Approved? not so quick there.. speed bumps...

Hi everyone,

/rant on
Called the BMI center this morning to confirm that they received the approval letter and was immediately transferred to the insurance claims person. It turns out that my Pumonologist and Cardiologist hadn't provided sufficient information to clear me for the surgery?   My first question was if they received anything from either one? and the answer was " yes but nothing that clearly states you are good to go".  This completely blows my mind because I had completed all of this testing 3 months ago and verified with one of the nurses that they received what they needed? apparently the nurse who looked over my file at the weigh-in had no clue of what she was reading and just told me what I wanted to hear. So here I am with an approval letter in hand and a little frustrated because my Pumonoligist is on vacation for a week and my Cardiologist isn't in the office until Wednesday. To make it even more interesting, the surgeon I choose for my procedure is no longer in my network of providers on my insurance carrier so I am now looking at an out of network surgery. What worries me about this is that I have been going to his office every month (since Dec 08) like clockwork for a weigh-in and no one ever mentioned it? Anyone else find that a bit odd? Now the optimist in me is internally telling myself to just relax and let things work themselves out (they usually do) but the pessimist is really angry right now. Thank you in advance for reading through my vent.


/rant off

Super Ouch!!!!!

This is where I was this time last week.

The person who answered the phone at the IPA said I was approved for 8/27 - 8/29.  The fax my PCP/HMO lady received that morning said the opposite and wanted me to have the test it turned out I already had and the pulmanary function test as well as pulmanary clearance.

I am hoping that even though your docs are out there is a trustworthy person in each office that you can get to call your doc and send the needed letters post haste.

I do not know what to do about the out of network doc.

Today according to the PCP/HMO lady I am approved for surgery and two days hospital.

Hi Randy,

I got nowhere with either office and was basically told that  they would write a note for the doctor when he returns. Needeless to say, I will be making a followup call on Wednesday and another on Monday. I know that another week won't make a difference but I hate having to jump through extra hoops because someone didn't do their due diligence.

On  a side note,

Is everything finally clear on your end?

Oh Omar!!!

I am sorry to hear of these "speed bumps".  They can and DO happen, unfortunately.

The clearances are relatively easy to handle, but I am not sure obout the "out of network" part.  Does your approval letter state which surgeon is approved?

Hi Omar. Sorry to hear the news! I landed up with being a self-pay because BCBS of IL changed their requirement from a 6 month supervised diet to a year. I didn't want to wait any longer.

I can tell you that I had to hound the bariatric office all through the process. If it wasn't one thing that was pending, then it was another. I never got the whole story. I even had to hound them for a surgery date - they wanted to put it off because the surgery scheduler was on vacation. Give me a break. Once I told them that I worked in a hospital and knew that there was someone else who could schedule, I got my date pronto!!

Keep on them until you get your approval. Hope you can resolve the doc issue too.

Lucy

 Hi Omar

I am sorry to hear your frustrating news.  I have been there too.  I got through my 6 month diet only to discover that there wasn't enough documentation so I had to do it all over again.  Grr.  

Is there any chance that you can be grandfathered in to your policy if your surgeon's practice was once "in network" and no longer in the net work.  If you started working with them when they were a network provider, your insurance company may still only charge network rates or the surgical practice may only charge you net work rates especially if you make noises about going elsewhere.

 I have had many physicians offices all of the sudden come up with compromises when I said they were not in my net work so I could not use them.  Amazing how prices drop or they pick up the difference.  

Hang in there,  It WILL happen.  

 yeah, once you get the approval , you can ask if someone else in the office is in-network. they can bill under that Doctor. If not , find another doctor if you want. the approval is for the procedure, not the doc. 
hope that helps...