Denied

Ok so I was a little bummed when I got the news that I was denied. I tried to get the information from the gal at the surgeons office. She read off a list of stuff but she read it really fast so I didn't really get it at first. Then she told me I am supposed to do some kind of exercise class (physical therapy or something). So I called my insurance company (cigna) to find out what it was exactly that I was denied for and they told me they were missing all kinds of paper work and that's why it was denied...such as my psych eval, my six month diet, my BMI, a letter from the bariatric surgeon and etc. (all things that have been completed for a while now) So I told them to send me a copy of the denial letter and he said they would. I asked about the physical therapy class and he said it ISNT required. So I'm feeling like I got the run around about the whole situation. I feel like I should call up there and ask to have someone else review the information instead of the girl who is working on it. I've had to be the one constantly calling her to find out what is going on. I finally had it the other day and called the insurance company (because she wouldnt call me back) only to find out they were waiting to hear back from her(for two weeks mind you) because they called to get some information she forgot to give them when she submitted the paperwork. I completed my six month diet in September and I have been patiently waiting for her to get it all sent in and taken care of and I haven't lost it when she didn't call me back on several occassions. I was even nice to her when she called me about the same thing after having spoken to me a couple days before....she didn't really know who I was apparently. errrrgggg. I'm sorry I'm just frustrated. Hopefully things will get all settled. She said she was going to work on the appeal. I'm just not sure I believe her. meh. Ok thanks for letting me rant and rave.

I can't say I'd be any less frustrated than you are, girl.  All you can do is to keep calling and reminding your surgeon's office to submit the CORRECT info back to insurance to overturn the denial.  I would call at least every other day, but I'm a bit pushy like that.  I'm here if you need an ear to vent to anytime.  Hope you get your surgery date really soon!

~ Renae

Hi.
I'm sure sorry for your troubles. I was self-pay, so I don't know too much about the insurance route, but I was wondering if you could go to your surgeon's office, ask for copies of everything the insurance company is needing and then send it to them yourself. Hope everything works out for you. If not, I think I'd be finding a new surgeon.
Blessings,
Mary

Call, call, call and make yourself heard!

I'd make a LOT of noise.  I was self-pay but if there had been a remote possibility of insurance paying and not getting a date because someone didn't do this or that...I'd be NOISEY!!!  It's your life you're talking about and so you have every right to expect service.  You have premiums paid on your behalf and so now it's time for them to take care of your business.  I'd personally go to the surgeon's office and ask for copies of what has been submitted and then go to supervisor of your contact at the insurance company.  You have every right to be frustrated!!!  If you don't handle it though it just might not get handled.  Nobody cares anymore about you than you do!!!  Good luck and that's what we're hear for...listen to yo rant and rave!

I'm sorry that you're having to deal with all the insurance nonsense. 

I would definitely speak to them, request your files and do it yourself if you have to.  I truly believe their "insurance coordinators" are severely lacking in either knowledge or skills.  Dr. Nelson was my initial choice as well when I decided on WLS because I was going the insurance route.  Their office could never seem to get approval for my surgery.  After much research, I found another doctor and was approved and scheduled within 4 days.  Granted, I had to go out of state to get it done, but insurance DID cover it!  It can be done. 

I wish you the very best!  Keep on trying, you'll get there!

I am totally pissed off for you.. OWLO requires a pscyh exam a phyiscal therapy exam nut class for you to be approved for them to do surgery...Your insurance company  requires the diet plus a few other things mainly that you meet the requirements for your particular insurance policy. The phyiscal is to see where you are phyiscally you will have to be on a treadmill and they will check your heart and lung capacity....ALL OWLO patients must do this...no exceptions no exceptions on the pscyh or nut classes  you will also have to do the h ploria test and a lung test at OWLO...
CALL OWLO demand to speak to BARRY KEITH he is the office manager let him know what is going on and how upset you are...and remember this sometimes insurance companies will blame the dr when the insurance company makes screw ups....their JOB is to deny elecive surgeries to make money...if you dont get any help let me know...LOL THEY HATE WHEN I CALL them to complain....

I'm so glad that there are so many people on here willing to help. I appreciate everything you guys have told me. I'll be taking a little bit of everything with me when I call them tomorrow. I've been busy working and etc so I haven't had a chance yet but tomorrow is my day off and I also have that physical therapy class to take too. I wasn't aware that OWLO required me to take the physical therapy class. Thats another example of things they haven't told me. arrrggg. anyway. I will keep you posted if anything becomes of it. Thanks again to everyone. Oh and I will let you know if they don't do anything Patti....I will warn them I know you!!! 

So I called them today. It started out bad but I guess thats just because I have a short temper. I called the office and asked to speak to the office manager and the girl said we don't really have one is there a problem or something. I just gave her a brief "I'm not happy" sort of thing and asked if I could speak to the office manager. Ok so she doesn't transfer me to the office manager she transfers me directly to the person who I've been dealing with this whole time. So she gets on the phone and asks me if she can help me and I say no I want to speak to the office manager. So yeah that wasn't awkward or anything. So finally someone else comes on and explain to her all of the stuff I've been told and how I feel frustrated and all that. So at last we spoke she and her boss are actually trying to work on my file/case/or whatever you want to call it. By the sounds of it, it seems that the information was sort of sent in half assed. IDK. just a guess from the vibe I'm getting. They have to contact my PCP again and get my six month diet info again to submit to the insurance company. So as soon as I have any info I will up date ya. Thanks again to everyone for their support and advice. I really needed it. you guys are awesome.