Doctor's office did not file insurance paperwork in time
I went to Dr. Cerabona's office in the Westchester Medical hospital on 10/16/08 with all my required paperwork and relayed medical exams and PCP's letter requesting RNY. On 11/25/08 I called the doctors office and was told by Phyliss ,the person in charge of filing the insurance request , that the insurance company had not responded. I had to wait until the Monday after Thanksgiving to learn that "Phyliss" had finally faxed the paperwork on 11/25/08. I had sat at her desk while she entered on the doctors operating schedule the date of 12/12/08 she later informed me that the doctor would be at a conference that date, and that an associate doctor would perform the operation. I said no because my wife had the operation with Dr. Cerabona five years ago and we were happy with the results and only would use Dr. Cerabona.
She then informed me that I would go in on 12/15/08 but that the insurance company had still not approved the operation. I called again and she said to me did you hear from the insurance company and I answered ,"why would I hear from them when it is the doctor's office who filed the paperwork".
The insurance company finally came back and denied the coverage, because they stated that I did not have proof of attending medically supervised weight loss program in the last six months. I had forwarded a letter with my history of weight loss efforts including a letter from an attorney that I had gotten a settlement in the phen/phen case. I weight 275 and have a BMI of 43 and have various health problems, what do they need that I be hospitalized to be approved. I made a major mistake in not sending the paperwork directly to the insurance company myself. So for now I am going to give up and try to loss the losing battle on my own.
She then informed me that I would go in on 12/15/08 but that the insurance company had still not approved the operation. I called again and she said to me did you hear from the insurance company and I answered ,"why would I hear from them when it is the doctor's office who filed the paperwork".
The insurance company finally came back and denied the coverage, because they stated that I did not have proof of attending medically supervised weight loss program in the last six months. I had forwarded a letter with my history of weight loss efforts including a letter from an attorney that I had gotten a settlement in the phen/phen case. I weight 275 and have a BMI of 43 and have various health problems, what do they need that I be hospitalized to be approved. I made a major mistake in not sending the paperwork directly to the insurance company myself. So for now I am going to give up and try to loss the losing battle on my own.
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