Insurance Frustration Over Denied Claim

I'm working with my doctor and insurance to get pre-authorized for my DS surgery. I have met all of the requirements, but was denied my original claim. The reason was that they couldn't see the 6 months of dietician notes in my submission. I got updated notes, with dates and times and provided to my surgeon's office. They resubmitted but were denied the new claim since the old one wasn't "closed" just "denied". So we can file an appeal. Which is perfectly fine. However, they will not accept the appeal without their (the insurance companies own) denial letter. It's been 2 weeks and no letter. They refuse to fax it to my surgeon's office and will not send it electronically. I just am being told to sit patiently and check the mail everyday. 

I know I'm complaining and I'm sorry to vent, but I'm just frustrated. I've done everything they've asked and now they won't accept the clarifying paperwork unless it's attached to the letter that they themselves authored? Ugh. 

Insurance is so infuriating. I know it will come and things will move again, I just feel like I've lost almost a full month with all of this back and forth for a piece of paper. 

Well doesn't that just suck?

This kind of crap happens all the time. Go up the food chain. Call every day - be polite, but be persistent. Be the squeaky wheel. when the first person (take names and job titles) tells you to keep on waiting, demand to speak with a supervisor. If that person isn't helpful, ask for his or her supervisor. Everyone has a supervisor.

Another thought is to read for yourself their policy on how appeals are conducted. It is possible that they are violating their own policies either in terms of what you are required to do or the time frame in which they are supposed to provide you with this magic piece of paper. And no one is going to tell you that over the phone, you need to read the policy - which is a contract - for yourself.

Larra

My doctor filed the appeal. I called to ensure it was received, and I'm glad I did. The fax number on the insurance company's letter was wrong and they never got the fax. New fax number received, paperwork re-sent again. Oy. This is so frustrating. I feel like I have to be a dog with a bone and just fight for everything. 

Now I just hope they review my appeal quickly (I'm confident my papers are all in order and the requirements are all clearly met) and approve me. I'm READY! 

According to my claim manager, I should have a decision "on or before July 30th". *fingers crossed* 

Denied again. :( While the information was included, the "checkboxes" didn't have the dates. Seems administrative and we're filing a 2nd level appeal.

We'll see...

I was with you.. I had been denied and for one reason, my 6 month diet seems was shy by a week.  So I had gotten a weigh in at the Dr's and then they wanted more information about being followed by a DR, while WW was taken into affect.  It was quite the goofy set of guidelines.. I did not appeal but was denied after 6 wks of waiting the first time around and they said I needed a peer to peer review, which is their way of denying.  I called my surgeons not knowing when they had their review and they said it took a whole one minute and was approved with the new weight in letter.  So keep at it!  Also when you do call to get information from the insurance company take notes with dates, names and times...It's helpful! 

Now I think they're playing games. They've denied their own denial. So they denied the same thing twice. So I guess I have 3 denials now? Oy. I feel it's games and I'm actually losing hope that this will work. I haven't given up, but I'm trying to accept that this may not be for me. I've tried to "prove" everything in the insurance guidelines and that I have (very easily) completed all of their requirements. 

Now they say that the weight loss "program" I was on wasn't specific enough. They argued about 6 months, and I showed them that I have well over a year. Now the "program" isn't a real "program" and just chit-chat that my doctor put in his notes (which they have). They also have my worksheets, workbooks, lesson plans, 2.5 years of food journaling. 

What more can I possibly share with them to see that this has been a long road for me and something that my doctor and I have been working on for ages! This isn't something that I just came up with. Until May, I never wanted surgery. Now I see that's the best choice for me, and all of the work I've been doing for well over a year is discounted. 

I'm losing faith... and hope. 

I'm not sure if anyone's reading this or not, but I have a 'fun' update. My insurance has a partner program they offer and that program's nurse called to check on how things were going with me. When I told her I was denied and it was basically over, she looked into the system to see the submission. Well, I can't even believe this: there were about 15-20 pages that my surgeon submitted that were NOT included in the submission, appeal or scanned into the system. Can you believe it? For whatever reason, these pages just went poof. 

So, I have a new claim submitted with ALL of the pages. We'l see... I'm really tired of the games and could use some good news or something. This process has been absolutely horrible, if I'm honest. 

You don't have Cigna by chance do you?