Going Under the Knife - Part 2

[sandycombs]

Remember last week when I said I was having Gastric Sleeve surgery Tuesday (tomorrow)? Well, that's been cancelled. I received a letter from the insurance company Friday stating the hospital where my surgeon practices is not eligible because it is not a "Blue Distinction Center which is required for bariatric surgery." That sounds suspiciously like insurance speak for "we don't want to pay, so we decided your hospital needs to apply for this special certification created by us." And there's nothing we can do about it.

The decision came out of the blue as an "important update" to the approval letter they sent back in March. My surgeon wasn't even aware of the situation. His office is closed on Friday afternoons, so he didn't see the letter until I called the instant his office opened this morning and asked about it.

To say I'm disappointed is an understatement. After all the hoops we went through to get to this stage, just to have the rug pulled out from underneath us at the last minute? It's not fair to me, it's not fair to my doctor, it's not fair to the hospital.

/rant

Sorry, I needed to get that out of my system. After being on the special pre-op diet for over a week, it will come as no surprise that I ate my feelings today. Now I feel like a beached whale. 🐳 Tomorrow I'm going to get back on the horse. I'm going to do a bit of tweaking to the bariatric diet and try to do this without the surgery. Wish me luck! I'm going to need it.

Comments

[baranduin]

That sucks so bad. I am so sorry.

Looks like it’s a new thing started by the Blues just last year. It does indeed look exactly like what you say it is. I just read the document from BCBS talking about the criteria for getting this certification for bariatric surgery.

https://www.bcbs.com/sites/default/files/file-attachments/page/bariatric.program.selection.criteria.pdf

I wonder where your facility did not meet the requirements. Sorry, healthcare data analyst here.

I’d eat my feelings too. Man that sucks.

[sandycombs]

Thanks for that link. Although I have no proof, I think the fact that the word "cost" is used 84 times in the document explains a lot.

[baranduin]

It could be but I don’t necessarily think so. There are two levels of this thing and cost comes in to it on the second “+” level, not the first. Though of course that’s what I would think too right off the bat and especially since it is so new. Super suspicious. Especially since it seems to be placed on top of existing accreditations that the hospital would have to have to literally stay open like the JCAHO.

You could pursue this with your insurance company to inquire where the hospital fell short. To be honest I’d want to know if it was a quality metric like post-surgical infection and comorbidity rates and not something completely venial like a form was filled out wrong by the hospital.

Man our healthcare system sucks.

[baranduin]

Oh. I forgot. I’d look at the contract for the wording around bariatric surgery benefits just in case the insurance company screwed up.

[ancalime8301]

Ugh! Insurance companies can be the worst. :-( *hugs*