things is going to happen: I'll get a yes (final answer), a no (final answer) or a we need more info, which will delay things yet again.

My policy doesn't qualify for the affordable care act independent review, so it all comes down to this. I have been working with Walter Lindstrom's office (a HUGE help - if you need help navigating the appeals process, CALL them) and they have sent over 120 pages of information to the benefits contact, had conversations with her, helped her prepare her documentation for the board, etc. At the moment, things are about as good as they're going to get.

We were not able to find out which criteria they will use to evaluate my case - United Healthcare's or the best practices provided by the American Society for Metabolic and Bariatric Surgery, or perhaps some new criteria we're not aware of. If we do United, I MIGHT prevail; if we do ASMBS, I will probably win. Third party: who knows.

Kelley at Lindstrom's office remains optimistic that we'll win. I am just wrung out and numb over all of this waiting.

I should know late next week what is going on. Good thoughts gratefully appreciated until then!

If this fails, I believe I have an option to keep gaining weight to get me over the 40 BMI threshold and resubmit in July (6 months after initial submission), or worst case, wait until 2014 when this policy will fall under affordable care act and be required to do external review. Then again, perhaps surgery won't be covered. Hubby has assured me we'll do private pay if need be in 2014.

Have I told you that I just want to get on with my life?

Thanks for reading this far...

Good luck with your approval!

I will be praying that everything works out for you and that you get a big YES on monday.    Insurance companies are SO stupid IMHO not approving surgery.   Don't they realize they'd probably get the cost of the surgery back by not having to pay for all the medications that people take.    Geezzz....anyway  I will keep you in constant prayer and have some of my friends do the same.   I am believing God to make this happen for you.

 

Hugs and blessings ~~~ Vivian

I am swinging a chicken for you that the answer is a resounding yes! Thanks for the update and let us know how it goes.

Prayers are coming your way!!! I hope you get good news today!!!!!