April 27, 2006
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Another bump in the road…
Well I just spoke with my insurance company and was told that my file was in “medical review staffing” and to call back later today for a status update. A few moments later Jason told me that someone from Wausau had called the house looking for me and that he gave her my cell phone number. However no one had called my cell…so I called them back. I was then told that the surgery was listed as an “exclusion” on my insurance.
Well yeah, this is why my doctor sent in all of the documentation that he had and a letter of recommendation.
She then told me that they could not approve it at this time because it was listed as an “exclusion”. I asked what I should do and she told me that I would need to contact my HR Dept. (of our parent company) and talk to them about this, that HR would be the only ones to change this because they are the ones who put it in the policy to begin with.
Okay…so I call HR and am told that it is true that this is an “exclusion” and that it must be “medically necessary” for someone to have this surgery. I said that I already knew that and that I have spoken with the insurance many times regarding this and that I even had a list of the criteria that must be met in order for it to be deemed as medically necessary faxed to me and gave it to my doctor in which he included with the letter of recommendation and notes that he sent to the insurance. I also told her that I meet that criteria and she told me…
“oh c’mon now Maria, you’re not morbidly obese and you’d have to be in order to meet criteria”
Oh yes…she did. I was FLOORED!
I went on to state to her that,
“no…I’m not morbidly obese…I’m SUPER MORBIDLY OBESE and have a BMI over 50″
…but she interrupted me and went on and on about what is “classified as medical necessity”. I told her that I’ve been researching this for over 2 years now and have been conversing with the insurance on it for over 1 1/2 years and that I’m well aware of the criteria that must be met in order to qualify for this surgery…but she went on anyway.
She then interrupted me and said, “Maria, are you going to let me finish or are you just going to keep talking?” 
What I wanted to say was, “who in the f*** are you to tell me what I AM or am NOT?? Have you seen my medical history? Do you know what I currently have or even what a BMI is??” I’m telling you that STUPIDITY SHOULD BE PAINFUL people!!!
I finally told her that I would just let the surgeon’s office fight it out with the insurance and that I’m done with this conversation. She said that she would “check on it” with the insurance and get back to me…I told her there’s no need for her to get involved after what she just stated. 
Yeah…I pay for insurance and my own company is fighting me on this. This is completely ridiculous!
UPDATE!!
I just got off the phone with my insurance again (they called me this time). They apologized…apparently I was “misinformed”. Ya think??
They assured me that they “have not dropped the ball on this” and that “the surgery IS covered” under my insurance and that they will personally “review my case” and will contact me if “any further documentation is required”. I thanked them for calling me and correcting the situation…but OMG!
Why must people torture me? Like I need more stress!
At least I know that it’s not over yet.
Comments (12)
Egads! I can’t believe she said that to you!
“Oh c’mon now..”? I’d have smacked her one. What an ignorant cow – even if she were right, which obviously she’s not, that’s an outrageously patronising tone to take. I thank goodness that our HR team - although there are moments, with them – is comprised of really good people. I had no worries whatsoever two years ago when I had the surgery on my back. They were good as gold and everyone at work did everything they could to make my return as problem free as possible – to the point where they wouldn’t let me in the office before 11 and made me leave by 3pm each day in order to avoid the rush hour. I’m so sorry you don’t have that kind of support at work
That’s crap! I would not have bitten my tongue. I’m pretty sure that I would have lashed out at her.
I’m hating the fact that you are having to deal with this junk. 
Not that it’s an issue now, but I would’ve asked what criteria she used to determine morbid obesity and why is she using a different scale than the one approved by the American Medical Association. Doi.
Glad to hear your insurance company recanted. But MY GOODNESS, your HR lady ounds like a pushy know-it-all.
So much stupid going around
How unkind of your HR woman!
That is totally infuriating! This is when you say, “Oh, why don’t you go shoot yourself and put me out of my misery.”
Of course I would never really say that, but it cracks me up every time I imagine having the nerve. 
I’m glad that it sounds like it’s getting straightened out.
First, nice new Look and Feel.
Second, for fuck’s sake, the last thing you need is someone who is not a doctor to give you the “Oh come on, Maria….” bullshit. Geezus, I can fully imagine the rage that must’ve poured through your body at such a patronizing comment! Who the fuck does she think she is? Fuck her. I’d personally ask someone besides this woman to be involved in my case as it’s obvious she has some sort of bias here. Man! I’m pissed just reading this! Who are these people to play god with our lives? I swear, you might have a lawsuit against these people if something happens to you and it happened because they held this up. Geezus!
well, how do I follow that? patience…
People like that should die. Or be made badly uncomfortable. I told another friend of mine going into the army the only difference between boot camp and a garden center in spring is at basic you get to shoot guns, blow up things and fight people, and at work you just desperately want to at times.
My new coworkers think I’m real cool….for a 30 year old dude.
30?! that’s some creative arithmetic…
sorry, just had to share :-p love you honey 
Can’t you write whoever’s in charge a letter?
Tell ‘em if it was their wife, mother, daughter, sister– that they’d surely understand and wanna help.
hang in there.
Oh Maria ~ what a mess.
I’m glad that they have not “dropped the ball”.
I’m so outta the loop ~ have you had the surgery already?
If not, when are you scheduled?
I’ll keep you in my thoughts, m’dear.