Insurance Approval - Dr. Mailipur - Huntsville, AL

Hi All,

I am going round and round the the nurse at Mr. Mailipur's office regarding insurance approval.  She keeps saying that I must have 7 months (a consultation plus six months of supervised weight loss through my pcp).  Well, my lovely PCP, failed to write down our discussion in May and also last Fall, even though SHE is the one *****commended two surgeons (Facundus and Murrell).  I am at my wits end because November should be my last  (sixth) visit and she says it won't be approved until December (a seventh visit!)...this may push me out to 2010 when I don't have any sick leave and a whole new deductible!!! 

Ideas are appreciated...this is such crap...I'm starting to think there is a reason I should  not have the surgery since it has become such an ordeal. 

Oh, and my primary care provider, is basically denying either discussion in May and the Fall...SHE is the one who gave me the referrals!  Clearly, I will be finding a new PCP when this is all over with. 

I know its a pain but the ladies at Dr. M's won't send the paperwor****il everything is crossed off the list. I was a little different since my insurance was BCBS of MN and didn't follow BCBS of AL's policy. Did the doctor not document anything in your record? If your PCP didn't all the insurance company looks at is what's on paper.

Its a big old pain in the hiney but worth it after the surgery is over and you start to see results!

Good luck!
Noel

just hang in there, I learned really quick that there are a lot of hoops for insurance you have to jump through....you think this is all tough, wait till you actually have the surgery...theres a lot of tough decisions there also.  everything does happen for a reason. 

keep trying, keep working, if you want it bad enough, youll do what they tell you to because they know what they have to turn in to get it approved.  i know this is tough, but just hang in there!  DONT GIVE UP!  its worth it i promise!!

No, my PCP FAILED to write down that we discussed the WLS and says she doesn't remember.  I am furious with them.  Then on top of that, BCBS says I have to have six months, and Dr. M's nurse says 7!  I've spoken with BC/BS and they are trying to help me, but I can't get Dr. M's nurse to budge...they are talking layoffs tomorrow and I am very worried I am on the list.  I have done everything I am supposed to and they are making up new rules. When BCBS calls me back, I'm going to three-way with Dr. M's office to see if that will make any difference.  And, when this is over and done, finding a new PCP since obviously their record keeping practices are very lax to say the least.  

Thanks for the encouragement!  I want this surgery and am doing my part...I am trying to not over-stress about the layoffs - that will just add insult to injury at this point.  How to pay for Cobra when you only get $200 a week on top of all the other bills...ugh..it makes my head hurt!  

Leanne the insurance did tell you correct and Dr. Malipur office is also correct.  What some one is not telling you is that the first visit does not count toward the 6 months.  That visit if for the consult and weigh in.  You have to visit the doctor exactly 1 month apart and it has to be 1 month and not a week or a few days before the month is up.  The doctor nurse has done this so much that she knows what it takes to get you approved.  BCBS will tell you 6 month and then when you send in the paperwork and is denied they will then tell you why.  Please listen to the nurse at the surgeon office. I think if I were you I would find a new PCP after this is all done and over with.