Change in policy! - Page 4 - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

JustJoy · 06-08-2009, 01:57 PM

First I want to thank everyone for their support, the suggestions to call my insurance company were taken. I called them and got the same information we were given at the beginning, checked the information on the insurance Web site and it was also the same. The last policy update was made June 2008.

I've been in touch with my surgeon's office as well and it isn't the policy that has changed but the way the insurance company has chosen to interpret the criteria. I think it's a sneaky way of doing business. I mean if you want to make it tougher, change the policy. But changing the way you interpret something.. just feels underhanded and sneaky to me.

I realize they're a business, I know this better than some due to working in insurance myself, but I wish they'd just have the nerve to be up front about wanting to make it tougher to gain approval. I don't think I can get them to grandfather me in since we haven't yet filed for approval. We were supposed to do that in the middle of next month.

You all who have said that in the scheme of things 3 months isn't all that long are right. It's just that if I have to do the extra 3 months I'll have to have another psych eval, which will probably come out of my pocket this time. That's $262 I don't have.

I've got a call in to my pain management doc to ask about a letter of recommendation from them. I've talked to him about my weight and he's said more than once that losing weight would help my back. I'm waiting on a return call now. I'll call my PCP tomorrow and ask her if there's anything extra she can write that might help us meet the requirements.

I haven't given up by any means, I'm just frustrated. If it happens that I have to do an additional 3 months so be it. It's not like pitching a fit will help matters any right?

For those that offered I'm in a size 24 jean. We can PM about details if you can help me out.

Thanks again for the support. Seriously it really helps and I wouldn't have even considered contacting my insurance company even though it's the logical step to take.

Native2u · 06-08-2009, 02:21 PM

Quote:

Originally Posted by lillylaroo

Both of you STOP! For Christ sake this is someone's thread and they are down in the dumps. We don't need to turn this into a debate session. Just listen to Joy's troubles and provide ADVICE not OPINION. Please. Some of us are getting sick of this. Start a thread where you all can debate about whatever. I surely don't want to post and have it turn out like this. PLEASE with sincerity.

OK...I feel that I had legit questions for her that I was "hoping" she'd answer.

mistymee · 06-08-2009, 02:23 PM

Best of luck to you, chickie! You'll get through this one way or the other, right?

As for the jeans.. I would've been happy to send you some, but I've already donated that size of my clothing.

(and I've promised a friends daughter all the recent size 16 clothes I've 'outgrown' as she's in some dire financial straights herself.. it feels good to help lesson the burden as others have done so for me! She's supposed to be coming over to pick out what she wants, next week!)

Hopefully someone will have what you need. It sucks to spend money for what will be, in reality, a short period of time!

Native2u · 06-08-2009, 02:59 PM

Joy, I'm so sorry that your insurance company is putting you though this h*ll. That isn't right of them to do this, and I also feel that you should be "grandfathered" in.

JustJoy · 06-09-2009, 12:16 PM

Update:

I'm trying to not get too excited yet but I just spoke with my PCP's office and they're faxing a letter over to my surgeon with the necessary information. I've got all the crossables crossed that it's sufficient for insurance approval. I'm just thrilled to pieces that my doctor is willing to help me out.

I e-mailed one of the bariatric team to let her know a fax would be on its way and asked her to let me know if the letter was sufficient.

Hopefully it is and hopefully I find out today. If it isn't sufficient I'll take the extra three months and make it work.

But I'm going to keep everything crossed that it's enough and that I don't have to do the extra three months.