Delays. Impatience. Venting.

I just want to know already!  A little rant.  I began in June by attending the WL seminar at the local Hospital, one of two "Center's of Excellence" my insurance requires that are local. I decided the sleeve was a good option for me, I wanted to rid myself, hopefully, of diabetes, high blood pressure, high cholesterol & triglycerides.  I also wanted to improve my energy, stamina, endurance, ability to exercise and to improve the way I look & feel about myself, a little boost to the self esteem.   I scheduled and kept all the necessary appointments, paid out my copays and out of pocket expenses.  I was, in the end, denied.  Not by the insurance company mind you, by the surgery center.  Long story.  By now, it's the end of August and I've wasted time and money.  I transferred my information to the other "Center of Excellence" and started over.  This is a pretty busy practice so even though I had completed most of the requirements, there were a few more requirements with this center, and I had to repeat the Psych exam which was one piece of the medical history they were not allowed to transfer and have a sleep study. I had to wait several weeks to get into the Psych Dr and then more for the appointment with the surgeon.  Finally, at the end of September I see the surgeon.  She says I am a good candidate but since I take a PPI and have had issues with acid reflux she wanted to exam the condition of my stomach lining (which I agree, and am thankful she suggested) so I needed to complete an endoscopy and upper GI (to check for hernia).  Since I am vegetarian and had trouble with the previous nutritionist relating to it, as well as having issues with a weak upper body when it comes to weight/resistance training she wants me to visit with their nutritionist and their exercise Dr to develop a plan so I can exercise and avoid injury (a problem I have had in the past)   This is NOT covered by insurance though and several visits pre and post op as well as phone and email access comes package priced at $600.00.  I agree with the decision to see these experts but I also want to see the insurance approval before paying out the money.  I was told I needed to give their insurance specialist a few days to submit for the approval and it took about 7-10 days to get word back from my insurance. That was over 3 weeks ago.  We scheduled the appointments a few weeks out to make sure the approval was secured first.  Fast Forward... My endoscopy and upper GI had to be rescheduled because I developed a cold.  It was 3 weeks until the next available appointment.  So, I will not get these done until mid almost the middle of November.  Then, I checked with my insurance company last week to see if a decision had been made and they claim no one had submitted for approval.  The coordinator at the Dr's office claims to have faxed the information but the insurance denies getting it.  It was resubmitted last week.  Since my $600 appointments were scheduled for the 24th of Oct, and the insurance company was now saying they wanted 15 days to make a decision, I had to reschedule those appointments as well.  Also for Nov.  I learn today that they forgot to set up the upper GI with the endoscopy, so now I am awaiting word if it can be coordinated with my other procedure or not.  Tick Tock.  While I had them on the phone, I ask if they could look to see if there was anything back from the insurance company (wishful thinking) and I was told there were notes but she couldn't interpret them and transferred me.  I got voicemail.  I decided to call the insurance company to see what it was about.  I was told that the requested supporting documentation on the same day they resubmitted for approval but had not yet heard back from anyone.  I am frustrated!  Now, I KNOW I am not the only patient, and that there are probably many people sitting around waiting for their information to be processed too but come on already!  I am ok waiting to get the actual surgery, but I just want to get the freaking approval already!  I feel like I have to babysit the whole process.(Had I not checked myself who knows how long it would have been before they realized the information was not received)   I'll feel better about the process once I know it will actually happen.  Right now I feel as if I am just spending all this time and energy on something I don't even know will happen, and I have been doing it since June!  When I switched hospitals I had this pipe dream that I would have my surgery by the first of November.  Now I am hoping for sometime in December.  I've asked family for ideas for Christmas gifts so I can shop now, but they laugh and tell me it's not even Halloween yet. I am trying to just go with the positive vibe that everything will work out, that I need to prepare for the eventuality that I won't feel up to doing the "holiday" things in December and just do them now anyway.  For having an insurance company that didn't have any supervised diet, or other criteria to meet (I was told originally that it would take 2 months tops to do all the necessary appointments, get info submitted, get approval and the surgery done!) if approved, it will be closer to 6 months!  At least 5 months to hear a YAY or NAY.  Sigh……   Ok, for anyone still with me, thanks for "listening" to my vent.  It's just all getting to me at this moment.  

You were denied by the first surgical center, and THAT was the long story? Do you think it's possible this center will deny you for the same reason?

Sorry for rambling, but I was frustrated and needed to vent.  YES, the first surgical center WAS a longer story, believe it or not.  No, I wouldn't be denied for the same reasons, if I am denied it will be by the insurance company (I see no reason to expect that).  The Surgeon at the new center has already cleared me.

I think this is crazy I'm sorry and good luck hope everything works out

Everyone gets frustrated - it generally takes longer than anticipated.  Time usually lags because all those appointments and testing have to be coordinated.   Six months seems to be standard time-frame.  I always asked to be put on "cancellation" list so if someone else cancelled at the last minute, I could grab that slot.  (Got in to see dietician two months earlier than scheduled because I happened to stop by office because I had PCP appt. in same building - and dietician had open appt. for the next morning.)

First question, though, is why were you denied?  You say you were denied by the surgeon's office - not your insurance company.  I assume you've discussed the denial with your new surgeon's office and you're confident you'll be approved?  Also, my insurance company took their full 14 business day allowance to approve my surgery.  

Inch by inch, step by step, it will happen!  I was careful not to become "a thorn in their side" when calling the doctor/insurance office - did not want to **** them off - always said I didn't want to become a nuisance but had to coordinate with work and family.  They were okay and would say don't worry, feel free to call anytime.  Always called them by name too.

Good luck.  I'll keep my fingers crossed for you.

Can I ask why the first surgeon's office denied your surgery?  That's so unusual unless there was some medical or psychological reason.

It REALLY is a long story, with a lot of detail, if you want the entire picture.  When I tell it in it's basic form, it usually just raises questions and I end up having to tell more and more of it until it becomes a long story. (or people make assumptions about the detail that are all wrong)  LOL  But, hey, I'll give it a shot.  No guarantee's it will be short, just shorter than the whole story…..  ;-)

I'm a light weight, BMI about 36-37, co-morbities x4.  Did everything asked of me, passed the physical and met all medical requirements.  Met with Psych.  She was a real oddball on a power trip.  She told me during the session there were "a few things" she'd like to see me work on before clearing me, they would be in her report.  She said all this meant was that instead of getting surgery in a month, it might take few months. When she finally turned in the report and there was NOTHING in it for me to "work on".  It's like she forgot or something. (it did take her 3+ weeks to return it, and it was only supposed to take 7-10 days) Very odd. The surgeons office just said she did not clear me.  I protested. They said I needed to talk to her if I wanted explanation. Called her 3 times, never did she return my call. Surgeons office said they would review my entire file and make a determination.  They called me 2 weeks later to say they were not going to clear me (mind you I have not yet even met the surgeons) I was told the Dr's didn't feel I was "sick enough" for surgery.  Again, I protested citing that based on their seminar and stated qualifications, I was "sick enough" During my physical, the Dr raised no concerns about me "not being sick enough"  The Nut was concerned about me getting in my protein, but I followed her plan and proved I could do what was asked and was even able to exceed the protein requirement.  I was cleared for the exercise portion with no mention of "not being sick enough"  

I was however "sick enough" when they took all my co-pays and out of pocket expenses.  

I was talking with a Blue Cross Health coach and she, without details, told me that another patient had a similar experience at this same surgery center.  Denied by the Psych with no real explanation, denied surgery by the surgical staff after meeting the qualifications.  The ONLY thing we would think of was that there was something during the Psych exam or process that led them to believe that I might not be as successful as they hope patients will be and it would effect their "scores" to remain a Center of Blue Distinction with Blue Cross.  

I'm vegetarian, which came up in the psych exam and with the NUT.  The NUT didn't like it, she kept telling me how difficult it would be, instead of helping me find ways to make it work. She argued against protein drinks after the first couple of months. So maybe that was it, maybe they didn't think I would get in the required protein, maybe I was too "out of the box" especially if their numbers were iffy to begin with.  This is all speculation.

At the new surgery center, I AM apparently sick enough and they are willing to work around the vegetarianism, and I passed the Psych with flying colors.  

Now, on to the waiting game….

Thank you for your response.  Sounds like you're with a better program now and will move forward.  Very best of luck to you.