someone please help me (long story)

Mommy O.
on 4/20/07 8:32 am
Well, its been a year and im still at squar one ... i've posted about this before.  The problem now is that my insurance denied a refferal to a doctor in austin about 6 months ago. Well about 2 months ago they decided to change their mind and approve it. After the referal was denied for the doctor in austin i looked for a doctor who is closer to me and i called my insurance. They said that they could switch the denied referl to this new doctor and that it would be approved because it was alot closer to me. SO i go to this new doctor and after my initial visit i get a letter informing me that the first doctor is approved after all and therefore they were not able to change my referal to the doctor who is closest to me.  So, I call insurance again and i ask them what i should do since i already have the process started with this new doctor. They tell me to contact my PCM and to ask him for a new referal to my current doctor. I do that and when they submit the request it turns out that it is denied because i already have an active referal for the same diagnosis. (but i did ask if this would be a problem and insurance told me absolutly not, the first approved referal would be canceled and the new referal would be activated)  and all this referal buisness is just for office visits!  Im yet to be approved for the surgery! After a year of this back and forth ... im sooooo frustrated.  SO my question is ... what do i do? .. should i just go to the first docter who am already approved to see (office visits only) ... and have them start from step one in getting my approved for surgery ... (resubmit, instead of appeal) Or, do i insist the referal be changed to my current doctor, who has already started the process of getting me approved for surgery? ( i was denied because i didn't have co-morbs, so we are in the process of an appeal, because i do have co-morbs but the surgeons insurance person did not submit) IM just so confused and frustrated with this .. please help.
gary viscio
on 4/20/07 9:33 am - Oceanside, NY
RNY on 07/01/03 with
If you have to pick one, then pick the one you're happy with.  If you can chose either one, then pick the one you're happy with.  If they only allow one and not the other, then you'll have to go with who is in their plan. BUT, enough of this BS.  Tell them you want it approved right now.  And, if they don't get back to you within  a day or two, go right to the Insurance Department in your state an file a complaint.  A year is way to long for a pre cert process.  I mean, your not even in the appeal process.
Gary Viscio
www.ObesityLawyers.Com
RNY 7/1/03  -166lbs
Mommy O.
on 4/20/07 10:28 am
Both doctors are in the network and i like both of them .. the one im with now has a nutritionist and his staff so she is going to be helpful after surgery  I am just haveing issues in my life because this surgery has been postponed for so long and i need to find the quickest way to get it done so that i can get on with my life. I just wanted to know if i have a better chance of getting approved for the surgery if i stay with the doctor i am with now , who i need to get a referal for.. (he already submited the request for surgery but it was denied)  Or if it would be better to just resubmit the request for surgery with the doctor who i do have a referal for.
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