Insurance issue!

Here is my issue. Well the doctors office told me they sent in the paper work on the 31st of January. Me being the impatient person I am. I called the insurance company to find out if they had any updates on the certification for surgery and they told me that they have not received my paperwork yet. So I have a call into the doctors office. Need less to say I am very discouraged. I was hoping to have my surgery in March. Melissa

Same thing happened to me, I had to call to make sure they resent it then I called Ins to make sure they got it. Dr office's are busy and sometimes think they sent something and didn't. It's just they get so busy. Ins could have even lost it then say dr's never sent it.After I called Dr then ins again they got it. Make sure you get names and times when you make calls Sorry you had some time wasted I would call each week so they know your waiting

Melissa, same thing happened to me! Mine was submited 12/30/05 and I waited 30 days to find out nothing had been received! I was beside myself and not a happy camper! I called tish at dr blackstone's and told her what happened.... They refaxed everything and I called the insurance two days later to find they hadn't received it(even though the dr's office had confirmation the fax was successful). Tish refaxed again(3rd time) and I called the insurance to verify receipt of my paperwork(they received it) and I requested the name and phone number of the "case manager" who had my stuff. I was told by the rep that this case mgr did not talk to members. I told the rep that after a month of wasted time and the monthly premiums I pay for their services somebody would talk to me. I left voice mail three consecutive days with no response. The third day I mentioned that my next step would be certified mail requesting a response. I finally got a call back from the interventions "person" at the insurance and he assured me my paperwork was being reviewed and he would call back. On the call back, this insurance person told me I was denied because of "sketchy notes" written by the doc who did my supervised weight loss program(dr e) my options were for them to do a peer review(doc to doc) or the appeals road. I waited one more week to allow for the peer to peer review to occur and received a denial letter stating I did not have "medical necessity" for the RNY surgery. What a crock of _______(pick your own word!)! I felt totally devastated, wanted to give up! A friend said wait the weekend then come out fighting Monday(2/12). I called my "friend" at the insurance to find out what had happened.....Nothing! I told him that I had received the denial letter and he said he was calling blackstone's office "to see what was going on". I told him I wanted to know specific quantitative and qualitative reasons for the denial...Exactly what was lacking in my program. I also explained that I needed the names of some doctors providing medically supervised weight loss programs that met their guidelines and the names of surgeons in my insurance company's network in san diego or los angeles - that if they were denying coverage with dr blackstone I was going elsewhere!(I had no intentions of going anywhere else - I wanted them to know I wasn't going away easily or quietly) the insurance guy called me to tell me that tish wasn't changing a thing and that they would send the paperwork again and the doctor had better re-review it, but he'd call by noon Tuesday(2/14). I couldn't believe it! I called tish and she confirmed that ....Apparently she mentioned to him I had mentioned something about getting an attorney if I had to! Valentine's day the insurance guy called to tell me that the medical doctor there had re-reviewed the paperwork and found everything "was there" and certified the approval. Are you missy? Because if you are we have talked via email and work for the same place! I can give you the name and number of the person I dealt with at the insurance. Stand your ground and keep tish in the loop! Blackstone's office went the extra mile to get my auth ...I was facing the appeals process all because I expressed my displeasure at their losing my stuff and asking them to account for it! INSURANCE IS A BENEFIT AND SERVICE WE PAY FOR AT QUITE A PRICE....IT IS LIKE ANY OTHER SERVICE WHERE ONE DESERVES PROMPT AND COURTEOUS TREATMENT! Kathy

Keep on them!! I don't think the insurance clerks at the surgeons' offices really realize how important this surgery is. To them it's just a day job and paperwork. I wish that the WLS surgeon's offices would hire post-ops only on their staff so that the staff is empathetic and really realizes how important all the steps are pre-op to get approved. It's a matter of life and death - literally. Call DAILY!! Don't assume ANYTHING! Keep us posted on your progress! Dr. Blackstone is a popular doctor, so I doubt you can get a March date so late in Feb, but it might be early April when you get your surgery. Or you can have her assoc dr, Dr. Kieran do it, I've heard nothing but great things about her as well. She might be able to work you in sooner that Dr. Blackstone. Both are top notch! Keep us posted on your pre-op progress. We are rooting for you 100%!!!! Hugs, Trisha