Been A Long Time

Jan 31, 2012

Well, I haven’t updated since before my 1^st nutrition class back in December. I am 4 classes in. Technically my 90^th day is  tomorrow to qualify for the Multi-disciplinary regimen for what Aetna requires. The classes have been quite informative at the Wellspan Medical Weight Management Program in York, PA. I have found that they aren’t quite prepared for the 90 day regimen. Their program is designed for the 6 month supervised diet.    In this program one should attend 1 nutrition class per month. I have been doubling up on classes each month because I’m trying to get everything in 3.  This journey teaches you a lot about patience.  I’ve run into some annoyances along the way.  

1. I called in early December and made an appointment with the surgeon. He was booked until Jan 23^rd.
2. I tried to set up my pych eval and pulmonary testing so that it could already be done when I met with the surgeon. They wouldn’t give me an appointment until after I met with the surgeon first…….Really?
3. Finally had appt with surgeon last Monday. It went ok until I tried to discuss Aetna’s insurance requirements with his nurse (who takes care of gathering and submitting info to the insurance co.) and she knows nothing about it. Keep in mind that this woman has been doing this for years. I think she’s been with him since he’s started doing these surgeries which I know has been at least 10 years. So then she asks me if I have a copy of Aetna’s policy.   I pull it up on my phone because I didn’t have a copy with me. She starts reading it but she’s totally disregarding the 3 month requirements. She then asks me to fax it to her. I say ok but I’m getting a little concerned that my paperwork won’t be submitted properly because she’s clueless. I thought Aetna was a pretty popular insurance plan. So I get paperwork so that I can set up my pysch eval appointment and they tell me that someone will call me in a week about the pulmonary testing. Ok Great!
4. Psch eval- I call and make an appointment. They tell me that I have to bring in the paperwork that the surgeon’s office gave me within 48 hours to reserve my appointment. Ok great. They said they could get me in on Feb 1^st at 10:30am. I stop past the office to drop off the “important” paperwork that same evening and the woman at the desk tells me that my appointment isn’t in the computer and someone else is now scheduled for that time…….Really!!?? Luckily they have another appt at 2:30 but that meant I had to rearrange my Drs. Appt with my PCP to an earlier time. Thank God he’s flexible (Dr. Ronald Broadwater in Cockeysville is awesome by the way)
5. The pulmonary folks call on Friday the 27^th to schedule my appt…..Awesome!......until they tell me that they can’t see me until March 27^th. Ok so now I’m really annoyed. I say ok but I’m not happy about it. Are these folks really that busy? 
6. So I call and left a message for my surgeon’s nurse to ask if she received the insurance requirements policy that I’d faxed to her and also if she could refer me to a different pulmonary office so that I could see if they could see me sooner. She calls back and says no about the pulmonary because they will be the folks present during my surgery. (Even more annoyed) Here’s the kicker; yes she received the insurance requirements but I may as well do the six months because the only insurance company’s that she knows of that you can do 3 months is BCBS and some other ins co that I could care less about. I replied as nicely as possible “Why do I have to wait 6 months when the policy clearly states that you can choose 3 months?” Her response “If they deny you it will take another 3 months to appeal.” Now I’m really uncomfortable. Uncomfortable to the point that I don’t think I want her submitting anything for me. She’s not sure and she’s not trying lo learn or reach out to Aetna so that she submits everything properly.

  Here’s my frame of mind right now. A co-worker at my office has just started the process and has enrolled in GBMC’s program. She met with her surgeon for the first time today (Appt was scheduled in 2 weeks). They know about Aetna’s policy and told her up front that she could do the 3 month. I called them and told them about my situation and they told me to get my nutrition and pych eval records so that I wouldn’t have to start from scratch. All I need to do is attend an Information seminar, schedule an appt with the Dr and go from there. So the saga continues...

I'll try and update sooner. :)

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