Frustrated - vent

Sorry, I need to vent about Dr S's office.

I have called my insurance company - UHC - several times and each time the rep confirmed I do not need a 6 month diet history.  I only need a letter of determination...BMI of 40+ or 35+ with co-morbids.

I DO need a 5 year weigh history, which I provided to Dr S's office via email.

Dr. S's office told me I need a visit with a dietician and my psych eval, those have been done.

So, I've been trying to follow up with them to confirm they received my weight history and gotten no response.  I started 'nagging' on Friday and finally got someone to pick up the phone and look at my chart. 

Now they are telling me they did not receive my weight history, I need a letter of Medical Necessity from my PCP (originally told I did not need this) and that I am 'confused' about weight history vs. diet history and UCH requires 6 months supervised diet history.

UGH. 

What do I have to do to convince them I have spoken to MY UHC and I do NOT need a 6 month diet history?  Or is my UHC giving me wrong info?

UGH!

I'm sorry you are having so much trouble with Dr. S's office. I've found the best time to call is somewhere between an hour after they open and before lunch. So, around 9:30-10:30ish.  Teresa has seemed kind of ummm.... I'm thinking of the word.... she just seems either busy or pre-occupied like she doesn't want to be bothered. Not sure what the deal is there. 

I've also noticed that they aren't that great with email. I've stuck to the fax and then followed up with a phone call telling them I faxed something.

Here's what I would do next. Call UHC and have them direct you to where you can print out the exact requirements for your policy.  I did this with BCBS and it was as easy as going on the web. If Dr. S's office still insists you need the diet history, fax them a copy of your policy.

I think all the documentation I provided was overkill. In that respect, I would go ahead and see if your PCP can write up a letter of medical necessity real quick. It doesn't have to be a long letter, just a brief description of your medical/weight history. This is assuming your PCP is supportive and won't take forever to write the letter. I was lucky enough to get letters from my PCP and my Endo within the same day.

I hope they get all of this straightened out for you!  We need to get on that losers bench together.

Thanks Lisa! I really appreciate your support and words of wisdom!

I did call my PCP for the letter of Med Necessity.  They are supportive and it was 'no big deal' so I agree, and just went for that one.  Pick my battles as I call it. :)

Think I'll call my ins co now and see if I can get thru.  Who knows, they might have 24/7 support, worth a shot.

hugs,
Angie

Angie :  I know how frustrating waiting is :  I went thru it as well.
As Tia has often said all we can do is keep calling and calling.

The help in the Dr's offices don't understand it may be just a job to them but it is
OUR LIVES that are put on hold everytime they think  Oh I will deal with that later.

Call the insurance company ; get it in writing what they require and Call/fax/email
the Dr's office till you get the answers you need.

Take care and God Bless

Angie,

My advice would be to get copies of EVERYTHING and fax it yourself if you have access to a fax.  The other options would be to mail everything to them certified so that you get a signature OR walk everything in there yourself and personally hand them the paperwork so that there cannot be any excuses.

I went back and forth and back and forth with Dr. S' office and the insurance company for weeks until everyone had everything that they needed.  I was on the phone with them at least twice a week and sometimes more.  It's unfortunate that we have to do this, but it's necessary for us to advocate for ourselves.  Teresa is especially frustrating because she is a Dr. S post-op herself and she should know how it is....these are our lives and not just her "job".  According to her, after she had surgery she begged Dr. S' office to create a position for her so that she could work for/with him.  I find that "interesting".

Anyways, I had good luck contacting their Bariatric Program Manager, Christine Walsh when I ran into problems.  Every time that I did, she was very prompt with a solution.  I used to have her e-mail address but had a computer crash and do not any longer.  Her number is 410-550-4471.

Hope that helps!
Heather

Hang in there Angie!  Can  you get it in writing from the ins comp what they need so you can present that to your doctor's office? Some of this stuff is so confusing.

Hi Angie,

I found that they often have faxes that do not make it to your folder.  If you have access to a scanner my recommendation is to scan everything send it attached to an email to Teresa, that you CC to both Dr. S. and Christine.  Amazingly these always make it where they are supposed to.  I also noticed that anytime you email Teresa always CC Dr. S.  She responds to these in a much more timely fashion.

Hope this helps.

Traci

Angie, I had my surgery through UHC, and even though the insurance was spectacular where I paid pennies compared to the cost, it took months to get everything they wanted.

They did ask for 6 months supervised diet program though.

With any help line, I follow the rule of  "call 3 times and average the answers you get or take the 2 out of 3 that match!"