Hoping for some advice from the experts!

[FloridaJen]

Is Lindstrom still a go-to attorney for appeals?

 

[Munchkin]

I wish you the best of luck! Doing the best thing for you is not always the easiest thing. I had my DS when the surgery became less scary than what the rest of my life was going to be if I did nothing. My regret is that I didn't do it a lot sooner. Like in my 20's!

I saw my surgeon at my 6 week checkup and that was it. Done. He was a cutter, I had been cut, and lived to tell about it. His job was done. Since then it's been my job to manage my care.

Read that EOC and see where you stand. You will have a clearer picture of your options then. In the meanwhile there is a lot to read here.

 

[FloridaJen]

I wish you the best of luck! Doing the best thing for you is not always the easiest thing. I had my DS when the surgery became less scary than what the rest of my life was going to be if I did nothing. My regret is that I didn't do it a lot sooner. Like in my 20's!

I saw my surgeon at my 6 week checkup and that was it. Done. He was a cutter, I had been cut, and lived to tell about it. His job was done. Since then it's been my job to manage my care.

Read that EOC and see where you stand. You will have a clearer picture of your options then. In the meanwhile there is a lot to read here.

I just worry about needing any kind of complication surgery. And there IS so much to read here, for sure.

 

[DianaCox]

Benefits booklet is generally NOT the EoC, which is the actual insurance contract. You get it from HR, not the insurance company. And while you’re talking to HR, ask if the insurance plan is self funded or fully funded.

 

[FloridaJen]

Benefits booklet is generally NOT the EoC, which is the actual insurance contract. You get it from HR, not the insurance company. And while you’re talking to HR, ask if the insurance plan is self funded or fully funded.

.

I will try. Our benefits person sucks.

 

[DianaCox]

If you don’t get the answers you need from the benefits person, demand to speak to their supervisor.

 

[FloridaJen]

If you don’t get the answers you need from the benefits person, demand to speak to their supervisor.

Oh I will!

 

[Larra]

Benefits booklet is likely just a "summary of benefits" and will not provide specifics. Tomorrow get ahold of your HR and get the ball rolling. Again, be prepared for ignorance, but go up the food chain until you find someone who knows what an EOC is.

 

[JackieOnLine]

I hope you get what you need - glad to see you posting here, getting good advice.

 

[Larra]

I haven't seen Lindstrom's name for years.

 

[FloridaJen]

I haven't seen Lindstrom's name for years.

he seems to still be around helping people!

I heard back from the one bariatric place (does not do DS) that was the one who brought up the "Once per lifetime" and she informed me the surgeon who removed my band is no longer practicing and they do not have any records on me. My Mexico band doctor is dead. So she said as long as my medical records don't talk about the band, I should get approved. They are listed as previous surgeries on all my new patient paperwork at various doctors (and of course the document they had me fill out) - wouldn't this count as medical records?

Also, you guys were not joking about the EOC. Here is my exchange below (and also 2 calls to Florida Blue)....

Me:
I am having some issues with our benefits and have hired someone to help me navigate an appeal. I need to get a copy of our EOC (evidence of coverage). This would be a long document that shows the details of the contracts/agreements for coverage. I was told this comes from HR, I cannot get it through Florida Blue. Could you please help me attain this or point me in the direction of someone who can?

HR:
Good Morning Jennifer,

Florida Blue members advocate would be able to assist you with your request. The phone number is (800) 352-2583 Monday – Thursday 9 am to 5 pm ET and Friday 9 am to 6 pm ET. In addition, you will find requested documents by setting up an account on the Florida Blue website at www.floridablue.com and clicking on the icon Benefits & Coverage at the top of the page.

Please do not hesitate to contact me if you need further assistance.

Me:
Good morning, I’ve already done this. I was told this document comes from HR.

HR:
Please provide the name and phone number of whom at Florida Blue has given you this information. I would like to share this information with our Florida Blue account manager.

Me:
I don’t have a name and I called the number on the back of my card. On the phone again now with number you provided to see if someone new can help me, she is saying the same thing, her name is Kecia.
Are you familiar with the Evidence of Coverage? It’s really the contract between us and Florida Blue, so HR should have it.

HR:
I will forward your request to the Florida Blue account manager.

 

[Larra]

Remember to always get the name, job title, and phone number of each person you contact, and keep a record of this with date and time and brief summary of conversation. I don't know if it will help or not in the long run, but you never know.
Also, when you run into a road block, don't hesitate to ask to speak with a supervisor. Be polite but persistent. And get the name, job title, etc for the supervisor, too.