Updated: Livid!! Am I just being irrational? Now APPROVED!

[DSRIGGS]

Both hospitals were in network for our BCBS PPO

 

[DianaCox]

"Either I will be on my way to California to finally get the life changing and saving surgery I fought for a year to get.....or I will lose my approval and with no further rights to ever appeal....and I will not be getting the DS and have no hope of ever getting it."

Um, that is a catastrophizing more than a little. You can get your approval extended - you just explain that you and your surgeon had a professional falling out, especially after she failed to advise you to stop taking HRT prior to surgery and unnecessarily and unprofessionally put you through physical, emotional and personal hell by failing to provide proper and appropriate pre-op consultation and advice. And point out to them that if she tries to BILL them for the day-of-surgery costs, they should refuse to pay it, since she is at fault for the surgery not happening that day (unless she then tries to stick YOU with the bill!). And why would you think that you would not be allowed to resubmit? And you could change jobs, insurance companies, etc.

 

[Amey]

At this point I don't know that I feel safe considering 3 of 5 proctored DS surgeries have had major complications or wound up as a sleeve only.

I have obamacare insurance with the only plan in Idaho that even has an exception to an exclusion for bariatric surgery. There are only 2 companies in SE Idaho that offer it in their ins plans... 1 is the Federal Government and the other is an insurance company that requires you to sell a certain amount of insurance to qualify for their insurance.

Dr Medvetz and the hospital assured me when they sent me home that I would not be charged or billed for anything that day. She admitted it was her mistake and apologized for not looking at my file sooner.

I have now been off the estrogen for a month.... And at the time of the surgery she said that the proctor would be back on May 11th to do surgeries that week so it would work out perfectly.

On Monday at the 'pre-op' appt she told me that I had to lose 40 pounds in 30 days or she wouldn't touch me and that if I wanted it bad enough I would find a way to make it happen. I have gained 40 pounds since my very 1st appt in September last year. Since then I had my band out where I gained 20 pounds in the following 6 weeks and I gained 10 pounds in the 3 weeks since I was off estrogen. (I was never weighed that surgery day and it didn't seem to be an issue). I told her that amount of weight in that time frame was impossible and that people that have this surgery don't even lose that and it wasn't healthy. She told me that another woman lost 50 pounds... Then her nurse said yea but she weighed like 500 pounds and Dr M have her a dirty look. She also asked me how I could let myself get to be this big.... That I'm bigger than I was that day she was going to do surgery and she would not opera recon me if I weighed more than I did at my first consultation in September last year before she took my band out. And she said that she didn't even know if the proctor could be here by July to do my surgery. I asked her if I needed to find another surgeon and she just shrugged her shoulders and said it's up to you and walked out.

I think that the disaster of that Saturday really angered her and the proctor felt like he came here for nothing. Being the pain in the ass that I am.... I called Dr B's office in PA to see if I could make an appt for the 12th. Yup sure enough he's not going to be in Idaho that week. I think he is pissed and she is embarrassed and frustrated. The office stopped returning my calls after that surgery disaster. Who's to say I won't wake up with just a sleeve or that I'll have to go to another dr to fix a leak that she won't take responsibility for... Or that if I lose 39.9 pounds that she still won't do surgery....or what if I only lose 15 pounds? Or she finds some other reason? I have lost 8 pounds since Monday. I know the first week is always the biggest loss... So I'm starving with no '9 more days left' to know when it will be over.... It's just indefinitely.... And that's really frustrating to think this could all be for nothing.

I'm so confused.... Part of me says to jump ship sooner rather than later and pray that I can get the provider changed....that taking a chance with her isn't worth the risk of her flaky rules and complication rate. Another part of me says that 'I would do anything for this' and jumping through her flaming hoops and taking that risk with her is doing just that.

I really thought getting the approval would be the end of the frustration and hell. But it's just opened another door in Pandora's box. I don't understand why it has to be this hard. I just want to be healthy and not be lied to or have the rug pulled out from under me anymore. Everybody says to find another doctor.... And I truly don't feel secure or safe with her.... I feel like I'm between a rock and a hard place.

 

[DianaCox]

You need to change surgeons - no doubt about that. But you seem to have a choice between Simper and Keshishian - so pursue both and see who can get you in soonest/least cost, since they are both good choices, and then GO. But make sure you talk to the insurance ombudsman on Monday and get it in writing that (1) you can change to another surgeon, and (2) that you can get an extension on the approval in case it takes longer to get on one of the surgeons' schedules.

 

[Larra]

What @DianaCox said. You have your approval. You have good options for surgeon. Get yourself scheduled with one or the other and look forward and not back.

 

[Amey]

I know I can get an extension... My insurance has already told me that. So that part I'm not worried about.

I emailed my approval docs to Dr Simper's office on Tuesday and was told to call back on Friday to see what they found out. When I called she had not even looked at my stuff... Told me to call back Monday. And that she needed to talk to Dr S or McKinley to see what they said. And could not tell me how far out they are scheduling.

I filled out the online form for Dr K on Wed. On Thursday Kristina called me and had already talked to my insurance. For ***** and giggles I filled out the link on their page for financial assistance and was approved for a loan for travel costs and the program fee. And she told me they are currently scheduling for end of May.

Of course Simper would be less expensive..... But Dr ks office seems more on the ball.

My insurance company told me this.... That they can't have 2 active numbers for the same surgery. It was suggested by a supervisor (incidentally the same one that was a total bitch before is sugary sweet now and even gave me her personal extension and returns phone calls) that on the authorization request that the Dr's office writes to request that it be processed and a decision made pending and before the other approval # is voided because once it's voided it can't be undone. The supervisor said that she couldn't guarantee that the medical management team would grant the request but it couldn't hurt.

The Dept of Insurance ombudsman, Kate Frank, has a call in to my insurance regarding the change of provider and has requested an answer by the end of next week. I'm going to wait to submit anything to my insurance until I hear from her. But I'm guessing they are just going to tell her the same thing they told me and Kristina at Dr Ks office. That a new provider requires a new request for pre authorization and the process starts over. However.... I have an APPROVAL for the surgery. So I guess that makes it all complicated. However... And this is what I keep going back to... When I had my band out I had originally gone to Simper for a revision. The ins approved the band removal but denied the revision to DS. Dr Medvetz's office used that authorization to move the provider to her as I doesn't see a point in traveling 8 hours for day surgery. BUT.... That was a straight-forward approval...... Not one that was forced on them by the Dept of Ins.... And I don't know if that would be the same as before or if the rules change. That's what I'm hoping a Kate Frank can clarify for me.

 

[Susan in Tennessee]

I know I can get an extension... My insurance has already told me that. So that part I'm not worried about.

I emailed my approval docs to Dr Simper's office on Tuesday and was told to call back on Friday to see what they found out. When I called she had not even looked at my stuff... Told me to call back Monday. And that she needed to talk to Dr S or McKinley to see what they said. And could not tell me how far out they are scheduling.

I filled out the online form for Dr K on Wed. On Thursday Kristina called me and had already talked to my insurance. For ***** and giggles I filled out the link on their page for financial assistance and was approved for a loan for travel costs and the program fee. And she told me they are currently scheduling for end of May.

Of course Simper would be less expensive..... But Dr ks office seems more on the ball.

My insurance company told me this.... That they can't have 2 active numbers for the same surgery. It was suggested by a supervisor (incidentally the same one that was a total bitch before is sugary sweet now and even gave me her personal extension and returns phone calls) that on the authorization request that the Dr's office writes to request that it be processed and a decision made pending and before the other approval # is voided because once it's voided it can't be undone. The supervisor said that she couldn't guarantee that the medical management team would grant the request but it couldn't hurt.

The Dept of Insurance ombudsman, Kate Frank, has a call in to my insurance regarding the change of provider and has requested an answer by the end of next week. I'm going to wait to submit anything to my insurance until I hear from her. But I'm guessing they are just going to tell her the same thing they told me and Kristina at Dr Ks office. That a new provider requires a new request for pre authorization and the process starts over. However.... I have an APPROVAL for the surgery. So I guess that makes it all complicated. However... And this is what I keep going back to... When I had my band out I had originally gone to Simper for a revision. The ins approved the band removal but denied the revision to DS. Dr Medvetz's office used that authorization to move the provider to her as I doesn't see a point in traveling 8 hours for day surgery. BUT.... That was a straight-forward approval...... Not one that was forced on them by the Dept of Ins.... And I don't know if that would be the same as before or if the rules change. That's what I'm hoping a Kate Frank can clarify for me.

Amey, I see the odd situation you are in and feel your frustration. With your surgery made possible by the overturning of your insurance determination by the insurance board, I'd be scared someone in the medical offices will screw it up by doing something out of order, etc, giving your ins a way to say, sorry, you blew it, sister! It does sound like you are doing all you can to be cautious and in the right order. Hopefully the ombudsman will help a lot. Just make darn sure everyone in the dr offices knows it's a "special" approval and it only lasts until a certain date, etc. sometimes humans hear the first part of what we say, then assume they already know the rest of what you are going to say and stop listening, .thus the funky part of your situation goes right by them, without being comprehended! It does sound like from your dealings and many others too, that Dr. K's office is very efficient.

 

[Amey]

Dr. Simper's office is submitting paperwork to my insurance company today. The finance company from Dr. K's site said I could use the loan for Dr. Simper...soo YAY for half the debt and being closer to home. Please send me prayers, swinging critters, crossed fingers, toes and bra straps my way that my insurance company will okay the change in provider and not use this as an excuse to cancel my authorization all together.....and that the current surgeon will allow the transfer without putting me through more hell. I'll just over here in the corner holding my breath......

 

[Susan in Tennessee]

Dr. Simper's office is submitting paperwork to my insurance company today. The finance company from Dr. K's site said I could use the loan for Dr. Simper...soo YAY for half the debt and being closer to home. Please send me prayers, swinging critters, crossed fingers, toes and bra straps my way that my insurance company will okay the change in provider and not use this as an excuse to cancel my authorization all together.....and that the current surgeon will allow the transfer without putting me through more hell. I'll just over here in the corner holding my breath......

is there seriously a way the current surgeon could NOT allow the transfer? I hope it all goes smoothly for you!

 

[Larra]

Sounds like a plan is almost in place. I'll cross fingers and toes but leave my bra straps out of this!

 

[Amey]

Technically they could make it hell for me - require me to make an appointment at my cost to 'talk about it', or tell me that I'm just bailing out because I don't want to follow the rules and that I will never be successful and make me feel like total worthless ****. Or they could send it in to my insurance as a VOID instead of a TRANSFER which would totally **** me. I wouldn't put anything past them at this point.

 

[newanatomy]

Good luck!!

 

[Charris]

Good luck!!

@Amey they are putting you throw it but remember YOU GOT THIS. You got your denial over turned. They are trying to to tire you out. Exhaust you so you throw you white flag in. You have come this far take a deep breath, gather your thoughts, and don't give in. It's a shame how the do people. I wonder if we paid our premiums the way they provide service would there be a change in their behaviors?

BTW***I'm so glad you got rid of Dr. M. Someone needs to knock her azz Off her high horse and remind her you pay her salary and she works for the patient. What a b****! My mom always said no women doctors for her because they are B******! lol I'm sure not all are but having worked in the hospitals as a RN for over 40 years she swore by it

 

[Amey]

@Amey they are putting you throw it but remember YOU GOT THIS. You got your denial over turned. They are trying to to tire you out. Exhaust you so you throw you white flag in. You have come this far take a deep breath, gather your thoughts, and don't give in. It's a shame how the do people. I wonder if we paid our premiums the way they provide service would there be a change in their behaviors?

BTW***I'm so glad you got rid of Dr. M. Someone needs to knock her azz Off her high horse and remind her you pay her salary and she works for the patient. What a b****! My mom always said no women doctors for her because they are B******! lol I'm sure not all are but having worked in the hospitals as a RN for over 40 years she swore by it

I don't know about female doctors....I have hated every one that I've had except my current PCP. She orders all the blood tests without question and just put 'standing order' on them so that I can go in to the lab anytime to have them run without an appointment with her. I don't even think she looks at the results....she knows I keep track of them and will call her if I have any concerns. She is an MD that is also a naturopath so she treats the whole body and not just the symptoms. And...she is looking forward to learning about my surgery. So....I'll keep her for awhile lol.

 

[Charris]

I don't know about female doctors....I have hated every one that I've had except my current PCP. She orders all the blood tests without question and just put 'standing order' on them so that I can go in to the lab anytime to have them run without an appointment with her. I don't even think she looks at the results....she knows I keep track of them and will call her if I have any concerns. She is an MD that is also a naturopath so she treats the whole body and not just the symptoms. And...she is looking forward to learning about my surgery. So....I'll keep her for awhile lol.

Yup she sounds like a keeper