Friday, January 15, 2010

DETOUR ahead?

It is actually painful to type.

It seems as though my insurance company has issued a letter of denial to my surgeon. I went through this before, when I was supposed to have my surgery on Nov. 9. The bariatrics center and I accomplished all the things on the list of that letter for this attempt, but one of the items indicated that I must attend two post-op support meetings. I would have done so but my insurance company never informed of that requirement, despite the fact I called them two or three times and asked if there were any potential problems.

Since November 9 and I found out about the denial, the bariatrics center has not had any post-op meetings, they don't start again until later on this month. They were kind enough to meet with me once more to discuss post-op exercise and also invited me to attend the public information meetings everyone must attend to begin the program, where I was able to meet and ask questions to two lap band patients that have been successful. The bariatrics center documented both meetings and submitted them with the second round of pre-authorization materials.

I spent some time on the phone with customer service from my insurance company, and it seems as though my surgeon must contact their doctor for a "Peer to Peer Review." This all transpired yesterday (Thursday) and my surgery is scheduled for Monday. My surgeon was in the operating room all day yesterday and is returning there again this morning for another procedure. I am told that he will call this afternoon.

What if his morning procedure goes longer than expected? What if all the company doctors he can speak with take the afternoon off? Another northeastern snow storm moves in? His office is invaded by a band of angry termites, the building is evacuated, he remembers he must make the phone call, runs to his car but realizes he left the number on his desk and the extermination team has already begun fumigating with poisonous fumes? OK, the last one leans to the ridiculous side, just a little.

I have been walking around like a child readying for Christmas morning for the past two weeks. How deflating.

However, I am trying to keep things in perspective. After all, my bariatrics center did tell me not to eat any solids, so I suppose there is at least a 50/50 here, right? And although my "Christmas present" may be a little spoiled, in the end, my longevity is really what is at stake. I want to live longer than my parents who both had passed before I was 25 (breast cancer and aneurysm). This is only a tool to achieve weight loss and health, not a cure. So, I have to view this as an obstacle, one that will me stronger for having negotiated it.

However, I must say, my viewpoint was significantly different, as was my demeanor, about 18 hours ago.

Please everyone, hope for me, I need it.

By the Mrs. Amy W., I watched your video last night. Congratulations, I love victory stories.


  1. FB, I'm so sorry! And....I'm in the same boat with you. I have jumped through hoops and got a denial letter with a list of additional things to do. I still don't have a surgery date and am waiting for the peer to peer conversation to happen as well. It's so frustrating. Do you have BCBS,because it sounds like the same MO?
    Hang in there. You've been so strong on the pre-op diet, I was reading your blog yesterday and laughed out loud about the finger headed to the mouth. I wonder if all of my little habits like that can ever be broken. I'm sending you good thoughts and hope that this is resolved quickly. Be strong and keep us posted!
    "Band me Baby!"

  2. I am so sorry the insurance company is being difficult! I found your blog through Amy's and am looking forward to following your journey. I'm sure your surgeon can push your approval through. My husband and I are both trying to get banded and are in our 6 months supervised diet phase. He has to do liquids a whole 6 months! Imagine that! Unfortunately, I see an insurance denial in my future as well but we will both persevere! Good luck!

  3. Ugh that can be SO frustrating. I really hope this works out for you and that your doctor and insurance company is able to make this happen. Don't give up!!

  4. Thank you FB! But oh man I feel for you! Stay positive though until you hear otherwise. This REALLY freaking sucks for you!!! ARGH! Several of the girls on the blogs had their surgery pushed bc she was sick...I admire your patience and it has to happen. But these freakin insurance companies get me so worked up! They just make it so hard bc people give up...but you won't!!!

  5. OMG this SUCKS! But I am sure they will work hard to get you in there on time. In the meantime, keep drinking those protein shakes, and I will pray for you (even better than hoping!)

    I paid for my surgery myself, my insurance covers NO bariatric surgery whatsoever! Insurance companies can bite me.

    Good luck FB!

  6. Hi there,

    I'm sorry to hear there could be a potential delay, but I'm hoping that it won't be. I'll keep my fingers crossed for you. Hang in there and don't give up.