Insurance Frustrations and the Waiting Game

VixStats
03/14/13  -  279.2 Highest Weight Ever
03/26/13  -  277.7  Lost  1.5 lbs
04/23/13  -  268.5  Lost  9.2 lbs
05/21/13  -  256.7  Lost 11.8 lbs
06/25/13  -  256.3  Lost     .4 lbs
07/23/13  -  256.2  Lost     .1 lbs
08/20/13  -  257.8  Gain  1.6 lbs
        Total So Far  Lost 21.4 lbs

<>< ~ <>< Aloha everyone ><> ~ ><>

Earlier this year I remember thinking, 'that's all I have to do; show up to doctor appts once a month for 6 months, see a dietitian, and see a therapist?' I should have known getting approval from insurance for VSG that easily was too good to be true. 

My sixth and final visit with my weight management doctor was on August 20. The following day I called my surgeons office to remind them to submit the request to Blue Shield. I was told it normally takes 3-4 weeks for the insurance to give an answer. So I wait....

Until last weekend (3 weeks later), I get a letter in the mail from Blue Shield saying that they could not process my request for VSG because I did not provide documentation proving I had completed the pre-requisites. Whaaaaat? So on Monday, 9/9/13 I called my surgeons office inquiring WTF. They assured me that it was already taken care of and submitted and they weren't sure why the insurance claimed to have not received the documentation. They did mention that the insurance was specifically questioning my Nutritionist visit, stating that it seems like it was just a consult, not an actual visit. I'm thinking, whatever stupid insurance, go ahead 
and stall if you like, but my ducks are in a row. 

And yesterday, 9/12/13, while already defeated with car problems, I get word that the insurance has in deed DENIED my request for VSG due to insufficient documentation. My surgeon's office explained to me that the department that processes HMO paperwork and turns it in to the insurance apparently didn't turn in the paperwork? After all this time, I am denied because somebody, who probably makes more per hour than I do, decided it would be ok to not turn in the supporting documentation with my request for VSG?!?


And starts the appeals process. Oh wait, not quite! Before the appeals process is started, Blue Shield has to schedule a phone interview with my surgeon. It will take Blue Shield 3-4 days to schedule this interview. Which means they won't get around to scheduling it until next week. My surgeon is only in the office on Tuesdays, since Blue Shield won't even get around to scheduling the interview until say Tuesday, its likely the interview will not take place until the week after, or there after. 


For many months I have had my hopes set on having VSG mid to late September. I picked that date because it was reasonable according to the known
                                                                            timeline of everything. Now, who                                                                                             knows when this process will end. 
                                                                            Not a fan of the waiting game.

                         <3 VixRevision