The Day Before Surgery

I thought the day before surgery was going to be difficult because I was unable to eat food, only clear liquids. That's not where the problem lied. I never got hungry enough to be bothered by the ;ack of food.

I received a phone call about 2pm at work. It was the doctor's office urgently spelling out why tomorrow may not in fact be my surgery date.

When I was ready to have surgery back in December, there weren't any appointments available until January. My insurance changed on January 1st so I had to wait to get approval from my new insurance company. I was rejected not once, but 3 times due to the format the records were submitted in and lack of medical record proof of the weight loss program I was on. We fought the decision and re-applied several times, only to be rejected time and time again. My head was spinning and ended up in a depression, eating whatever I wanted.

In March or April we decided to try my husband's insurance. After a few weeks we received a call from the surgeon's office stating I was approved for the Gastric Bypass. I was overjoyed. The scheduled date was June 30, 2009. I couldn't have been happier.

Two weeks before the surgery I arrived at my pre-surgical appointment to register with the hospital to find out what to expect and what was needed of me before the surgery. When that appointment was over I had another across town at the main hospital where the Weight Center was located. Upon weighing in I discovered that, even after being strict for the past 2 weeks with what I ate and shrinking what my stomache could hold naturally, I was still at a higher weight than I was the last time they saw me in December. Heartbroken and furious with myself, I asked what I needed to do to keep my date of June 30. The nurse spoke with the doctor and stated that I needed to come back for a documented weigh in by the end of the following week. I worked extremely hard and was able to lose 5 pounds that week. I was back on track with my original date.

Back to today. I was shocked when I heard the surgeon's Nurse inform me that my insurance was stating that the surgery was not approved for payment and without that authorization they would not operate tomorrow. I felt a wave of tears pouring down my face. Here I was, at work, in a professional environment, trying to remain sane.

I asked what could be done. I had to call the insurance company and find out why I was not approved, contrary to previous go-aheads from the same insurance. I found out that there was a clerical error that was at the root of the issue. When my insurance company was informed of my surgical date, the Customer Service Representative entered the days date of the call as if my surgery was that day. Since I failed to have the surgery on that given date, the approval was no longer in acceptance status. I had also not informed my husband's insurance that I had my own primary insurance and the claim had been denied. The final thing was that they needed my insurance information to verify that it had been denied. "I AM having this surgery tomorrow!" I exclaimed. She suggested that I have my surgeon call and speak with the department that handles the authorization.

I immediately rang the surgeons office and explained where we stood. She called and spoke with them. By the time we spoke at 4pm the issue had not been resolved. She pushed my appointment to the 3rd slot instead of the 1st to give the hospital time to get approval and she asked me to call back in the morning.

I couldn't wait that long. I had to know! I stayed at work almost 2 extra hours using the phone to starighten things out. My final call was to the insurance company. After 10 minutes of trying to reach a live person I was on the line with a very caring individual who immediately spoke with the Precertification department. I waited another 5 minutes on hold. When she returned she filled me in on the current status of tomorrow's claim. I was officially approved for tomorrow's date as well as 10 days after surgical hospital stay. She was even thoughtful enough to provide me with a confirmation number so that I will have something to reference with the hospital in the morning.

The surgery has been pushed back to 1:45pm. I will be on the phone with the hospital at 8am to verify.

If you ever have to deal with surgical insurance, for a pending procedure, call well in advance to verify coverage and approval and don't only check once.

I will appreciate this procedure even more now with everything I went through to get there.

Say a prayer for me please.

Missy