Denied...Revision was next week!!!

I'm typing this from Myrtle Beach...I am suppose to be on vacation but instead I am having to deal with the stress of insurance. I wish all this could have been taken care of before I left. I really don't know why my surgeon's office would let the proccess get far before sending it into the insurance for approval. Now I am already days into my pre-op diet and stopped my Plavix and gave myself 1 shot of Lovenox all to find out this might not happen when planned. Yesterday when I called BCBS they said it was pending because they had called my surgeon's office on July 3rd needing information and had not heard back from them. Then I called the surgeon's office and all the important people were over in clinic but the receptionist said she had heard I had been aproved and everything was a go...I said not what I was just told so I needed to get a messaged to the patient coordinator ASAP. Never heard back yesterday. I called BCBS again in the afternoon and they said my case went for physician review at about 3:25 and to call back today. So today I called back and they told me it had been denied...at first the guy was referring to the wrong procedure..wrong date, etc. So I got him to look further...and for July 20th...DENIED...as of late yesterday afternoon....hmmm that was really quick...I have a thick file...I asked for the reason and he said he didn't have it...that it wasn't in the system that "they" just put in the computer it was denied and called the surgeons office and will be sending 2 letters to me and surgeons outlining appeals process. I asked if I could speak with the person who made the decision so I could find out the reason and was told no. I called my surgeon's office and told them, and the patient coordinator was out today, I spoke with the dietition and she said the nurse would call me back, no one had by 4:30 so I just went to the beach since I had already wasted my afternoon. She did e-mail me to say that she had called BCBS about a week ago to give them more information and no one called her back. So I don't know if there is a bunch of miscommunication between BCBS/Patient Coor/Nurse or what...and I don't know when or if this surgery will happen now. But what I do know is I want to know soon if I need to continue with this pre-op diet and shots...and also if some miracle happens and my date stays as the 20th then I'm thinking I'm not going to be able to get my Mom down for the surgery now, because it's getting too late to book at decent priced ticket. Sarah Margaret Revision/Hernia Repair 7/20/2006

Sarah, two of Dr.Rehnke's patient were scheduled also to recieve their WLS at the Palms of Pasadena. One with approval already. They got calls from BCBS Yesterday & Today, that they were being denied now. With their only re-course to appeal through a lawyer. They were both scheduled for the Lap Bandings. Here is the Lawyer suggested by Susan (Dr.Rehnke's Staff) Obesity Law and Advocacy Center - www.obesitylaw.com Walter Lindstrom, Jr. (I believe he has had both gastric bypass and the band) [email protected] Good luck, Mike

Sarah--I am sorry--hope it all works out.

Sarah Margaret, I am soooo sorry to hear about this setback! I know how frustrating it is to try to deal with BCBS but keep after them. They are the worlds worst about "losing" paperwork, or never receiving paperwork that was sent repeatedly. Ask your surgeons office to call them for a denial reason and if they can't get something definitive, ask the surgeon's office if you need to continue with all the pre-op stuff. NO point in putting yourself through all that for nothing. Try not to be too upset about this - look at it as merely a delay. I'm praying you get good news soon! Enjoy your vacation with the family! Hugs! Vickie J.

Oh Sarah, how frustrating! I will be praying all works out, including the flight for mom. sometimes southwest has last minute deals, perhaps that would help? Anyway, if surgery is delayed, we have to trust God has His hand in it. If its denied, then just fight it out till its approved, I think someone just made a mistake. I hope you can enjoy your vacation still. hugs, Tami

I am so sorry to hear this. I know how you were looking forward to this surgery. I also know how insurance companies can be a big pain in the behind. I will be praying that all goes well and you will get this surgery when the time is right. Now or later.