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Update on my Process

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Old 12-04-2008, 07:40 AM   #1
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Default Update on my Process

So, everything was falling into place. I completed my 6 months of dieting with my PCP (7 total appointments, actually: May-November). I completed my psych evaluation. I had my consultation with my surgeon, who agreed to the procedure I want (the DS).

Then I had all my diet appointment records sent to my surgeon's ofice. the insurance staff there said my May and June appointments owuldn't count because, even though diet and exercise were clearly outlined in the discussion of the notes, at the top of the sheet, the reason for visit was listed as follow-up for diabetes. So, I talked to my doc yesterday, and she is going to amend the reason for my June visit to include weight loss specifically. I also have an appointment for a December weight loss follow-up just in case insurance rejects it anyway.

Then my surgeon's office informs me I must complete my nutritionist visit prior to submitting me to insurance. This is NOT a requirement of my insurance, but a policy of my surgeon. I wouldn't have a problem with this if it had been explained to me as such earlier; rather, when I met with the insurance coordinator back in October, she said to hold off on the nut visit until as close to actual surgery as possible, and another office staff member had assured me I did not need the nut visit prior to insurance submittal. But now I do. grr. So, I made a nut appointment for later this month.

All sounds on track for December submittal to insurance for approval, right?

Well, I was. Until two days ago.

Without warning and with little time to mentally process everything, my company's HR gavea presentation on Tuesday about our upcoming open enrollment for benefits. I already have all my benefits set up, so I figured no big deal. How wrong I was.

As of Jan. 1, we wil be changing insurance companies from our current ***S of NJ to UHC. It's a nicer plan--lower premiums, no doctor or specialist copays, includes vision within the medical plan...

But it has a clear exclusion of all WLS for any reason.

I about threw up in the middle of the crowded conference room. 7 months of working, coordinating, going to doctors, making the doctors send things to each other, fulfilling all the requirements and jumping through all the hoops...

I've spoken to my HR manager. COBRA continuation of my current plan is not an option. My fiance's insurance covers the surgery but does not recognize domestic partnerships, so we would have to get married, which we weren't planning on doing until long afte rmy surgery--we were planning for 10/10/10. Now we're thinking we may just go to the courthouse and get married this month (he actually suggested this-how's that for commitment and wanting to help me?), and maybe not tell many people, not wear the rings, etc., and have an actual wedding later like we planned.

Ugh, it's just such a mess...
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Highest known weight: 324
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Got down to about 185 before pregnancy;
Benjamin David born March 24, 2012, 7 pounds 11 ounces
Post-pregnancy: 206.5
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Old 12-04-2008, 08:55 AM   #2
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Ah, Jilly, that sucks. I'm so sorry. I know you have been so organized and practical about this and to have all these things happen. Argh!!!!!

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Old 12-04-2008, 09:13 AM   #3
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Oh my gosh... can you go back to your PCP and explain whats going on, maybe they can help you.

This is horrible !!



Your DF sounds like a great guy

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Old 12-04-2008, 10:46 AM   #4
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Aww Jill, I'm so sorry to hear that.

You'd think your company would give you advanced notice of changing insurances! My insurance was dropped this year but I knew about for over a year.

They be dumb.
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Old 12-04-2008, 11:03 AM   #5
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Working in HR I see more and more policies come across for review that exclude WLS under all circumstances. Rationale given is always the high cost of the procedure plus any complications tend to be pricey.

If you go with DH's idea and get married to get his coverage be careful to file all of your claims for anything that might be even remotely related to the surgery under his coverage, if you keep yours as well. If you have an 'optional' surgical procedure that isn't covered then no complications, even life threatening ones, will be covered by your policy. The insurance companies are really stretching to make things 'related' in claims these days so they can deny payment. If you file on his after the fact it can be denied for not claiming in a timely manner. (You could fight it, yes, but the insurance company tends to bank on the fact that most people don't.)

Sorry this is happening to you honey. I try to give my people as much notice as possible of change, but sometimes three weeks is as much as I get with renewal procedures.
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Old 12-04-2008, 11:50 AM   #6
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Jilliebean!! That is sooooo messed up!!!!!! Have you talked to your surgeon about stepping up the date? Wow, it's DEC. already, ya this is really bad timing! A little more notice would have been good.

Sorry, honey!
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Old 12-04-2008, 02:19 PM   #7
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I won't be keeping my own insurance if I am added to Jeff's--not paying 2 premiums! His are high enough for the 2 of us.

There's no way of getting in for actual surgery this month--my surgeon only does 1 DS a week, only on Thursday, so we lose that last Thursday of the month/year since it's Christmas. Plus, they are already scheduling for him out into late Januray for RNYs, late February for the DS.

Looks like I will be joining Jeff's insurance. You'll know who it is if you hear wedding bells this weekend or next

I did verify that my surgeon is in-network on his insurance, too. Glad SOMETHING gave me the answer I wanted!
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Got down to about 185 before pregnancy;
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Old 12-04-2008, 02:57 PM   #8
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Jill - as someone who had her "big party" wedding and her "at the courthouse" wedding separate (for different reasons, but still), I can tell you it doesn't matter a whit that you have two. that things got a little dramatic for you, but it will all work out.
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Old 12-04-2008, 11:16 PM   #9
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Sorry about the insurance switch up- totally unfair!! Hang in there Jillybean.

The things that were planned are still going to happen- just not in the order originally thought. No one needs to know about the courthouse

He sounds like a great guy and obviously cares about you and your health- someone that supports you like that- you can't go wrong. You hang in there girl! We all support you!!
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Old 12-05-2008, 09:52 AM   #10
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Wedding Bells ....... YEA !!!!

Keep us posted.
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Old 12-05-2008, 02:48 PM   #11
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This is just ridiculous.

All that work and now a change that throws a monkeywrench into everything.

I'm so sorry to hear what you're being put through.
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Old 12-22-2008, 03:28 PM   #12
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I just read about this---man that really sucks!!

Any updates??
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Old 12-22-2008, 10:31 PM   #13
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I am so sorry to hear that that happened Jill (by the way I am new). Does your job have a wellnes program or health coordinator? I worked for local government. I worked there for 6 years, just now finding out that they offered WLS. It's not publicized, it's only approved by the Wellness Coordinator.
If that doesn't work it sounds like there will still be a celebration....ahhhh weddings
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Old 12-23-2008, 08:26 AM   #14
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We went to the courthouse and got married on the 8th after my HR manager at work confirmed that there was no way the new policy would cover WLS and that I would not be able to continue the current policy via COBRA.

So, on paper, we are married, but no wedding rings, kept my same last name, etc. We will still have the wedding we want on 10/10/10. I'll be on his insurance effective Jan. 1, and I have already completed all the insurance requirements, so hopefully my surgeon's office will submit my info to insurance for approval ASAP in the new year! Assuming that happens and I get approved on the first try, I'm looking at surgery probably in March.
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*Jill*
Highest known weight: 324
Weight on morning of DS surgery: 308.5
Got down to about 185 before pregnancy;
Benjamin David born March 24, 2012, 7 pounds 11 ounces
Post-pregnancy: 206.5
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Old 12-23-2008, 09:09 AM   #15
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Congrats!!!!!!!!
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