Problems with insurance/office personnel

Hi all,  I need to rant and maybe get a little advice.   My surgeons office submitted the request to my insurance recently.  I'm not sure if they are supposed to, but they didn't tell me they were submitting this yet and I had not yet sent my medical information to them to submit with the request.  The only reason I even knew they submitted the request is because I got a letter today from my insurer saying they didn't have adequate information to make a review.  My surgeon has asked me to get permission from my neurologist for the surgery and my appointment with the neurologist isn't until the 18th of this month.  My surgeon and I discussed the fact that if my neurologist does not give the permission we might then discuss a different procedure such as the LAP-Band.  I thought the the request would be submitted when all this was finally resolved. I called my surgeons office and was told I would have to work it out with the insurance company (Tricare), so I called them and they told me that only the surgeons office could submit the requested information to make a review.  I almost begged them for the information which they gave me, but they would'nt budge on letting me send it to them. I then called back my surgeons office to let them know what the insurance said and tell them what items of information they (the insurer) needed to make the review.   The woman in the office told me it had been my responsibility to get this information to them before they submitted the request, but I had no idea the request would be submitted yet.  One of the items of information they needed was proof of arthritis, but I don't even have arthritis and have no way of obtaining proof of something I don't have.    So sorry for the length of this, but I'm so frustrated and don't really know where to turn now.  The women in my surgeons office got very upset with me and accused me of being combative.  Did anyone see the movie "Anger Managment" and the scene on the airplain where Adam Sandler was accused by the stewardess of getting violent or something, well that's exactly how I felt.  I just kept trying to get informtion on what their processes were and what I could do.  I finally did get upset when she kept shutting me down and telling me about all the problem patients she has to deal with.  I'm afraid now that I'm always going to have trouble with this woman.  I hate to start all over, but I don't want to have to worry about this kind of behavior spilling over into other business I have with the office, which in the long run will be a lot I think.   Any advice is appreciated. Thanks

RUN!!! I'm angeling a friend who has had her surgery cancelled 3 different times with that office.  They have been very ugly to her.  Unfortunately, I think he's currently the only surgeon who will work with Tricare.  The problem with TriCare is that they approve people and then they pay very very little or they don't pay at all.  It's not really motivating for anyone to go through the hastle that they require to get hooked up as a TriCare doc. I think there's a surgeon in Tucson who works with TriCare?  Dr. Burpee?......  Also, Dr. Schlesinger was applying for it? ..........Write down names and comments made to you by office staff.  There's always someone higher than that person who "cares" how patient's are treated.  One of my friends used to work there but she has gone to a warm and fuzzy job now. Good luck!  ...........Anyone who has TriCare should just automatically get great medical coverage!  After all.......y'all are serving our Country!!!!!

Thanks so much for the reply.  It's very nice to know I'm not alone in my problems with this office.  I will look up Dr. Burpee and Dr. Schlesinger.  I took your advice and wrote down a little memo for record on the the interchange between the women in the office and myself. Thanks Again!

I cancelled my procedure with this office and went to a different Doctor because I had numerous problems with the staff - they were disrespectful and mean!

Thanks for the reply.  Do you happen to have TRICARE?  What office did you switch to? THanks, SHawn

I know that Dr. Villares only had one person in the office on the day of my consultation (Sept. 4th) and that they have hired two new people to help her out. When I was there on the day of my consultation, I confirmed with Eleanor, (their one office person) that she had NOT received all of the information needed by my insurance company, and got her assurance that she would not submit to the insurance company until all of the information was received by her office. When it all was received it seemed to take forever (three days) for her to submit it to the insurance office, and it's been a little difficult to communicate with them (my fault really, as I only have a 20 minute window when the office is open and I'm also free to speak on the phone), but they have been responsive to my frequent phone calls and have worked with me to get records from all sorts of strange places so as to beef up my request to the insurance company. I was very pleased with Dr. Villares himself when I met with him in September. I believe that IF the insurance company approves me, it will be due to the extra efforts on the part of those lovely ladies in that office.  It's easy to get frustrated and to want everything to happen instantaneously. I've just been very lucky that real life has imploded my free minutes so I don't have time to think about the whole insurance thing on a daily basis. I will be calling the ladies in the surgeon's office again tomorrow for a status report before calling the insurance company.  I"m sorry you had such a difficult time with the people at this office. We'll see how things progress as my insurance application begins to mature and gets to the point of approval or denial.

Hi Lithia, Thanks for the reply.  I'm glad things are going smooth for you.  I have not turned anything in yet, so I'm really not sure why my information got submitted in the first place.  I too liked Dr. Villares a lot.  I hope Eleanor was just having a bad day when she spoke to me because I didn't get any of the helpfullness you spoke of.  Based on the other person that responded to me I was thinking that maybe the office is not thrilled with Tricare patients because apparently Tricare can be a pain in the rear for Doctors Offices.  I hope thats not the case because she also said Dr. Villares may be the only Tricare provider in the area.  Do you have Tricare by any chance? Thanks again for responding, Shawn

I don't have tricare, I have BCBS of AZ (PPO). I think that Eleanor has been highly stressed out, they've hired two people to help her, Carmen does the insurance and Stevie does ... Not sure. I think I"m a micromanager (hubby says) so I was very explicit. I had a sudden brainstorm during the consultation "how on earth will they know that my stuff is not complete yet? I don't want them to submit until it is complete." So I specifically told Eleanor not to submit yet. When they did submit the paperwork, they submitted it to the wrong place, and being the micromanager I am, I realized almost right away that they had made a mistake (truthfully, an easy mistake to make, as I got wrong information from BCBS in the beginning just like Eleanor). They corrected it right away as soon as I pointed out the error. I'll be calling again tomorrow (more micromanaging) to make sure that they've sent for and received certain records and then sent them off to the insurance company. Luckily for me the insurance company has given me their fax number so if I have to send stuff for my application, I can do that directly and bypass the surgeon's office.  I think that you have a difficult insurance company, and Dr. Villares staff are certainly not perfect. Unless I have a more pressing reason to change beyond a few holdups with the office staff, I'm not going to try to change surgeon's offices. At this point I consider my chances of even being approved for surgery to be pretty slim, so I'll just micromanage my insurance applicatin thingie as much as possible, and then appeal. It's just not a perfect world.  As I mentioned before, it has helped me a lot to know that I have a zillion other things going on in my life.  Have you tried to call back (honey and sugar often do the trick) and ask for a fax number and any codes or reference numbers, tell them you'd like to send a personal letter with the application for approval. Or whatever else it takes. Perhaps you got someone who was just mean at Tricare the first time, and you need to try to get a nicer person who can give you the fax number. I've actually been pleasantly surprised at the nice treatment I've gotten from my insurance company. 

Man I really appreciate all your thoughts and ideas.  I have not called back yet.  I'm still waiting for my neurologist appointment on the 18th to see if I"m going to get permission from him.  If he gives his permission, then I will call back and see what I can do for them.  I really don't mind doing the leg work, I just don't want to step on any toes with either the office or the insurance.  Thanks again, Shawn