Insurance vs Surgeons office

I am completely at my wits end and not sure if there is anyone here that can help me but I need to vent. I have been battling to get all my ducks in a row for so long now and just when I thought I was so close, bam, another door slams in my face. My ins is BCBS of MI but I live in Florida.  My surgeon's office has been less than helpful in this journey, however, I don't have another option in my area.  The surgeon is highly qualified, it's her staff that are a bunch of *******. The documents they first sent to my ins came back denied.  So, I got everything together and I submitted a much more thorough packet.  It took 8 months, but I finally received an approval letter from my insurance.  I sent it over to my surgeon's office hoping that we can finally schedule the surgery.  I even had my rep from BCBSMI call my surgeon's office to assure them that I was approved, but she wasn't able to give them a pre-auth number but did give them  a phone number to where they could call to get it. NOW...I get an email from my surgeon's office that says that they called my Ins and they have no receipt of ever receiving my documentation and that it was sent to the wrong address.  She says that they have to re-submit it all over again.  First she says she is going to fax it, then she says she if going to mail it.  When I ask if she is going to FAX and MAIL, she says that they won't accept a fax so she has to mail it. How can she say that they never received it, if I got an approval letter????????  I'm at my wits end and really sick to my stomach about this.  This woman is very unfriendly and frankly tells me if I don't like it, I can go to another doctor, knowing I don't have another doctor that does the surgery in my area!!! What would you do if you were me??

IMHO: If you have the approval letter, you are approved.  I don't see how they can go back and say you aren't. I would call the insurance company and ask to speak to a supervisor.  Tell them there are two conflicting stories and ask what her records show.  If they show you do not have approval, ask her where you should fax a copy of the approval letter you got.  I would come at it from the perspective that you have approval, and their notations on your account are wrong. Seems if you have that letter, it's a no brainer from a legal perspective. Did your surgeon's office get a copy of the approval letter from the insurance company directly? I think typically, they send a copy of the letter to them, too.   If you get it cleared up with the insurance co, maybe they could give you the preauthorization code.  Then call the surgeon's office and tell them you'd like to schedule the surgery.   If you can't get the office to cooperate at all or you feel like you are pushiing a rope,  call and ask to speak with the surgeon, or you may have to schedule an appointment to see him.  I would ask him if he really doesn't want your business.  He may not be aware of what is going on with his staff. Luck to you! Martha

Agreed...I think you have an auth letter, you're set to go. Now, why is it that you can't go to another doctor? If the fit with this surgeon isn't good, I wouldn't want her cutting me up, I can tell you that much.  This is MAJOR surgery, and you have to trust the person that is cutting, stapling, etc. on your gut. JMHO.

Ok....so I called my rep at BCBS and told her what my surgeon's office told me.  She saw in my record that my surgeon's office had called three times to try to acquire a pre-auth number and that she had spoken to three different reps.  All who told her that they never recv'd my documents.  Being the wonderful rep that she is, she emailed all three of the reps and copied the woman that sent me the approval letter.  She said she would call me once she gets an answer but I still haven't got the call.  I just don't understand how I could get an approval letter but three different reps tell my surgeon's office that I'm not approved.  Ugh. Back to the surgeon's office - Paul, I am dealing with the office manager/bariatric nurse.  She's the mean one.  The ins lady isn't very bright but hasn't been mean to me...yet. I will keep you all informed and thanks for the advice! -Traci