insurance woes

[kph]

Well the surgery my boyfriend had scheduled for Monday has been postponed due to insurance issues. Both us and the Dr's office were told that he didn't have the 6 month dieting criteria that I had. Now 6 days before the surgery they deny him coverage because they say he didn't meet the criteria. He said it felt like someone had just took a pin and burst all his dreams. But the good news is that he told me this morning that he is even more determined to follow their criteria and have the surgery. It just won't be until late summer now. I am looking into an appeal this morning but both the Dr's office and I feel it won't help. But hey, anything is worth a try, the worst they can do is deny the appeal and make him follow the rules.

 

[Bigtallsis]

KPH
wow I am so sorry to hear the news from your insurance company, how could they over-look that until now? I know I have called my surgeons office more than once to make sure I didnt have to do 6 month diet ahead , they told me because i had proof of over 3years of trying to loose on my own with every diet there seems to be that I didnt have to do the 6 month documentation with my dr. For that I am thankful, but still haven't got to see surgeon, have did all the required test, etc, going to surgeon's office may4, will keep everyone posted.
Thank GOD your boyfriend has determination, I can surely understand how he feels like a pin, * balloon, but thank goodness he has you and has faith and determination he is a role model to others. to NOT GIVE UP< there's always hope. Please keep us posted as things go along.
Donna

 

[Pat99]

I also had a 6 month diet criteria but all that was required were notes from office visits from my doctor stating that weight loss was recommended. Even though I only go to my PCP 2 to 4 times a year at the most she had notes going back years showing that she recommended me to lose weight. Have your BF call his PCP to see if he / she can help him out with office visit notes. It's worth a try. Good luck.

 

[kph]

The insurance company is adamant. I spoke with them. He must be working with the surgeon (I don't get what the difference is). We even documented that he worked with Weight Watchers for 5 years. Usually United Healthcare is a great insurance and easy to work with but every now and then they make life difficult. The Dr's office told me that since he will have lost quite a bit of weight in the next 4 months he won't have to adhere to a liquid diet for 2 weeks prior to surgery. That is a plus. They also said that they won't tell him his surgery date until they know it has been approved. I feel so bad for him. I was on the phone with the insurance company for 2 days hours at a time going from one department to the other. We both feel all beat up by the insurance company right now.
Thanks for letting me get all that out.

 

[Pat99]

Well, on the plus side at least things are on track now. So sorry the 2 of you have to deal with this at this juncture. Please keep us posted and don't give up. It will be all worth it in the end.