Very Down tonight regarding Inurance

I have not officially been denied yet, but I called my insurance company today and they told me that because my bmi was less than 40 that my case needed to be sent to their physician for medical review. I have diabetes, high blood pressure, PCOS, high cholesterol, and arthritis in my knees. I started asking some questions about the information that was sent from my surgeons office and come to find out they do not even have a complete list of all my medications. I then called my surgeon's coordinator and she told me that my insurance company  called her yesterday and said I did not have enough co morbidities and to please refax the list? What the ?????? I have been so upset and don't know what to do at this point.

 While I love my surgeon...I have not had confidence in some of his staff. I worry that my information was not completely in order. I also know that I meet the requirements for my insurance company (UHC PPO) by having a 5 year history of a bmi between 35-39.

I don't know what to do at this point. I feel as if there is no way I will be approved and all this hard work will be for nothing ;(

While Dr. Hart is a great surgeon... his office staff sucks big time.... I too started with his office and left because of his office staff  screwing up my ins paperwork.... sorry your exp the same thing I did.

You have 2 choices ... stick it out and fight or leave and get another surgeon.

Good luck

CC

 Thank you so much for answering my post. I was beginning to think I was paranoid. I do not contact the surgical coordinator alot, however when I do she is "nasty" and more often than not she does not know who I am. I always hear..."I deal with insuranc every day", well guess what..so do I! I have been a RN for 20 years and I am well aware of how the system works. The bottom line is that they did not submit all of my information and it was not done properly. I just really hate to go through this entire process again with another doctor. I need to check and see which docs are in my network and start all over, I guess. Thanks again for the post.



Vonnie

Btw...did you get denied becsause of a screw up with paper work?

yes,, I got denied because of the paperwork..... Then I took my file and went to Dr. Macik's office (he takes UHC).... gave it to Tiffany and she faxed it up and miracle of miracles I was approved.

So, really if you have all the necessary required paperwork ...... it isn't starting over. Tiffany in his office does this all the time.... and a lot of patients are from dr.hart's office and she has the 411 on the situation over there... actually among nurses and folks among bariatric surgeons it' s farily well known his office manager and staff are horrible..... !!!!!!!!!!!!!

A real shame cause him and Johnson are great surgeons... why su*****ompetency internally is a mystery

CC

Thank you so much.....I just spoke to Tiffany and I have an appt for Tuesday. This is all so ridiculous.

It is ridiculous.... but it worked out for the best. Dr. Macik is wonderful... his  name is on the wall of Northside and John's creek bariatric wings..... also, I was in major car accident 2 months after my surgery.... he was there for me in ways I can't even begin to describe. I was hurting and soo scared but whenever I called (even Memorial day) he would take my calls...

Good luck

CC

Take a deep breath. You haven't been denied YET if I understand correctly.  Maybe it will work out ok.   It's good to have a backup plan, but hopefuly you WILL be approved. I am praying for you!

I'm sorrry to hear of all of your troubles.  I don't really have any advice except to say you should make a complaint to the doctor about his office staff.  This process is already hard enough without incompetent people with sucky attitudes.  That kind of behavior should be unacceptable.  I would send a letter (maybe even more than once) by mail and by email just in case he does not get it.  I would tell the surgeon that you went to someone else b/c of his staff. 

Sorry again..and keep venting here.. it really helps..

I am sorry you are having such a hard time! I agree with CC - Dr. Macik is great and I love Tiffany!
Hopefully it won't take long for them to get it sent in and get this resolved!