Panic mode!!! Now what do I do??

[CaraOC]

so I'm about 80lbs down from my DS on February 4th of this year. As you all have read here I've been plagued with hip arthritis and associated pain. I've had cortisone shots and what not but my mobility has worsened and the pain increased so my doc sends me off to the orthopedic surgeon and he tells me it's time for the total hip replacement. I thought that was where I was going so I decided to just get it over with so I'm scheduled for surgery next month. I've been doing the pre surgery stuff as instructed and still limping and bitching about in the meantime. Today I had to do a hospital total joint orientation class. Boring but I sat through it (discretely placing words with friends with Diana Cox). I get my mail today and I'm now in shock and disbelief !! It's from asshole CIGNA saying they aren't gonna cover it cause it's not medically necessary!!!!????WTF? How can this be? I don't know what to do from here. I paid for my WLS cash because my insurance has an exclusionary Claus but seriously? Why would anyone have a hip replaced that wasn't medically necessary ??? I think I'm gonna need a drink and re read their letter. I need an attack plan. I need this surgery. Im limping about like an idiot and I can't even take pain meds now in prep for surgery that I thought I was having!!! Is it normal for insurance assholes to play this game?? Help and advice PLEASE.

 

[Munchkin]

Read your actual real policy and see what it says. When your doc filled out the paperwork, did he not say it was medically necessary? Get ready to appeal. I'm sure you can get this sorted out! Ridiculous!

BTW, I just spent 2 weeks taking care of a friend who had THR in July. Even just a couple days postop she said the difference in her pain levels from preop was huge. She wished she had done it sooner.

 

[DianaCox]

You know the drill - PM Larra and me with the denial, your EoC and hip replacement policy, and get a copy of the request for precert your orthopod submitted and we'll sort it out.

 

[southernlady]

With Diana & Larra to help, this will be sorted out.

I am gonna move this to the non-WLS area tho.

 

[Susan in Tennessee]

oh, crap, just what you don't need, more stress on top of your PAIN! Sounds like a job for "Super Insurance Women" and we all know who they are! I'm betting your side wins. Congrats on the 80 el-bees you've melted away!

 

[Larra]

Idiots!, No, not you @CaraOC the idiots at the insurance company. The reason people have hip replacement is pain. 99% of the time, maybe more, there is no other reason people put themselves through a hip replacement (or knee, etc). I bet that surgeon does them every week, and almost every patient got to him for the same reason you did.
Get your policy, find out what the surgeon submitted (though given that this is his bread and butter he probably didn't screw this up) and we'll go from there. there are sadly lots of policies that exclude bariatric surgery but I've yet to hear of one that didn't cover hip replacements.

 

[CaraOC]

Idiots!, No, not you @CaraOC the idiots at the insurance company. The reason people have hip replacement is pain. 99% of the time, maybe more, there is no other reason people put themselves through a hip replacement (or knee, etc). I bet that surgeon does them every week, and almost every patient got to him for the same reason you did.
Get your policy, find out what the surgeon submitted (though given that this is his bread and butter he probably didn't screw this up) and we'll go from there. there are sadly lots of policies that exclude bariatric surgery but I've yet to hear of one that didn't cover hip replacements.

Thanks Larra!! No shit I'm in pain and in prep for surgery I'm off all pain meds!! Or NSAIDS anyway, and that's all that works really. I just emailed @DianaCox the letter insurance sent me. I may be a nurse but I'm an idiot when it comes to insurance so I might need you to take me by my sweaty fat hand and talk me slowly, and avoiding big words through this. I just got back from the hospital where I continued on like this hasn't happened and had my pre op stuff done. EKG, labs, urine, MRSA swab. I'm scheduled already for September 1st. Is this gonna happen?? Do I need to take a hostage?? I'm in if needed.

 

[CaraOC]

You know the drill - PM Larra and me with the denial, your EoC and hip replacement policy, and get a copy of the request for precert your orthopod submitted and we'll sort it out.

Diana, I just adore you (even though you kick my sorry arse repeatedly at Words with Friends), but I told you I'm an idiot and I don't know what the above "PM or EoC" is??

 

[CaraOC]

I did quite a bit of research into finding the best Mexican bariatric surgeon, with whom I am well pleased, but HELL no to crossing the border for a new hip!! I pay way too much for health insurance it's about time it fucking paid for something!!!!!

 

[DianaCox]

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[southernlady]

@CaraOC to PM Diana..click on her avatar (the small photo of her). And overlay will pop up and do "Start a Conversation". You can also add Larra OR if you click the checkbox below the text box that says "allow others to add people", then Diana can add Larra.

 

[marissamast]

Does the insurance company even see how RIDICULOUS that sounds? What? People just go around saying "Hey! A hip replacement sounds fun! Let's get one of those!" And what Dr would recommend one that wasn't medically necessary? SMH!