Triumphant Appeal

Today I’ve finished the first draft of my funding appeal. I’ve compiled information from my circle, my doctor, my insurance specialist as well as a handfull of other agencies. If any of this–the timeline, the process, the information about different surgeries available, what costs to expect, etc.–can be used to help others in my situation, I am thrilled. Weaving through the insurance maze, alone, is quite a feat. My statistics and figures are based on what is normal for Southern California, however much of the process is the same for all of us considering weight loss surgery.

It’s humbling to ask people to help me accomplish this. As someone who spends a lot of time caring for others, it is uncomfortable. But the bottom line is this. I’m not willing to crawl off to a corner, lie down somewhere and die. It is not my time. I have so much to offer and so much to teach about my experience. And for someone who is used to accomplishing whatever I set my mind to, I know there is no possible way I can accomplish this alone.

1 comment March 20, 2008

Plotting Through the Insurance Maze

I looked at the Blue Cross Provider Directory and found USC University Hospital under both the Small Group HMO network and the Small Group PPO/Lumenos network. However, I only found Dr. Peter Crookes (the bariatric surgeon I want to use) listed under the PPO/Lumenous network and it doesn’t look like he participates in the Small Group HMO network.

I did call his administrator to see if they contract with the Bluecross Saver HMO plan and she wasn’t sure. She was going to investigate but asked that I find out what the particular “medical group” or “IPA” for that plan is. She explained that the HMOs contract with a third party group that acts as a “middle man.”???? Once she has the name of this medical group/IPA she can find out if they do business with the Bluecross Saver HMO plan.

I give my kudos to Steve, the insurance specialist who has been helping me weed through all this for the past year. I’ll take an infected Windows system with a corrupted registry, blown motherboard, crashed hard drive and crazy-panicked customer any time over dealing with insurance double-speak all day! Gulp.

Add a comment March 11, 2008