Bariatric lessons

So, once you have gotten yourself through all of the hoops that are required to ask for approval to have bariatric surgery, you then have to get through the biggest hurdle: getting approval from your insurance company.  I would imagine that if you are diabetic or have heart disease, this is an easier hoop to get through, but I have a new lesson to blog about.  I am generally a very trusting person.  I generally give people the benefit of the doubt.  However, if you are standoffish to me or fake in the way you are being "helpful," I will become a little suspicious and take things into my own hands.  You may not like that, but I am a highly educated person whose first career was in the business world, and back in the day, you had to DO your job to keep it and/or get paid for it.  Apparently, that is no longer the case.

As I said, I tend to give people the benefit of doubt.  So, when they insurance coordinator told me that it usually takes 11-20 days to get a response back from the insurance company, I gave him the benefit of doubt and waited 15 days before I called for an update.  His response to me was "I will call you as soon as I know something.  But you are welcome to call me if you feel the need." in a sort of standoffish way.  I don't like being treated that way, especially after 5 years here at Case.  So, I decided to take a look and logged onto my account with the insurance company (in case you don't know, you can generally monitor activity on your health insurance through the internet these days).  When I logged on, the only claim that showed up was for the psych evaluation.  I noticed that you could do a live chat with a customer service rep, so I decided to ask.  They informed me that they had not received the paperwork to start the approval process.  "You will need to contact your doctor to let them know it never arrived."  Now, because I still want to give everyone the benefit of doubt, I then asked if it was possible that it was in process and just hadn't been recorded on my account (does someone have to put it in line and then once a decision is made it gets recorded?).  The rep told me that because it most likely would have been mailed in (I found out later that it was 26 pages so, yes, it most likely was mailed), they would have immediately put a note in my file to indicate that they had received it.  They had no such note.  So, no, it was not in process somewhere.

I immediately called the insurance coordinator back (around 3:30pm) and got his voice mail.  Now, you have to know that every time I have tried to call this guy in the afternoon, he has 1) not been available (I get voicemail) and 2) he never returns my call (I have to call him the next day).  I called three times before 5pm and never got him.  The next morning, I tried to call at 8:30 and still got his voice mail.  So I thought, well maybe he's returning calls and will call me back.  Okay, I understand that at any one time, he is juggling 200 files in various stages of completeness, but really, he can't return my call within 4 working hours of my leaving a message?  At 10am, I finally called him back again and he seemed surprised to hear from me.  I informed him about my conversation with the insurance company.  He told me "well, maybe it's in process and they haven't recorded it yet.  But I will call and find out."  I went onto explain that I did ask that question because I didn't want to have to bother him, but they assured me there should have been some sort of note that they had received it.  He thanked me for calling and said he would get on it.  My frustration here is now, how long do I wait before I follow up again.  Is he mailing it again?  Or would have have found a way to fax it to them? 

I guess my point here is, don't assume that people are doing their jobs.  Now, I have no reason to believe that he didn't send out the paperwork.  However, I do have to wonder why (because certainly mine is the first that got lost somewhere between him and the insurance company, could it?) he hadn't followed up before then.  When I send things by mail or fax, I ask for comfirmation of receipt.  Nobody does, but if I don't hear something back within a reasonable period of time, I call.  This comes from having been a tax accountant and knowing that if people didn't get the forms I sent, it could cost my clients and/or company a lot of money in penalties and fees.  It's just continued frustration because my life is basically on hold until this decision is made.  I just want to know when the surgery is going to be (if it IS going to be) so I can then have a timeframe for recovery, etc.  The experiments I do are time sensitive and I cannot plan major ones until I know when I will be out for 2 weeks!  I don't think it's too much to ask that people do their jobs and stay on top of things so I am not in limbo forever!