Well, after three weeks of wrangling with my former primary care physician over a medical record the insurance company was demanding...I have finally been approved for bariatric (weight loss) surgery! Also, on the same day---a date has been set! YAAAAY!
The insurance had all of my medical records---or so I thought. They didn't have a medical record for me from 2008. I was under the impression that when I requested copies of my entire record from my former doctor. Turns ot, I was wrong. I'm telling you, there was a great deal of wrangling with the doctor's staff over this one record. It slowed down the entire approval process I actually received a letter from the the insuranc company saying I had been denied for bariatric surgery. Part of the reason? Because they didn't have that one record from 2008. Tuesday, I received a called from the surgeon's office saying the insurance company called and had reversed the denial. Ain't God good?!?
My surgery is in mid-January. Hallelujah! Again, never be afraid to advocate for yourself!
Julius White ~ Radio Talk Show Host of "Talk Back Live" 10:00 p.m. - 12 p.m., Sundays, on 98.7 KISS FM in Birmingham, Alabama
Tuesday, December 21, 2010
Wednesday, December 1, 2010
To be or not to be...approved for weight loss surgery. Toiling with the Health Insurance puzzle
Paraphrasing former U.S. Secretary of Defense Donald Rumsfeld, "there are known unknowns that we know about" when it comes to securing approval for bariatric surgery. It's those unknown surprises that get 'cha. Health insurance companies have so many hurdles for persons seeking "weight loss surgery" to jump over. Some may require a 7 month, doctor supervised, diet and exercise plan, or scaled down 3-4 month version with the candidate being part of a weight loss program (ex., like the national groups that singer Jennifer Hudson reps now), a body mass index of at least 35 with two co-morbidities such as type 2 diabetes, high blood pressure, and proof of a prolonged history of obesity with negative results of anti-obesity treatments.
That is where I find myself now. Stuck in the red tape hassle. Before one embarks on the bariatric surgery journey, there is homework to do. First, you must decide how you will pay for your surgery. Whether your (private) insurance will pay for the surgery and of course, how much the insurance will pay. My insurance company will pay 90% of the surgery, leaving the remaining 10% and whatever is left of my deductible to pay. If you are without health insurance and it's deemed medically necessary for you to have the bariatric surgery, the self- pay option is available. Check with the hospital and surgeon's office about payment arrangements.
Also, there are some instances I've heard about in which the surgeon is able to get insurance companies to sidestep the rigorous rules of weight loss surgery because of the candidate has a BMI of 47 or over, or the candidate has other dire medical needs directly related to their obesity (I can't prove it, just heard about it).
So, I've paid out of pocket for tests my health insurance does not pay for ---h. pylori bacteria biopsi, EKG. The EKG came back abnormal, so I had to have a nuclear stress to make sure my heart, lungs, blood pressure were healthy enough for me to have the surgery. I'm glad to say I cleared those tests. I was especially glad/relieved to know that my heart health is good. By the way, my health insurance did have to kick in for the nuclear stress test.
But now, I'm in a holding pattern. After all the tests, mental evaluations, nutrition and physical fitness consultations went by swimmingly, the insurance company is stuck on medical records from 2008. Out nearly 10 years of records, they have, the stickler is on 2008. My surgeon's coordinator requested my medical records from my former primary care physician for that year, but was told they didn't have any records for me from 2008. Not true, after I pressed the issue. I even contacted the doctor in Montgomery who diagnosed me with sleep apnea to send records to the surgeon's office.
Bottom line...be proactive in all that you do. Don't be afraid to advocate for yourself when it comes to your health. For that matter, don't be afraid to advocate for your friends and family's healthcare. Stay tuned for the next episode!
That is where I find myself now. Stuck in the red tape hassle. Before one embarks on the bariatric surgery journey, there is homework to do. First, you must decide how you will pay for your surgery. Whether your (private) insurance will pay for the surgery and of course, how much the insurance will pay. My insurance company will pay 90% of the surgery, leaving the remaining 10% and whatever is left of my deductible to pay. If you are without health insurance and it's deemed medically necessary for you to have the bariatric surgery, the self- pay option is available. Check with the hospital and surgeon's office about payment arrangements.
Also, there are some instances I've heard about in which the surgeon is able to get insurance companies to sidestep the rigorous rules of weight loss surgery because of the candidate has a BMI of 47 or over, or the candidate has other dire medical needs directly related to their obesity (I can't prove it, just heard about it).
So, I've paid out of pocket for tests my health insurance does not pay for ---h. pylori bacteria biopsi, EKG. The EKG came back abnormal, so I had to have a nuclear stress to make sure my heart, lungs, blood pressure were healthy enough for me to have the surgery. I'm glad to say I cleared those tests. I was especially glad/relieved to know that my heart health is good. By the way, my health insurance did have to kick in for the nuclear stress test.
But now, I'm in a holding pattern. After all the tests, mental evaluations, nutrition and physical fitness consultations went by swimmingly, the insurance company is stuck on medical records from 2008. Out nearly 10 years of records, they have, the stickler is on 2008. My surgeon's coordinator requested my medical records from my former primary care physician for that year, but was told they didn't have any records for me from 2008. Not true, after I pressed the issue. I even contacted the doctor in Montgomery who diagnosed me with sleep apnea to send records to the surgeon's office.
Bottom line...be proactive in all that you do. Don't be afraid to advocate for yourself when it comes to your health. For that matter, don't be afraid to advocate for your friends and family's healthcare. Stay tuned for the next episode!
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