Sorry that I have not been
around, but I have just been patiently waiting to hear back from my insurance
company whether I have been approved or not. Throughout this process I have
come to the conclusion that my surgeon's office staff is totally incompetent.
Last week I received a letter from my insurance company that they needed more
information (the basics- psych eval, nutritionist, physical exam, etc.) to
review my case (shouldn’t this have been submitted originally?). This was good, as this time I finally had a
reference number to use when calling them as in the past 4 submissions I had
nothing to reference. Well I used that
reference number this morning and here is the latest in my saga...
I called my insurance
company this morning because I have stopped relying on my surgeon's office for status
updates as they never have a clue and bad news they told me I was denied for
the lap band. The reason - a BMI of 39.6 with no comorbidities. I am really confused
as to why my BMI was listed at 39.6 as the doctor said I had a 41 BMI. Even
with that, I still can't believe they denied me because of 4 pounds!
Ridiculous!
I spoke with my doctor's
office this afternoon and they said that most likely my insurance company used
a different BMI calculator to calculate my BMI. I am really frustrated because
according to my calculations I do have at least a BMI of 40. I know that I am right on
the edge, but seriously to deny me for 4 pounds is ridiculous! My doctor's
office said that my only option is to appeal with a letter about how unhealthy
I am. They can't resubmit or adjust the numbers, I can only appeal. I am not
sure how this will work as they denied me because of 4 pounds and if I don't
meet the requirement, I don't meet the requirement. My other concern is why
didn't my doctor consider that they might use a different calculator? They
submit to Anthem on a daily basis and they should know the ins and outs.
Argh!!!
I am devastated,
frustrated, upset, beyond words about all of this. I am seriously considering going to Mexico as
an option. I spoke with Dr Ortiz's office in TJ today and I can be in surgery
in just two weeks! All for less than my deductible/ copay and my doctors stupid
$3000 program fee. I should have just gone to Mexico in the first place. Anyone use Dr. Ortiz?
Sorry for the rant but
this is from 6 months of frustration.
Cheers,
Robin
Oh poor you. It must be so frustrating. There are quite a few bloggers who have gone to Mexico for surgery but I can't remember who there surgeons are.
ReplyDeleteHow would surgery over the boarder fit with getting fills and aftercare from your local provider?
Go check out Amanda Kiska's blog - Amanda's Waning. She had surgery in Mexico, and it was an awesome experience. She's a big ol' rockstart, too, and lost over 100 lbs, I believe. If you check my followers you can find her picture, and if should link to her blog. Good luck, love...so sorry for all this garbage.
ReplyDeleteI'm so sorry! I had to pay for my surgery on my own. I didn't go to Mexico though. I used a doctor here and it was $10,000, but now it's gone down to $8,888.
ReplyDeleteAndrea, what part of the country are you in? My surgeon charges $23K! I can't imagine $8888! May be worth the trip!
DeleteYour post has me really scared. I am at 39.1 BMI now and I am 3 months into my 6 month weight loss program. I am planning to start gaining a few pounds but I didn't want to gain more than a few (6 gets me back to 40 BMI by my calculator). Do you mind telling me your insurance company? I am so happy (that is weird) you found out you have sleep apnea...you should be successful on your appeal. I can't self pay because they want $23K!!! Not happening. Mexico really scares me and I know my husband would not like that idea. Keep us posted!
ReplyDeleteMy insurance is Anthem Blue Cross of California. They are sticklers. You should be okay as you are under a supervised WLP. I really hope that I can be approved with the sleep apnea, because I don't really want to have to use a CPAP for the rest of my life. Good luck with your approval. I wish you the best!
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