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Why is this a fight?

T

TXEd.Dhelper

Member
I am awake. I just want to be my healthiest self at 53. My weight goes between 217 and 223. My latest doctor has approved my revision. GERD sucks and all the related issues.
Why is this a fight? I work full-time and am a Ed.D candidate. I followed the plan for success laid out in American. Yet, I still have to wait for approval for this life saving procedure! Something is wrong with the US medical system.
 
I'm so sorry you are enduring such roadblocks. I don't disagree, the US health care "industry" is a nightmare. Doctors and patients are at the mercy of the MBA beancounters who control insurance companies. PCP's are only allowed 15 minutes per patient. It simply stinks! My best advice is to work closely with your surgeon and his/her admin team, who should know how to work with the insurance companies if you are receiving denials on your procedure. In all likelihood they have dealt with similar denials in the past and know how to work on denials. I have a close cousin who has severe Chrone's disease, and her doctor found a monthly infusion that worked for her symptoms, but after having to switch insurances, her current insurance through her work will only approve an infusion once every three months, and not once per month. She winds up having to visit the doctor more and visit the ER which costs more than the infusion, but the insurance hasn't yet been willing to budge. I know her doctor is tirelessly lobbying the insurance company on her behalf.
 
mam said:
I'm so sorry you are enduring such roadblocks. I don't disagree, the US health care "industry" is a nightmare. Doctors and patients are at the mercy of the MBA beancounters who control insurance companies. PCP's are only allowed 15 minutes per patient. It simply stinks! My best advice is to work closely with your surgeon and his/her admin team, who should know how to work with the insurance companies if you are receiving denials on your procedure. In all likelihood they have dealt with similar denials in the past and know how to work on denials. I have a close cousin who has severe Chrone's disease, and her doctor found a monthly infusion that worked for her symptoms, but after having to switch insurances, her current insurance through her work will only approve an infusion once every three months, and not once per month. She winds up having to visit the doctor more and visit the ER which costs more than the infusion, but the insurance hasn't yet been willing to budge. I know her doctor is tirelessly lobbying the insurance company on her behalf.
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It's has taken 5 years of testing, probing, a dedication surgeon, lawyer, advocate, care coordinator, and prayers to get to this almost have a date for revision countdown. I have hope. And, I am still in pain even at this moment. What keep me going? I know there is a chance for me to one day feel better. Just some relief and it will be worth it! Thanks for caring you all!
 
So, still waiting. I was informed that everything needed was turned in and approved. But wait, I received an email and had to submit additional documentation of need. WTF Let's see what they do next. Next week should proved to be interesting. I need this to been done this summer.
 
I am still waiting and in pain tonight (well all day). I have only eaten foods that usually don't cause as much acid. I believe that my approval by should come by next week. The reviewer asked for additional documents which was provided. I am in round 4.75 of 5. Wow, I am never giving up!
 
The latest, all my records are sitting on the desk of a gatekeeper! I was verbal told this is the last step in my approval process. I did everything required and then some. I am so tired of being in pain. I want to workout. Its past time for me to find a new normal! I will never take life for granted. Each day is a blessing!
 
TXEd.Dhelper said:
I am awake. I just want to be my healthiest self at 53. My weight goes between 217 and 223. My latest doctor has approved my revision. GERD sucks and all the related issues.
Why is this a fight? I work full-time and am a Ed.D candidate. I followed the plan for success laid out in American. Yet, I still have to wait for approval for this life saving procedure! Something is wrong with the US medical system.
Click to expand...
I’m agree. This surgery should be covered by insurance as preventative.
 
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