I was a nervous wreck driving into work yesterday morning thinking about the “verdict” of my approval outcome for surgery. I couldn’t take it anymore…so as soon as I got to my office I called the insurance company. The conversation went something like this:
Insurance: This is Michelle, how may I help you?
Me: Hi Michelle, this is Maria O’Quinn…I was wondering what the status was on my case that is pending.
Insurance: Hold on just a moment Maria and I will look that up for you.
Me: Thanks 
Insurance: Well, it looks like we are still missing some information on your case.
Me: What? What information are you missing? I sent you over 60 pages of documentation. 
Insurance: It seems that we have not rec’d dietician notes
Me: Yes you have, it was in the first set of paperwork that was sent to you back in April of this year and again last week by my surgeon’s office. The document is dated 1/19/06 and is signed by Linda (the dietician). She marked what I ate for a week and then put me on MediFast for the next week and had me follow up with my Primary Care Physician. 
Insurance: Hold on just a moment please while I physically get your file.
Me: Fine…okay 
Insurance: Okay Maria, I see the document you are referring to and I will note this in your file
Me: Thank you 
Insurance: However, it seems that we are still missing other information
Me: What exactly are you still missing? 
Insurance: We still need the notes from a dietician or nutritionist on your post-op consult giving recommendation for post-op care; also consult notes from an exercise therapist for post-op recommendation on activities including cardiovascular, resistance training and specialized exercises; and we need the post-op care plan from your surgeon stating when you are supposed to come in for each follow-up visit and who you will be seeing at every visit.
Me: Oh you’ve got to be kidding me… 
Insurance: No ma’am…this is what the Medical Review Officer (MRO) is wanting to see and will not approve you until we receive this information
Me: And you need this by 6/22/06 right?
Insurance: That is correct, but if you need to we can can extend your deadline. Just give us a call and let us know.
Me: I may have to do that because to be honest with you, I’m not sure how I’m supposed to get this information. I have over 50 pages of documentation that I can send you on all of the items that I’ve been given by the surgeon’s office. They have us attend a Nutrition Class that is put on by the Direct of Bariatrics at the hospital and she give’s us a book filled with instructions from “dietary and nutrition plans” to “pre-op preparation” to “exercise recommendation” to “follow-up visits” etc. But there is no “one-on-one” consultations with anyone. They have a personal trainer that puts on a “exercise class” every first Monday of the month for my support group…but there’s no sign-in sheet…you just show up. Can I not just send you all of the documentation that has been given to me by the Bariatrics’ Team? 
Insurance: I see, well let me go talk to the MRO real quick and ask him if he would accept this information in lieu of the “consultation notes”.
Me: Thank you 
Insurance: Well, the MRO stated that he would accept your documentation IF you include a “written” statement from the person who put on the class stating that you did indeed attend the class where this information was given.
Me: I see, well I will see what I can do then. I’ll get back to you next week and hopefully I’ll be able to give you what you’re asking for. However, I do think that this is a bit much. I mean, I understand that you want to make sure that I will be receiving proper follow-up care and that the surgeon’s office can adequately provide this service…but good grief! I chose this surgeon because of his reputation in our city and he is renowned in his field. I wouldn’t have chosen to go with this group if I didn’t do my homework. I don’t want this procedure to be for nothing…I too want to make sure that I’m going to be taken care of. This is MY LIFE ya know. 
Insurance: I understand Maria, but I’m not the person making this decision, the MRO is and he is requesting this documentation.
Me: I know Michelle, I’m sorry…I’m very frustrated. 
Insurance: I know Maria, see if you can get this information to us and again, if you need to extend your deadline then just give me a call and I will do that for you. You can extend up to two weeks.
Me: Okay…I’ll see what I can do. Thanks for you help Michelle.
Insurance: Your welcome and good luck.
So this is where I’m at now. I talked to my surgeon’s office and they are going to try and get a copy of the sign-in sheet from Kim (the Director of Bariatrics). I’ve also left Kim a message because she is also my support group leader and I’m hoping that she will help me out here and write this statement that they are requesting. She does NOT work for my surgeon and is NOT required to do anything for his office…she works for the hospital and WITH the surgeon’s office. Unfortunately there are no guarantees on anything here. 
OH…and my mom told me yesterday that I can’t have any money from my grandpa’s estate because then SHE will have nothing left to live on when she’s retired. Yup…apparently there was a clause on that whole statement that she gave me of “I will do anything to save your life”…anything but give up that money. I’m not wanting her to mind you…in fact I’d told her NO flat out when she suggested pulling it from the estate to begin with…but it just sickens me that she would say this to me after telling me she’d do “anything”. Ya know? 
She’s a greedy person…she always has been. It always comes down to money for her…and I’m not that way, money isn’t everything. I guess I’m more like my father in that respect…if you have money then great…if not, well…no big deal…you just deal with it. You get by on what you’ve got.
Anyway…so there went “Plan B”…right out the window. 
I’ve decided that it’s not worth me worrying about over the weekend…it’s just too much stress.
I hope that you all have a lovely Father’s Day weekend.
I will be thinking of my daddy this weekend, that’s for sure. I wish he was here about right now. 

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