Highmark BC/BS Anyone??

I have Highmark BCBS and after having them put me through the ringer they denied me once again. The first time they denied me 1/2 hour after receiving my file. I contacted my insurance company before truly embarking on this journey and made sure that I had every thing lined up, even explained where I was as far as the insurance company. Silly me!! The insurance company is pointing the finger at the doctors who in turn are pointing the finger at the insurance company. The insurance company wouldn't even tell me what the letter they sent to the doctor said, based on "confidentiality" even though I am the patient!!!! AARRGGHH My PCP refuses to send my actual chart records and instead sent an ineffectual letter supporting the surgery. I now can not get them to send my records and haven't the funds to hire an attorney or self pay and I have a date of January 7th. Thanks for letting me vent, have been crying all day and am at my wits end. it is frustrating to know that after all I have done to line myself up to be able to have access to this tool, it now feels like a ghost. And having to keep this 15 pounds off since my last nutritional consult at the beginning of July is torture. Guess I now know that this tool is one that will not be available to mem, at least not in the foreseeable future. Changing insurance is not an option. Thanks for the venue to get this off of my chest. NA

Hi, To the best of my knowledge your PCP cannot deny YOU access to your records.....and a copy of the insurance letter should be in it....I am suprised the insurance company did not send it to you or your surgeon. You can march right down to his office and demand copies of everything in your file...the same as if you needed to get copies of Xrays from another provider...they are just giving you a hard time...though darned if I know why...but don't give up...remember David and Goliath...you have a legal right to everything conecerning you! You may not be able to get a lawyer etc..but you can sure call the State Insurance Commission and BBB and make a stink. I have read that some folks have to appeal 3 times...and if you feel the PCP is not on board..maybe your surgeon's office can refer you to someone more amenable?? So sorry to hear of your trouble...hope it all works out! Sher'

PS..Your PCP might be paranoid about faxing records due to Hippa regulations...so you get a copy of your records and fax them or take them ..yourself.....also if you signed a release of information for your PCP and surgeons and insurance co...I don't get it!!! Me thinks they are just trying to wear you down and maybe some egos have gotten in the way...I am working to get more of a letter from my PCP...who is faxing stuff to the surgeons...but only wrote the surgeon's name down on a script pad sheet and handed it to me like a Script..lol..and calls THAT a referral!!! (NO..No....no... dear man!)..... Keep the faith! Sher'

Your PCP should send the insurance company ANYTHING they request in order to get your approval. That makes no sense. Why would they hold you up like that? I noticed you didn't list in your profile your surgeon name, 'cause I gotta tell ya, I was pretty curious! In my experience, the insurance company needs what they need, and if you give them everything, they will approve. But for the doctor not to provide is simply outrageous to me. I'd raise some holy hell. Seriously. Good luck - if I were you, I wouldn't give up. Red tape, ugh. Lots of Love, Tammy

If the PCP does not believe in WLS, he will do just enough, but not one step more. Time for a new PCP. Your records can be forwarded!!! Peter

Thanks for all of your kind words. I am going in to the office tomorrow morning and raising h e double hockey sticks. The worst part is that this PCP is the one who kept pushing me to investigate this and even referred me to my surgeon. Will let you know how things go. Sorry to only vocalize when I am freaking out, but have been lurking for ages now, lol.

Hi NA I felt your PCP is wrong because he or she refuse to send copy of record of your health. This is your health and your right. Go back to your doctor s office and demand for copy all of your records and faxed to insurance company and I am praying for you to get surgery date SOON! Hugs Kathy K

Hi! Frustrating is it not? I like my PCP..but dealing with his office staff is a PILL...they forget they are doing a SERVICE for the patients and that they have a job because of PATIENTS...they get snooty as all get out! The tail starts wagging the dog!!! My PCP recommended me to my surgeon too...and wrote the surgeon's name down on a script sheet. signed it and handed it to me...I gave it to Nina (RN Coordinator) as almost a joke when I went for my first consult...and said.."here is my referral letter"...well..Lo and behold...she has had to be very 'assertive' with that office to get all of my records and when she asked for a letter of referral from the doc..they faxed her......(wait for it).....a COPY OF THE NOTE ON THE RX PAD!!!!! ( About 4 words on it mind you!)....so she is having to push to get the real letter he promised....Peter is RighT! I really don't understand what the antipathy is of PCP's towards this surgery...or why...especially if they have seen us for a long while and monitored our comorbs... Anyhoo...hope this works out for you!!! Best Wishes, Sher'

Your letter should be in your chart, right???? Ask to see your chart at your Dr's office. Find out what is wrong and have it corrected. Peter