GRRRRR Insurance companies stink! Ok...this is long
So I just called the insurance company advocate for the third time! She tells me that we are missing some things that the insurance company demands and so they denied me.....OK. So I ask what they are missing. She says they are missing proof that I have taken a nutritionist class, that I am aware of the lifestyle changes involved, that I understand that I will need to exercise along with the surgery, that I have taken a behavior modification accessment, and that I understand that I am responsible for several appointments with the surgeon as followup and maintaining the surgical whatever. SO I asked her, do you see the report from the nutritionist in the file? She says yes. I said ok so do you see the report from the psychologist in the file? She says yes. I said ok, do you see the request from my surgeon with his explanations that I have attended his educational seminar and passed plus met with his p.a. and had an educational appointment on required followups after surgery? She says yes. So I said, OK SO WHAT IS IT YOU ARE MISSING REGARDING THAT AGAIN????? She said I was right and she would submit a request to alleviate that portion of the denial. I said OK.
Then I said, is there another portion to the denial. She said yes. I asked what it was. She said that they denied me because my bmi is not at or above 50. I said, well ok however I do know that the surgeon sent in a preliminary request for information and that it stated that my insurance policy states my bmi has to be above 40. Can you review that please? She did and found that I was correct. Then I pointed out to her that my BMI is actually 43 and that is clearly above the 40 required by my policy. She found the proof in the paperwork submitted by my doctor and crafted a second request for review based on that.
SO she says it can take up to two more days to get the reviews back but I am clearly in the right on the two issues at hand. I said well about time (to myself of course, not gonna tick them off on purpose until they agree to the surgery) BUT YEESH really, they can't even read their own policy correctly??
Sorry, just had to vent. Now I wait another day or two for results....I am at the point where I feel like I'm never gonna get the surgery date set....but I know I will. Still, seems that way. Getting frustrated I guess.
Great job!
Now make sure you stay on top of this. If you don't hear something in the allotted 2 days, get back on the phone and (politely, of course) demand answers.
Also, given that you are already having problems with your insurer, keep every shred of documentation, and make a record of all phone conversations with date, time, who you speak with, job title, and summary of the conversation. You can't be too tnorough.
Larra
what you are experiencing with your insurance co. is very very common, they don't know your policy, what is in your policy and how it affects you. I have experienced this numerous times.....so what you experienced is not uncommon...always keep a copy of the updated subscriber agreement to refer to and NEVER believe your insurance co without verifying it...
