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    Monday, October 02, 2006

    Frustrated! Part 2

    Now, where was I? Oh yes, I was reliving my insurance nightmare.

    • After leaving the internist's office I called the insurance company again to confirm the requirements for weight loss surgery (WLS). I was assured I met both.
    • My last appointment at the WLS center was on Tuesday and I saw my primary care physician (PCP) on Thursday. He already had the report from the WLS center that had been sent to the insurance company. I was high on life to think that things were going as planned and even quicker than expected.
    • One month went by. I decided to call the insurance company to find out what the hold up was. They could see that my paperwork had been sent in but there was some sort of hold up. I found out that my paperwork had been sitting on somene's desk for 2 months on hold because the WLS center had not filed the paper to set the process in motion. The insurance company had never contacted anyone at the WLS center claiming that because it was summer that people were on vacation.
    • When I called the WLS center to let them know what the hold up was, I had to leave a message. I didn't receive a call for 2 days. I called back to let them know that they were not the only WLS center in Michigan. They stood to lose not one, but two patients (Mr. Sign and me).
    • Miraculously the insurance company received the letter they needed.
    • Another month went by and at the end of July Mr. Sign and I received insurance denial letters. My thoughts on WLS and insurance is that most people are initially denied because the insurance company knows that many people will not fight. All we needed to do was get our health records and prove through doctor's notes that we had been obese for 5 or more years.
    • I assumed this would be simple. I was dead wrong. We had switched doctors about 3 years before and I specifically remembered signing the papers to have our medical records transferred over. Our doctor's office could find no record of having them.
    • I spent the next week trying to track down our previous doctors as 2 of them had moved and there was no record of where they had gone (I found out both had mental breakdowns and were no longer MDs).
    • It took 3 weeks to get it all together. I faxed our paperwork to the insurance company and to the WLS center just to cover all avenues. The denial letter states very clearly that you will have a decision within 15 business days of receipt of information.
    • Mr. Sign received an approval letter almost 3 weeks ago. I called to find out where I was in the process. My case had not been looked at. I was furious and devastated.
    • I called again last week only to hear the same story. It didn't bother me quite as much that time. I've let it go. If it's meant to be, it will be.
    • The timing isn't what I thought it would be and I've basically put my life on hold to wait for my rebirth. I guess I put all my eggs in one basket and I only hope that basket isn't dropped.
    • A couple of people have aked why I think having WLS will help me when I was unable to make anything else work. I am looking at this as a last ditch effort. If I can't make this work, there are no other options for me. I have never been as determined about something as I have now become. I know I can do this!
    • Tina had asked if I was worried about dealing with the mental aspects that have quite possibly made me overweight. I feel like I am in a better place when dealing with the abuse I suffered as a child. I've recently been able to talk about it and have taken comfort in the fact that I'm not alone in this fight to take my life back from the monsters who chose to make my life hell.
    ~Edit/Rant~ As I was feeling that all was well with the world while I typed this, Mr. Sign called me. He called the insurance company and found out that my case has been CLOSED for lack of information. They felt that the letter I wrote and the info I sent was addition stuff that didn't apply to the appeal. WTF!?! The shitty part is that the letters I sent for both of us were identical except for the names and numbers and Mr. Sign got approved. The company neglected to tell me that the case was closed on the 20th of September when I called them the last two fucking times!!!!!! I don't know what to do or where to go with this info.

    The insurance company reopened my case and the WLS center doctors are supposed to be conferencing with the insurance doctors within the next two days to expedite the case. I say, "What the fuck ever!"


    tina said...

    Well that just plain SUCKS THE BIG ONE!

    Oh I am so embarrassed that I asked that before! I want to make it clear that I am in no way saying I think you shouldn't have the surgery - not that it should matter what I think. I was quite serious in my question and in no way did I intend to sound *negative*. This is what you have decided to do and you should go for it whole heartedly! It sounds like you have done ALOT of research into this - I realize that you are not going into it lightly.

    I guess I was also thinking of another blogger who had the surgery - and yes - she's lost a ton of weight. Where as you have talked about becoming healthy and want to live a long and healthy life - I don't think I've ever heard her mention anything like that. I hope she can keep the weight off, and of course, she is eating MUCH smaller amounts. But, when it comes down to it - she has not changed WHAT she eats. I think you are looking at it in a completely different light. I wish you the best of luck with this and will be most interested to continue to read of your journey.

    SignGurl said...

    Tina~ Don't be embarrassed! I didn't take your question as being negative at all. I would have answered you via email but I don't have yours. I thought your question was relevant to the topic of WLS and did need to be addressed in my own mind as well. Never feel afraid to ask a question.

    There are many people who have the surgery only to try to look better. I care only about my health and prolonging my life to be with my children. A friend recently reminded me that changing in looks will also have to be addressed as it's part of the package. I guess I'm just trying to wrap my head around the health aspects. I need to be honest with myself because as my life changes with WLS, the person changes also. This is a tricky supbject.

    MamaKBear said...

    Awwww sweetie, I feel your frustration all the way down here in Oklahoma! Hang in there, sweetie, if MrSign was approved, surely you will be too!! Big hugs!

    Nonny said...

    Someone totally dropped the ball at the insurance company. It could just be a blatant stall tactic but since Mr. Sign was approved I don't think that's the case. You've been so on top of the whole situation and then for you to not get any kind of explanation letter or whatnot is just pathetic. Hang in there babe!

    DZER said...

    yet more reasons to hate both doctors and insurance companies ... especially insurance companies!

    Big Pissy said...

    I don't even know what to say!

    That is just ridiculous!

    But don't give up now....maybe they'll put a rush on it since they f*cked up?

    SignGurl said...

    MamaK~ I think they can feel my frustration in China.

    Nonny~ The insurance company sucks big donkey balls!

    DZER~ Here, here!!!

    Big Pissy~ The surgeon is supposed to conference with the doctors at the insurance company to try to move things along quicker. I'll believe it when I see it.

    barman said...

    I have only had one real bad experience with the insurance company before and it was enough to drive me crazy. I can not believe you are still sane. I finally gave in as it dragged on month after month and the people I had to talk to were so rude. At one point they told me to stop calling. I hope that never happens again because I am sure I will be a pit bull and visit face to face if that is what it takes. What ever happened to patient bill of rights?

    I feel your pain. Hang in there and be sure to tell us when they finally say okey dokey.


    gab said...

    Well that about sums it up for all insurance companies. They never follow through and they never tell you a thing. Im so sorry for your frustration. And I hope it all turns out for you. For all the crap you've been put through they should just push you right through instead of confering. Oh well...Hugs

    MamaKBear said...

    Psst...I'm not showing updated to anyone for some reason...please stop by my place...prayers desperately needed!

    Suze said...

    Jenn, what an absolute nightmare! How can they do this to you? The whole process has been unnecessarily drawn out and negligent.

    I just want come over there and give you a big hug and kick their damn assess for this.

    I'm crossing my fingers that this time they get it right for a change!

    American Navel said...

    I want to find these insurance people and give them a good swift blow to the esophagus!

    Roxi said...

    fucking whore bitches..

    You want for me to run over them with my car ma'am?

    Kristen said...

    Oh gosh.......I'm so sorry your your disappointment right now.

    I'm with Roxi.......I'll help her run over em

    The Savage said...

    You want I should rough em up for ya boss?

    buddha_girl said...

    Take Navel up on his offer.

    It will be ok. Take deep breaths. It's a life-long change to which I can attest.

    We're in your corner. The insurance company fuckers? NOT SO MUCH!