Waiting on insurance now.

[star0210]

Oh that's so damned frustrating!

 

[JackieOnLine]

it's terrible they make you wait like this, just stupid

 

[brooklyngirl]

Oh man, that's so frustrating! I guess you found out the hard way that you're dealing with people that need to be pushed every step of the way

 

[jim1969]

"Good morning! This is your daily (or first call of the day) inquiring about the status of my submission for insurance approval. Why sure, I'll put my life on hold while you pretend to look at the stack of papers on your desk and tell me "it's still in the queue!""

I called them today just to make sure they received everything. I will check in every day to see how things are going!

 

[jim1969]

OMG Jim!! That really pisses me off!!! I know you already know this, but you have to assume and expect failure in EVERY single step of the way and do what Diana said, ride their F@*#& asses every step of the way. Unfortunately, that applies to pretty much everything in life now days, not just this. Every goddamn once in a while, you will actually meet someone whom actually gives a &@&& and will actually go out of their way to help you, but...thats the exception.

I've been watching your story for a while now and have been very patient and you have PAID your GD dues and I sincerely hope you get good news real soon!

Im glad I didn't wait for a month before I called them. I agree about paying my dues! I have never had such a hard time accomplishing any thing in my life. It seems since I started this if it can go wrong it will go wrong!

 

[jim1969]

Interesting day! Just to shed some light on how confusing my insurance is I will try to explain. My insurance card say's Forward Health but it is Badger Care Plus through the state of WI, United health Care is the HMO. So Dr Leslie's office sent my PA to Forward Health which requested more information but sent the request to the wrong hospital. After we straightened that all out Dr Leslie's office sent in the information Forward Health requested. So since then I have been calling the last couple days and checking the status of my PA. Today I called and was told that my PA was not suppose to be sent to Forward Health it was suppose to be sent to the HMO. Really! Why did they request more info? Then she tells me my HMO has changed as of April 1st and I would need to resubmit my PA to them. I Knew my HMO was going to change since last week. Something my wife forgot to mention. So I guess they have 14 days to get back to me.

 

[chevtow]

Anything to make the process difficult. Do you have a plan in place for the campground while you recover?

 

[jim1969]

Anything to make the process difficult. Do you have a plan in place for the campground while you recover?

Not yet, was hoping to have had surgery already. Ive been getting as much stuff done now as I can, Just in case they finally approve me! We open May 1st but only one really busy weekend from then until mid June.

 

[robs477]

Dang Jim....I really, really feel your pain. Just hang in there man, you're doing all the right things. It will bust through when you least expect it and then happen very quick.

 

[Will2014]

Man! So sorry to hear of your problems Jim. Take Larra's advice and be persistant. Remember also, there can be MANY reasons for DELIBERATE delays as well. These can occur if your doctor has a vacation planned, they are heavily booked for one month...but really wide open another, etc. Sometimes it's just bureaucracies being foolish, but other times it's by design I'm afraid. Just always remember: the squeaky wheel gets the grease!!

 

[GirlFriday]

Jim - I have to know where you are in the process. Have you heard anything?
I feel for you, I really do.

 

[hilary1617]

Jim, I'm sorry they've put you in insurance purgatory...

 

[jim1969]

Dr Leslies office called yesterday and the insurance denied my PA. I have not received my letter yet but Leslies office said, It was for two reasons.
1. They are not in the network. 2. My sleep Apnea is being controlled with my CPAP machine so its not necessary. Like I said this is 2nd hand and I am waiting for my letter to verify this info. I really think this is very week for denying me what do you guys think?

 

[DianaCox]

Yes, it's weak, but they are hoping you won't know how to appeal. But you do.

Not being in-network is not a good excuse, if there is nobody in-network who can do the surgery that has been recommended, then they have to provide access to an out-of-network surgeon.

Remind me what the requirements are for WLS on your plan. If your BMI is over 40, the NIH and Medicare guidelines for qualification for surgery do NOT require ANY comorbidities.

 

[jim1969]

Yes, it's weak, but they are hoping you won't know how to appeal. But you do.

Not being in-network is not a good excuse, if there is nobody in-network who can do the surgery that has been recommended, then they have to provide access to an out-of-network surgeon.

Remind me what the requirements are for WLS on your plan. If your BMI is over 40, the NIH and Medicare guidelines for qualification for surgery do NOT require ANY comorbidities.

It reads, The member has a BMI greater than 35 with at least one documented high risk, life limiting comorbid medical condition capable of producing a significant decrease in health status that are demonstrated to be unresponsive to appropriate treatment. There is evidence that significant weight loss can substantially improve the following comorbid conditions:
Sleep apnea.
Poorly controlled Diabetes Mellitus while compliant with appropriate medication regimen.
Poorly controlled hypertension while compliant with appropriate medication regimen.
Obesity related cardiomyopathy.