Doctors Office refusing to get approval

Has anyone run into this....

I have everything that my insurance company needs to submit for approval.  I have hand delivered everything they needed. 

Two days ago, I asked the office staff what is the procedure now, she keeps telling me that I need 6 months worth of doctors notes stating my weight loss failures.  I advised them that my insurance company doesn't require that, and provided my benefits sheet AGAIN, for the second time.  Because my insurance company is a medicare replacement company the office staff don't hear anything but medicare.

I called medicare AND Humana and both have said that I don't need a 6 month period of notes but the doctors office refuses to submit for approval telling me that they need 6 months of treatment for obesity. 

Because of the insurance plan I am on there is only one doctor in all of the Dallas Fort Worth area that I can go to, I am at their mercy.  Is there ANYONE that can help me, like an ombudsman or any department of that nature?

Have you tried having the insurance company contact the Dr.s office? I had an insurance snafu with another Dr.s office and I got the insurance company on the phone while I was in the Dr.s office and actually handed the phone to the insurance coordinator so she could be told exactly what was what.

I would do that if that would work but unfortunatly, when calling Humana's Bariatric Department, it takes 7 days to get a call back from them.  They did send me an email in which I forwarded to the doctors office today, but I have had no response as of yet.

Have you considered choosing another doctor in a town nearest yours? Must you stay in your immediate area?  After what you have experienced, would you even feel confident with this surgeon and his team if you did gain insurance approval?

I have thought about that ALOT today, but the next closest doctor (that takes Humana and practices at a center of Excellence) is 2 hours away.  Thats the crappy thing, I love my doctor...

Make the doctor aware that his office is not submitting.  Very often they leave too much up to the clerks that run the business end and he may have no idea that you are having a problem

Que

Your not too far from Tyler Tx. they have centers of excellence there and all of their surgeons are top notch......

My surgeon is two hours away from my home town and worth every second to get there...

Look outside your area...........I have a sister in Plano that may be able to help you locate one...

Let me know if that helps

Thanks Tara, Thats the next step...

I guess I am thinking about surgery day and not wanting to drive 2 hours afterwards.   I did call today, I call everyday to the office and apparently my email has made it.  I asked where it had been taken and I was advised that the woman that handles the the submissions to the Insurance company has the paperwork. 

So we shall see what happens tomorrow, if I dont get this submitted by the end of the week then I believe it is time to look in Tyler.

That really stinks!  My Dr. is in Wichita Falls, he didn't require a 6 month history unless insurance required it.  I live in Amarillo and drove a little over 3hrs to his office.  If you need any more info on him let me know. 

Good Luck and Keep Fighting!!

Thank you everyone, I guess driving hours to see a doctor isn't that out of the ordinary.  I so very much appreciate everyone's advice.

I believe I have gotten my answers....

I also believe that the doctors office after today is moving forward.  BUT, as I'm sitting here and thinking as I have been all day, I just am not sure I want to deal with this office for the next two years. 

I realized this ...
1. They aren't doing what the doctor wants them to do they are doing what they as an office person is wanting to do.
2. They don't listen to the patient.
3. They don't believe the patient may actually know what they are talking about.

The sad thing is, is that these people work with people on this journey daily and from what I am seeing is that there is a certain amount of psyching your self up to decide to go on this journey and they have no respect for that.

Two days ago when I left the office, I looked at the woman and said NO, NO, I am not doing what you are asking because it is unnecessary and walked out of the office in Tears...  You would think that is where you would be getting the  most support , I got the most support from the insurance company and Medicare... How ironic is that?

Maybe this was a good thing, I am seeing the issues that maybe harder to deal with later, after the surgery.  I'm sure the doctor is unaware that this is all going on, in fact I know.  After this is all said and done , I will be writing a letter.

Again thank you all for you advice and I will keep you posted, I know I cant be the only one that has gone through this, I'm just more stubborn lol when it comes to what I want and need!