Insurance Dissapointment - Big surprise!
BCBS of Illinois sucks and so does my doctors office. Here's the scoop. Had my 6 month nutritionist visit last monday and handed the paperwork to the girl that had my 5 year history of obesity. Called insurance next day didn't receive fax so I waited to wednesday and still didn't receive fax. I asked what info was needed on the cover page and called my doctors office and had to leave a message on the "insurance specialist's" to tell her how to do her job. Called thursday and they received the paperwork. I knew they wouldn't have an answer on monday, but I figured what the hell and gave them a call. The insurance company tells me that they can not review my request for surgery because they don't have 5 years of obesity history and that I did not have 6 months of Medically supervised nutritionist visits.
I said what do you mean, I went Jan 14, feb 14, mar 14, april 14, may 14, and jun 14 - 6 consecutive months, 6 doctors visits. Oh no she said. Jan 14 to feb 14 only counts as 1 month and so on, so I need another month to make 6 months. To make a long story short this sucks. If they wanted 180 damn days they should say that. Oh well - what they say goes, but they still suck.
I called my doctors office and they said oh no you did the 6 months and I said the insurance company said I didn't and I need to schedule another appointment. I said I need july 14th and she said sorry I have the 8th or the 26th. I said unacceptable I want the 14th the 8th is too early. She said she has to talk to the doctor. She put me on hold, came back and said I can come on the 13th. I said, no the 13th will be too early. She said fine, how about the 15th. I said that will work thank you. Then I asked to be transferred to the "insurance specialist". I got her live on the phone and told her they didn't receive my 5 year obesity history that I gave her. She told me she faxed it and doesn't know why they didnt receive it. I asked if she could fax it again and she said, no - she will wait until my next visit with the nutritionist - shes a punk!
Luckily I made backups of all my paperwork and to make a long story short I will be faxing my insurance company the paperwork personally. I don't need any more delays. My big question is that the doctors office deals with insurance companies all the time. Why would they not know about the 180 day = 6 months rule. Seems strange that they were "shocked" when I told them.
I expected this though. I heard that this particular insurance sucks, so I am not surprised I have hit my first brick wall. Who knows what else they will throw at me.
I will win this battle! I will not be defeated! If I have to hire a lawyer if I get denied after my "official 6 months" next month I will. I will not take no for an answer! I will be a VSG'er if its the last thing I do!
PS. BCBS ILL - YOU SUCK!!!!!!!!!!!!!!!!!!!
D
PSS. DONT trust your doctors office to be competent - they probably aren't!!!!!!!!!
I said what do you mean, I went Jan 14, feb 14, mar 14, april 14, may 14, and jun 14 - 6 consecutive months, 6 doctors visits. Oh no she said. Jan 14 to feb 14 only counts as 1 month and so on, so I need another month to make 6 months. To make a long story short this sucks. If they wanted 180 damn days they should say that. Oh well - what they say goes, but they still suck.
I called my doctors office and they said oh no you did the 6 months and I said the insurance company said I didn't and I need to schedule another appointment. I said I need july 14th and she said sorry I have the 8th or the 26th. I said unacceptable I want the 14th the 8th is too early. She said she has to talk to the doctor. She put me on hold, came back and said I can come on the 13th. I said, no the 13th will be too early. She said fine, how about the 15th. I said that will work thank you. Then I asked to be transferred to the "insurance specialist". I got her live on the phone and told her they didn't receive my 5 year obesity history that I gave her. She told me she faxed it and doesn't know why they didnt receive it. I asked if she could fax it again and she said, no - she will wait until my next visit with the nutritionist - shes a punk!
Luckily I made backups of all my paperwork and to make a long story short I will be faxing my insurance company the paperwork personally. I don't need any more delays. My big question is that the doctors office deals with insurance companies all the time. Why would they not know about the 180 day = 6 months rule. Seems strange that they were "shocked" when I told them.
I expected this though. I heard that this particular insurance sucks, so I am not surprised I have hit my first brick wall. Who knows what else they will throw at me.
I will win this battle! I will not be defeated! If I have to hire a lawyer if I get denied after my "official 6 months" next month I will. I will not take no for an answer! I will be a VSG'er if its the last thing I do!
PS. BCBS ILL - YOU SUCK!!!!!!!!!!!!!!!!!!!
DPSS. DONT trust your doctors office to be competent - they probably aren't!!!!!!!!!
Plastics - Extended Tummy Tuck - February 6th 2013
(deactivated member)
on 6/20/11 10:33 am
on 6/20/11 10:33 am
When I had my first surgery I had to go for 7 visits - the first visit is considered a "consult" and then the next 6 months meet the criteria. Also it took about 6 times faxing it to BCBS of MN for them to receive everything. My doctor faxed it and kept all logs referencing when it was sent and etc.
Good luck!
Good luck!
I'm a believer in everything happens for a reason... while this seems like a setback, it also gives you a 2nd chance to lose weight before the final paperwork is submitted.
You've got until July 15th, so go (NOW!) and set yourself up on MyFitnessPal and log everything that passes your lips from this point forward: no more bread, rice, potatos, sodas or anything with sugar in it. If you want the VSG, you have to prove to your insurance people (and yourself) that you can do this... there's no time like the present, especially given the timeline you're working with right now.
Keep your daily total under 30g of carbs (lots of deli meat and cheese got me through it) and make sure you get in a minimum of 64oz of water every day... you WILL lose weight if you stick to that plan. Even if it's not a lot, just showing them that you can commit to it and you can lose will go a long way towards working in your favor for an approval.
Good luck!
You've got until July 15th, so go (NOW!) and set yourself up on MyFitnessPal and log everything that passes your lips from this point forward: no more bread, rice, potatos, sodas or anything with sugar in it. If you want the VSG, you have to prove to your insurance people (and yourself) that you can do this... there's no time like the present, especially given the timeline you're working with right now.
Keep your daily total under 30g of carbs (lots of deli meat and cheese got me through it) and make sure you get in a minimum of 64oz of water every day... you WILL lose weight if you stick to that plan. Even if it's not a lot, just showing them that you can commit to it and you can lose will go a long way towards working in your favor for an approval.
Good luck!
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On June 20, 2011 at 5:42 PM Pacific Time, LittleMissSunshine wrote:
I'm a believer in everything happens for a reason... while this seems like a setback, it also gives you a 2nd chance to lose weight before the final paperwork is submitted.You've got until July 15th, so go (NOW!) and set yourself up on MyFitnessPal and log everything that passes your lips from this point forward: no more bread, rice, potatos, sodas or anything with sugar in it. If you want the VSG, you have to prove to your insurance people (and yourself) that you can do this... there's no time like the present, especially given the timeline you're working with right now.
Keep your daily total under 30g of carbs (lots of deli meat and cheese got me through it) and make sure you get in a minimum of 64oz of water every day... you WILL lose weight if you stick to that plan. Even if it's not a lot, just showing them that you can commit to it and you can lose will go a long way towards working in your favor for an approval.
Good luck!
Plastics - Extended Tummy Tuck - February 6th 2013
My doctor's office faxed documents to the insurance company too but since I had been reading different posts on this site where they had problems of the same manner I decided to go one step farther and everything the doctor faxed I sent certified mail (made them sign for it) no games that way.
May God Bless
Wow! That is horrible, and the complete opposite of my experience with BCBSIL. I don't know if it makes a difference that I'm PPO, and not HMO. Because I'm PPO, I ended up having to pay a little over $1100 for the surgery as well as $600 for the upper GI and $300 for the surgeon. I don't know if that makes a difference in how quick they are to approve (not sure which you have).
I can't believe you're having to deal with all this. Seems like you are at the mercy of whomever picks up your file that day.
Ridiculous!
I can't believe you're having to deal with all this. Seems like you are at the mercy of whomever picks up your file that day.
Ridiculous!
Plastics with Dr. Sauceda 6/8/12!! - LBL, BL/BA, Arm Lift & Medial Thigh Lift
On June 20, 2011 at 5:54 PM Pacific Time, Eileen36 wrote:
Wow! That is horrible, and the complete opposite of my experience with BCBSIL. I don't know if it makes a difference that I'm PPO, and not HMO. Because I'm PPO, I ended up having to pay a little over $1100 for the surgery as well as $600 for the upper GI and $300 for the surgeon. I don't know if that makes a difference in how quick they are to approve (not sure which you have).I can't believe you're having to deal with all this. Seems like you are at the mercy of whomever picks up your file that day.
Ridiculous!
Plastics - Extended Tummy Tuck - February 6th 2013
That sounds very much like my plan. $500 deductible, $2000 max out of pocket plus $100 per day hospital stay. I have BCBS TX and was approved in just a few days (had met all requirements -except psych eval- LONG before considering WLS). One more appointment and you should be good to go... It will definitely be worth the wait!!
SM- So sorry you are going through this after you have jumped through all of thier hoops!
I have Highmark BCBS-PA Because my hubby works for Intalco/Alcoa in Ferndale WA. I checked out all that too and figured I don't want someone telling me what to do for 7 more months of my life! I want to get done with it. A lady for the place I am going says they don't do that to discourage people!! What!! I would say fine to 3 months but half of a year is ridiculous! Also, they just got done paying 42,000 for a hip replacement surgery for me. I dont' want to go through that again but if I don't get the weight off quick, will end up doing the left hip!! They don't even think of how much money I will be saving them in the long run!!
I have taken the bull by the horns and have my first apt wed. 22nd and want to schedule the surgery asap!! I've been on a good diet since Feb. and can document the weighs so there shouldn;t be a problem!!
So, it is like I am buying a new car!! Cheap one at that at $15,000. I have 2 antique cars I drive and a 97 chevy blazer. Those are my vehicles and hubby has more. So, like buying a new car!! I am so excited!!
Good luck to you and don't let them off the hook!!
Don't you also have a case manager for your BCBS plan?
Go look it up and see you can even talk to them just for support!
Hope it all works out!!
Heleena
I have Highmark BCBS-PA Because my hubby works for Intalco/Alcoa in Ferndale WA. I checked out all that too and figured I don't want someone telling me what to do for 7 more months of my life! I want to get done with it. A lady for the place I am going says they don't do that to discourage people!! What!! I would say fine to 3 months but half of a year is ridiculous! Also, they just got done paying 42,000 for a hip replacement surgery for me. I dont' want to go through that again but if I don't get the weight off quick, will end up doing the left hip!! They don't even think of how much money I will be saving them in the long run!!
I have taken the bull by the horns and have my first apt wed. 22nd and want to schedule the surgery asap!! I've been on a good diet since Feb. and can document the weighs so there shouldn;t be a problem!!
So, it is like I am buying a new car!! Cheap one at that at $15,000. I have 2 antique cars I drive and a 97 chevy blazer. Those are my vehicles and hubby has more. So, like buying a new car!! I am so excited!!
Good luck to you and don't let them off the hook!!
Don't you also have a case manager for your BCBS plan?
Go look it up and see you can even talk to them just for support!
Hope it all works out!!
Heleena
I think there is something also about what your actual plan is...how things are covered!
I saw a great link from a surgeon who says there is no known reason for there to be a 6 month diet phase! That patients loose the same whether there was a diet or not! He felt it is so unfair to put the final stab at an obese person of making them wait another 6 months after proving their 5 years of overweight status. Plus, the ins. company is forcing people to go without so end up spending so much more on that person in the long run!! I will try and attach the link.
Wishing you the best SM
Heleena
I saw a great link from a surgeon who says there is no known reason for there to be a 6 month diet phase! That patients loose the same whether there was a diet or not! He felt it is so unfair to put the final stab at an obese person of making them wait another 6 months after proving their 5 years of overweight status. Plus, the ins. company is forcing people to go without so end up spending so much more on that person in the long run!! I will try and attach the link.
Wishing you the best SM
Heleena
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