Wednesday, September 12, 2012

Satan is spelled PHP

My rant against PHP.

You're REALLY going to want to read this, especially after what I have to say.

So, In July of 2010 I decide to FINALLY lose weight, call them up and ask about the program. They tell me (almost word for word from the brochure) what it entails, and send me a paper to have my doctor sign me up for. This was almost TWO YEARS ago, mind you. You get two payments: $500 after you lose 10% of your current weight and $1000 if you keep it off for a year. Max of $1500 per lifetime. Sounds good to me- what do I have to lose (pun intended)!

So I go to my first doctor's appointment weighing in at a whopping 256 lbs. If I had been thinking I would have started at my highest weight of 275, but I digress. I hand it over to my doctor who signs and faxes it in.

Move forward 8 months. March of 2011. I find out that I qualify for gastric bypass. I spend months researching, going to several different clinics to listen to their presentations, CALLING UP MY INSURANCE COMPANY TO ASK ABOUT BENEFITS (this will definitely come in to play later), and coming to a conclusion: I'm tired of being tired and huge. I'm only marginally making headway on my weight walking for an hour every morning and cutting my portions waaaaay (or should it be weigh) down. I talk it over with Scott (okay, maybe it was more like: “So, ummmmm, I've decided to get gastric bypass. You okay with that? 'Cause I might die, you know. It has happened. I want you to remarry, if I do. Just make sure she sings stupid songs at inopportune times, like me; it'll confuse the kids less. So...we're good?” So with his grunt and nod of approval (should I have talked to him while he was reading the newspaper?), I sign up. I spend about 10 more phone conversations WITH PHP DISCUSSING THE SURGERY. NO mention of the “inches away” plan, btw, and about a trillion with the Bariatric Clinic itself.

I find out that PHP will only pay $2500 towards the over $10000 cost of the procedure. “Well, that just about settles it. No surgery for me.” Then a miracle. The Bariatric Clinic calls and tells me that they will accept PHP's payment as full payment (I later find out this is ONLY for the clinic. They hit ALL OF US patients up a full month after our surgery with over $3000 in additional bills stating they are from the hospital and anesthesia and they weren't included in THEIR costs). So, the surgery is BACK ON!

The Clinic requires many weeks of classes, and PHP requires 6 months of doctor supervised weight loss before I can be eligible for the surgery. I make it. On August 13, 2011 I weigh in at 229 lbs. Officially at least 10% weight loss. Money, come to Momma. At the time they sent me my $500 check, I was scheduled for surgery for the first week of November. There's NO WAY PHP could say they didn't know about it.

November 7 was D-day. Scared to death of....well, death, I went into surgery sobbing like a baby and woke up screaming like a banchee. Apparently, they didn't believe me when I told them I take high-dose pain killers on a regular basis and they need to start me off at a high point. I crawled off the ceiling about an hour and a half later. Even Scott was yelling at the doctor to give me more drugs, and if you know Scott, yelling doesn't come naturally (when the kids aren't around, that is). So, several months of pure torture I won't go into right now. Not only physical, but mental as well. Then, of course, comes the additional $3000 in medical bills along with a letter saying PHP won't cover the mental exam that's required before the surgery (conveniently given to me AFTER the fact). So, financially, we're more than broke; Physically- I'm shedding weight like I'm Kate Moss prepping for a runway show. Not a joke. I don't think I stayed in one size for an entire week. Would I do it again, even with the $3k and other crap? In a heartbeat.

Fast-forward to August 20, 2012. One year after my $500 and I've certainly kept the weight off. Down to 144 to be exact. We have a basement that's crying to be finished and I'm checking the mailbox every 20 minutes for my $1000 bonus check. Nothing. Days pass. Nothing. Finally, on September 12 I finally call. “PHP How can I help you?” Asks a chipper voice that can only be fueled by several cups of caffeine. “Uh. Yes. I'm on the inches away program, and I've been waiting several weeks for my check, but it still hasn't come.” And let see, I'm using about $200 for lumber/screws/nails, a couple hundred for drywall, a few hundred more for carpeting. I was originally going to get Scott and I a new mattress set and some bedroom furniture, but decided we needed something for the whole family. “Okay. Let me check for you!” Paula Peppy replies. After about 3 ½ years she comes back. “Yep. It looks like you're ineligible because you had bariatric surgery.” She says with a smile I feel like smacking through the phone. “What. Are. You. Talking. About.” “Uh. Hold on, okay?” No. SOOOO not okay. Another day passes and Pukey Paula is back on. “Yeah. That's the deal. You're not eligible because you had surgery, and well, that makes you ineligible.” Still smiling through the phone says the obvious Harvard grad. “There was NOTHING on ANY papers I signed that said ANYTHING ABOUT THIS!! YOU'VE GOT TO BE KIDDING ME!! THIS IS A LOAD OF CRAP!” I won't bore you with the details, but let's just say I went on at length. Here's the clincher: She said they don't inform the PHP members, necessarily, but “the doctor's should know about it and they should have told you”. Oh, REALLY? You don't feel this falls under, perhaps, YOU'RE JURISDICTION?

I actually received the rejection letter the same day (of course). It states that “We will provide you, free of charge, the internal rule, guideline or policy used in making this determination.” Okay, is it just me, or is an internal rule a little like a three-year old making up the game as he goes along. Is this rule invisable or kept under lock-and-key? Does ANYONE have access to that information, or were we supposed to hire a Psychic to find out all our health benefits? Stop me when I reach the correct one.

Well, I told them I would contact every Newspaper, radio station and TV network I could find as well as the Indiana Insurance Commissioner and an Attorney (any pro-bono takers out there?)! But, of course, first I have to blog about it.

So, I foresee my next few months battling with the insurance company (because the IRS just isn't fun enough) in what will probably be a total loss. In case you haven't heard, our family doesn't do very well in court cases.

1 comment:

Cherie and Jeff said...

OH NO!!!!!!!! So sorry! Good luck with everything...we are on your side. It is just a joke the way the insurance/PHP's and all will take your money and tell you you have to call them to do anything even take an aspirin and when you do they don't give you the information you need...and it is just..."oh well". As I said. Good luck...hope you get some satisfaction!
Cherie and Jeff