Re: Ok second attempt to post!!! IM SO MADD!! What would you do?

[Guest guest]

i reckon the first thing i would try to do is calm down... note i

say try...is call daddy... get his professional opinion on what is

the best way to handle the situation.

then being the hard headed slightly spoiled totally LOUD opinionated

person i am, i would call dr rabkin up and say look dude you have

been my surgon i have faith in you you have been inside me already

and i am dying, i need you to fix this situation and it needs to be

done now.

again using all info that daddy can provide .... then if all else

fails i would have a throw down loosing it temper fit including

tears and snot and let him know how hes killing me and i have kids

that are going to need care preferably from him when i am gone ect

ect....oh yea this needs to be done in person for full benifets...

now weather or not this approch will get results i am not sure but

anything is possible, I had one of these fits with blue cross of

georgia and i offered to come in person to express my distress in

person and the phone rang the next day with approval... so...

other than that kat seriously... i think i would show up and do the

ER route i would tell the dr in private that IF insurance does not

pay that i will but it will be in incriments not a lump sum, but

something has to be done before i die, and i would put it to him

just like that... if he is half the man that a surgon should be he

should have some feeling of responsibility since he is your

surgon,and god knows you did not have this surgery to be unhealthy.

love n hugs

~peach~

>

> Ok Im almost violent Im so upset. If I owned an ozzie I might

unload

> it on FUTURE HOUSE AND NORTH BAY HEALTH PARTNERS!! I am almost

dizzy

> from all of the changes today. Ok I am venting, but Im also asking

> for each of your thoughts and guidance. I want to know what you

> would do in my situation. This isn't a short post so please

forgive

> me but its necessary in order to really help you understand the

> problem.

>

> History: RNY in April 04. Dr. Rabkin SF, open laparotomy to fix a

> perforated bowel May 04, June 04 open laparotomy due to bowel

> obstruction, internal bleeding and adhesions. All done by the same

> doctor (Perforation was done by a gastroenterologist NOT my

> surgeon). Lose my job because Im off work too long. Lose my

> insurance carrier August 31st 04. Get new job in August, get new

> insurance North Bay Health Partners effective Sept 1st. WHEW! Ok

but

> they don't actually get my policy started until the end of

> September. since then they have sent me NO information about my

> policy. I dont know whats covered and what isn't. I find out 2

days

> ago that I have an EPO..an employed peferred provider program.

Never

> heard of it before now, but its just like a PPO. Bad news for me

it

> seems.

>

> So first I get a call from the docs office today asking if they

can

> move my surgery to Wednesday because the OR didn't get enough time

> booked for my surgery if they are goig to do the tummy tuck too.

> Well I decided even if I have to pay the $4500 for it myself, its

> getting done at the same time because I don't want anymore

surgery!

> Wednesday works better for me anyway because I could use the extra

2

> days of work before hand to get my patients in order before I go

> (and the income!). I had the wrong hospital down..my surgery is

NOT

> at Cal Pacific..its at St. 's in San Francisco...an IN Network

> hospital. She also tells me that they haven't gotten the approval

> for my surgery yet and there is a concern because my surgeon is

out

> of network. OH GREAT!! So sometime after lunch today, I get a

call...

>

> Surgery has been DENIED completely! Because my surgeon is out of

> network!!!! They say they will pay but only if I go to an IN

NETWORK

> doctor! Ok Im pissed from that moment on. I call the insurance

> company and they tell me to go to my in network primary care

doctor.

> I tell the lady..I dont have one. She is shocked! Says you havent

> got an in network primary doc? Im like NO. I then remind her Ive

> only had this insurance for 2 months and I didn't even know I had

> this rule in my policy. She says well it should be listed in the

> information " we send you " . Excuse me? What INFORMATION! I haven't

> gotten a thing..I reply. She says oh. YA OH! So she goes on..

> well you need to go to an in network primary care doctor and get a

> referral for the surgery first, then get to an in network surgeon

> and be evaluated and then have them submit and we should be able

to

> cover it. Im like...Lady do you have any idea what you are saying

to

> me? I DON'T HAVE THE LUXURY OF TIME HERE! I HAVENT BEEN EATING

SOLID

> FOODS FOR WEEKS, AND IVE BEEN IN ER 5 TIMES ALREADY!!!! This is a

> complication from a surgery 9 months ago and Dr. Rabkin IS my

> doctor. You didn't tell me this a month ago or have problems with

> the fact that he had me in the hospital. Why am I hearing about

this

> now? What more do you want me to do? She says, Im sorry we can't

> help you, you need to go to an in network doctor and hangs up.

>

> I call Human resources crying (all this while in a patients home

> watching her IV drip very slowly and realizing that I have no

choice

> but to take care of it then because they will be closing in a few

> hours for the holiday weekend). I tell the lady in charge of

dealing

> with our insurance company whats going on. She can't believe it,

> says she is going to call and find out what she can do to help!

>

> She calls back about 1/2 hr later and says, you just need to go to

a

> different surgeon. LIKE DUH!!! She does say tho that the issue is

> that its been labeled urgent, but not EMERGENT. So I say, ok so

your

> telling me that if I go to ER in pain, and they contact Dr Rabkin,

> and he takes me to surgery because its emergent, THEN THEY PAY?

She

> says Yes. I say..Ok great thats what I will do. She says what? I

> said, ok well I will just go to ER and have them take me to

surgery

> from there! She says ok but you didn't hear that from me!!

>

> So I call back my surgeon. Talk to the insurance lady again there

> who has been going back and forth between us, and tell her..Look

Im

> going to show up at ER bright and early Wednesday morning with

pain

> (which is no big surprise since i haev it all the time now).

Expect

> a call. Because that is the only way they will pay for this, is if

I

> go through ER first. She calls the surgeon who says, they still

may

> not get paid. MY REPLY! THEN I WILL PAY YOU!!!! DAYUM! JUST GET

THIS

> DAMN THING DONE!!!

>

> So..Im now paying out of pocket for my tummy tuck..fine expected

to

> do that anyway, the hernia repair is OUT, because it is very

small,

> and frankly Im not paying an extra $3000 in surgeons fees for it

at

> the moment, and Im going to pay for my open exploratory laparotomy

> IF they deny me later. Hopefully the surgeon will accept from me

> what the insurance company would have paid..which is about another

> $1100.

>

> What would you all do in my situation? I figure if they refuse to

> pay for it, I will just get my father involved. He is an attorney

> and does insurance law also. In the meantime, that gets me into

> surgery and hopefully gets me better! What do you think my chances

> are of actually getting all this done? It really sucks having

> nothing in stone. But this is my life we are talking about..and as

a

> single mother I dont have the luxury of letting this go any longer

> and getting weaker and weaker while they run me from doc to doc.

>

> Kat

[Guest guest]

Kat

First and foremost, you need to calm down! Unfortunately insurance

companies are out to protect THEIR best interests.

Call the doctor that you need to call. If you really can go to the ER

and have this done, without the possibility of the insurance kicking

this out, then do so.

I'd call my father and ask him if you have a case and what you can do

IF the insurance company doesn't follow through.

Unfortunately the insurance company has the final say so about how and

what they'll pay. I don't know any way of circumventing them without

the chance of this blowing back up in your face sweetness.

Have you checked on obesityhelp.com to see if there is someone there

who might have gone through this very thing? I know it might be a

long shot but you never know.

And don't give up. If this has to be put on hold a few days then so

be it. Remember that you weren't willing to do this so fast before.

I know it's hard to be patient but you can do it!

I'll say a prayer that this turns out good for you!

>

> Ok Im almost violent Im so upset. If I owned an ozzie I might unload

> it on FUTURE HOUSE AND NORTH BAY HEALTH PARTNERS!! I am almost dizzy

> from all of the changes today. Ok I am venting, but Im also asking

> for each of your thoughts and guidance. I want to know what you

> would do in my situation. This isn't a short post so please forgive

> me but its necessary in order to really help you understand the

> problem.

>