Insurance update!!

Called both insurance companies today Medicare said they got the info from the Dr. Office and are reviewing it now ~~ that is my secondary insurance.

My primary insurance says they have not recieved info from the doctors office.  And to have them call or refax info.  Asked them to do that a week ago and recieved no response to the email.  Called their office today and got voicemail so I emailed them again.   GRRRRRRRRRRRRRRRRRRRRRRRRRRR!! I am about to give up!!

What!? Give up!  Don't you dare! Aren't you worth fighting for? Insurance companies certainly aren't going to fight for you, so you have to! So, pull yourself up, dust yourself off, put on your gloves, and let the games begin!!!!  They haven't seen NOTHING yet!!!!

My problem is not with the insurance company it's with the surgeons office they just seem to be dragging thier feet constantly.  When I spoke to the surgeon he was all upbeat and said he knew it had been a long time but he thought I would have the surgery by the latest end of June. 

But it is the office, I was told that because I had medicare and medicaid and they have to settle for a certain amount that they would drag it out and hope I would go away.  I said surely not ~~ but it is begining to look that way.

If you think your surgeon is the one partially at fault, I would change surgeons. I realize that location is a big part of it, but I don't think my doctor would ever lead me through the blazing hoops. You may want to seek out another doctor.  Mine was the most fabulous (Dr. Chua in Milwaukee), but if that's too far away, make some phone calls. It can't hurt. You might also want to keep calling your doctor's office and pester them as well! The squeeky wheel gets the grease!  Good Luck!

I'm sorry you are going through this Cindy... but being on Medicare/medicaid doesn't mean they are dragging their feet and hoping you would go away.   I am on medicaid and had no issues with them gettng to work with me. One thing I did tho, is I took matters into my own hands. I don't know who you are working with at the office, but I was working with Elaine.  I asked Elain to fax ME everything, and then I made damn sure it got to the insurance on time for the appeals and everything else.  I went to the Dr. again yesterday and everybody there has been wonderful.. don't give up on them just yet. They aren't "hoping you go away"...I found that they were my cheerleaders when I needed support after denial.  As always.. keep us posted!

How did your visit go with the doctor?  Yes I had been working with Elaine, but she stopped answering my emails so I forwarded all of them to Julie Dr. Wasco's nurse.  I got an email from her yesterday saying she would have someone investigate it.  Hopefully, that will help.   Medicaid has the info and it is in committee.  But Medicare (Secure Horizons) has never recieved it they say.  So I will try to contact them again tomorrow.  See if the office sent it to them yet. I just get frustrated when it feels my life is on hold.  How long did the whole insurance process take you??

My visit was with Betsy and it went well. I'm at my 2 week stall.. which can be frustrating.. but I know that it will pass and to keep doing what I am doing. The appt. went well.. I still have the open wound on my side and it will be there for a few weeks while that heals. I see Dr. on Friday.. and then after that I will be able to progress to other foods. woo hoo! Right now I discovered turkey hormel chili high in protien and 98% fat free and low in carbs.. its working out great for me right now.

Now lets discuss insurance. I was denied first pass. Then my appeal was denied, and then I won the appeal. If insurance denies you, the surgeons office will SUBMIT the information for you.. but they leave the appeal up to you. You will have to be proactive in making sure all of the needed information is sent to them (dr. office) so they can fax it.  I personally did it all myself... that way I knew it got done.   The whole process wass rather long to be honest. My last appt with Lori was on12/04/07. My information was sent to insurance almost a month later on 12/27.  I was denied on 1/4/08, appealed with in 30 days and then had my 2nd appeal and won on 02/26.08. It was close to a 3 month process that made me want to scream!  So I understand how you feel when you say your life is on hold waiting for someone else to make up their mind!

Have you gone to the Ombuds for help at all?  That's what I did back in 2001.  There were a lot less of us doing this back then, but they backed me up.  I was denied twice and they got me through the Administrative Appeal. Each insurance company is different, so you might want to find out exactly what ground they're basing their denials on, too.  That way, you can go to your medical records and use them to counter their denials in your appeal.  For instance, if they're just saying it's cosmetic, your medical records probably have reams of documentation showing medical basis for this surgery. In the Wisconsin Administrative Code (I don't have it right at hand, but could get the exact chapter), there's an exception for social appearance and function (that's not the exact wording, but it's the gist of it).  That's what I'm basing my appeal for the excision of the arm skin on.  I have a grievance hearing in 30 days with Group Health.  Hopefully some of what I'm fighting for will help y'all later!

Hi, I have Medicaid-Badgercare.  Not sure if you know the answer or not, but I am wondering how long they have to decide on approval for WLS.  I have my last nut. appt. June 23, then all info. is being submitted to Meidcaid-Badgercare for a decision.  Any info. you can give me would be appreciated.  Thanks.  How is your approval coming along?  I hope by now you have heard with great news!

Hi!  From what I've seen, approval for concrete medical reasons are usually 30 days.  If you're denied the first time, as many are, make sure you appeal right away.  The process shouldn't take more than 60 - 90 days.  This is me thinking back to 2005, though.  Things could have changed since then. The most important things to have on your side are a PCP and dietician who will advocate for you.  They are the ones who will be documenting your progress, making referrals, filling out forms, etc.  If you aren't sure they'll back you up if you're denied, take advantage of the Ombuds program.  They helped me in 2001 and they've helped me in other situations since.   As for me, my hearing is next week.  It's going to be interesting presenting my documentation with a drain sticking out from a surgery just 9 days prior!  Sometimes, though, seeing is believing.  Maybe seeing how far the skin hangs, how awful it looks on someone as short as I am and how it gets in my way will be what it takes to change their minds. Good luck with getting your approval!  Let me know how it goes. Feel free to ask me anything and I'll answer if I can.