So today was a total derail. I didn't realize that was how it was going until it was too late. I crashed hard. See today was 3 weeks since my psych eval, so I decided to call the center and see if they had got any notes on it yet.
Marie tells me that "yes, we got them! And we submitted everything to your insurance company on Augusta 4th. We should be hearing back soon." YAY!!, Right?
So I pull up my Harvard Pilgrim website and click on authorizations. Yep!
There is the request! There's Dr. Trieu's name...can you feel the excitement starting to build??... I click into it...
status: Denied.
WTH??
So I pull out my trusty insurance card and call them to see what mistake they have made. I mean...I did all the steps. I jumped through the hoops. They already told me that this procedure is something they cover and Dr. Trieu is in network. It's gotta be a mistake, right?
The lady that answered put me on hold...twice...trying to figure out why it was saying denied. She couldn't figure it out either. Then, finally, she comes back on the line to say that the hospital (the only one that Dr. Trieu has privileges at) does not meet the criteria.
...
WHAT? I called in April. You knew it was a bariatric procedure. You knew I was seeing Dr. Trieu for that procedure. How could it possibly have escaped your attention to mention to me that hospital he is affiliated with would not qualify for this procedure?????
...
She did say she was sorry that no one had informed me. Isn't that great? $3000 out of pocket, 4 months of jumping through hoops -eagerly-, not to mention half way through my out of pocket expenses and now they're telling me I have to start all over.
Not only is it unlikely that I will get through every thing in time to have the surgery done this year...do you want to know the real kicker???
I've lost so much weight that my BMI will no longer qualify if I walk into another consult at what I weigh today. How freaking sad is that? I'd need to gain weight to get approved now.
I am just so mad that I don't think I can begin to process where to go with this. I called one of the "qualifying" hospitals and sure enough she said "the first step is the seminar and then we'd get you scheduled for a consult"....ah deja vu! I started crying. I couldn't help it. I was so mad and frustrated.
...
So...deep breaths. I did not buy any chips. :) I am going to wait until tomorrow and see if Marie has any luck at all when she calls Harvard Pilgrim to try and argue with them. I am going to walk tonight. And then tomorrow I will start figuring out how to fight this. There has to be away.
I always say things happen for a reason. I am having a really hard time seeing the message today. But that's ok. That's why there's tomorrow.
Thank you all for listening to this not so upbeat post. I guess turbulence is part of the ride.
~Mikki
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