Now I had hoped to be on by now telling you when my surgical date was and getting ready for that date. But the walls fell crumbling down. We had put together all the paperwork and you remember the issue I had with my PCP not wanting to give a clearance letter. Well when I was able to speak with him directly, he of course was okay with it. Fast forward a few days we are waiting for final approval from the insurance company, I am a nervous wreck just waiting to hear those words, "You are approved." They would be wonderful. I was at work, my cell phone rang, and picked it up. My surgeons office was on the line, ( here we go I thought, smiling to myself), "Steve, I am afraid the insurance company denied you", and then the world stopped spinning.
I had everything planned down to a T. My diet was working, my wife was on board all my coworkers supported me everything was happening, tests being done, just a flurry of activity and then, BANG!, someone slapped me and woke me up. At first I had this amazing level of sadness and truly wanted to cry. That sadness quickly was displaced by an intense a feeling of anger as I had ever felt. How Dare They! Oh I was outraged, who do I call , who's neck do I have to ring! Well after the initial emotional swings the depression kicks in. I start thinking I am going to look like an ass to all my friends and people who are supporting me in this. I am going to be fat and a liar. What the heck do I do now.
Thankfully my wife managed to somehow get me to some semblance of normalcy. A lot of surgeries are denied at first so then you go through the appeals process and I felt certain that in that appeals process I would win, but there was a very big problem. The company I was working for was being sold. The new company would e taking over Jan 1st and my benefits would be changing.
So now if i didn't get the surgery approved right away, we couldn't bother any more because the surgical date would be after the new insurance company took over and they would require a whole new set of hoops to jump through, and they might not cover weight loss surgery or maybe they did but wouldn't have my surgeon and team in their "Network." Also if it goes past the year all the money ive had to pay for testing and appointments that goes toward my deductible and maximum out of pocket, would be reset costing me a lot.
I want to give you a little background in case I haven't before. My wife has myself and her on her companies health insurance with united healthcare. Well my wife's company specifically excluded coverage for weight loss surgery, so for years there was no way to get this done. Then when I was lucky enough to be hired at my current job, I decided to take my own insurance on top of the other as a way to get this surgery done. This insurance is a duet between Tufts and Cigna, called care-link. Its a partnership between the two and as a result it is almost impossible to figure out who does what.
The last time i called i was transferred 6 times , 3 times with Tufts and 3 times with Cigna. This care-link plan's pre-certification for surgery is handled by Cigna. Well it appeared that due to us moving up my nutritionists appointment by a few days from December 1st to the end of November we Didn't show 3 months of consecutive weight loss based care. So I had to hot foot it to my PCP to have them weight me in so we could have this appointment for the month of December.
This was to be followed up two days later ( last Friday) by a peer to peer phone call between my surgeon and the doctor at Cigna who denied me. SO last Friday I waited by the phone and I got the call. "Steve, they cancelled the peer to peer, and are escalating the new paperwork to the same doctor again he will get back to us either later today or Monday.
Friday closed out without a call. So Monday i do get the call and i now need to go see the nutritionist to have 3 months with both my pcp and my surgeon. Of course it is in Brighton and it is Wednesday, after which I am meeting with the anesthesia ad surgical teams just in case. Once I do this we will fax that paper over to the insurance company and wait yet again. So today "Wednesday," is a big day . There is a little happier bit. The company I work for will have one more month of benefits before switching so we now have more time to have this done, although I will take a financial hit. Also the benefit packages we have to choose from will be offered by Blue Cross Blue Shield of Texas. Who does indeed have my surgeon on their network. So it is not quite as bad as it was, I will let you all know how this turns out. Stay Tuned!
I leave you today with another comic strip.
No comments:
Post a Comment