don't think my surgeon's office's insurance lady will help me?

I was recently told by the UAW rep at my husband's employer that the customer service # on the back of my insurance card is the wrong #. The contract and group # are right, but the customer service # is wrong. They told me that they will be sending me a new card with the correct #s on it. When the surgeon's office submitted information to the people whose # is on the back of my card they told me that i need 12 months supervised diet. When I called the # that I was told to call by the UAW rep, they told me that 6 months supervised diet is needed but waived for me since my bmi is over 50. They gave me a providor inquiry # for my surgeon's office to call and verify benefits. This is not the same # that she had called before. I called her and told her this information and she told me that it doesn't matter what # she called as long as the group # is the same. Why did it make such a big difference in criteria then? I am afraid that she won't call the new providor inquiry # for me and I will be stuck waiting 12 months.

You need to insist and tell her that you will do a conference call with her.  SHE WORKS FOR YOU...essentially.....it is her job to deal with all insurance issues....if you dont like her attitude call the DR.  and let him know she wont do what you asked for .  Be proactive and courteous and ensure that she does this. Good Luck

How long will it be before you have  a new insurance card with an updated number on it?  If you dont know I would certainly call my insurance provider and request a new updated card. In the past it has taken me only a day or two to be issued a replacement card.  I am sure she will call again once you have been issued a new card.  I am still preop and once I decided wls was for me I wanted it done the next day.  Its a process that has tried my patience at every corner.   I have stayed very proactive in this process and have taken the time to send short emails to the ladies in the insurance dept at my surgeons office thanking them for their patience with me and such.  Remember you catch more bees with honey than with vinegar. 

Hello, I am the person in the surgeon's office that works with the insurance co.  Maybe I can help here.  In our office we track every plan we work with to try to keep up with all the changes in criteria.  Mostly only self funded plans cover and they can have and change criteria at any time without notifying you.  Some of the reluctance for your insurance gal is that she will literally spend an hour or more going thru voice mail to get to the dept that will "hopefully" tell her the current criteria of your plan.  Now times that call by hundreds of patients and you will see how difficult it is for her to make multiple calls for you.  So it is in your best interest to access that criteria yourself and take it to her.  One of the best ways to get the right info for your plan is to contact your human resources dept to find the name and number of your particular companies insurance person that processes your claims.  They usually have at least one person that they field questions to .  If you can get that contact person, they should be able to give you the "right" criteria for your plan to preauthorize.  If that does not work, ask for a supervisor or medial reivew team menber.  Depending on the Insurance co you maybe able to access that online  under medical policies.  Don't ignore any other members on your insurance plan that you know have had surgery.  They will usually be very helpful for you.  Take this information printed out to your surgeon's office.  One last caution, multiple times daily I get calls from very frustrated people that are told by the insurance co that they should just send in a letter and records and it will be covered.  It is a lie and is told by a customer service rep that either does not have access to the correct information or does not have to time to look it up.  It is a line that is given out all the time.  I usually am the messenger that tells you what we know needs to be done.  Remember don't shoot the messenger.  She is just telling you what is usually the truth of the matter and trying to save you from a denial. Hope this helps some.  Email me if you continue to get stuck.   Take care, Mary PS Is this plan a BC/BS of Mich?  If so I may have your answer for you just email me.

I had a somewhat similar experience (but not the wrong number).  I called my insurance company twice and got 2 different set of criteria for approval.  What happened was that my employer has their own insurance but it is managed by Principal.  Principal has criteria AND my employer has criteria.  The first time I called they gave me Principal's criteria...which was wrong.  The second time I called they gave me the correct information which were my employer's criteria (which was a much more strict 12 month supervised diet instead of 12 weeks...grrr). Could something similar have happened with you? Kari

AMEN! I am the insurance nurse at my office too.  I have over 300 patients on my list in various stages of getting surgery approval. We do know what we are doing but really cannot spend 3 hours on the phone every day for one patient. That is why we fax and send a letter to each insurer for each new patient. We request their criteria in writing, usually via fax, and get pretty good results. Also, websites are good. Unless a patient can prove otherwise, they usually have to do the requirements we have for their insurer. That is why it is so important for the patient to be involved.  We want to get you to surgery, but if you call us everyday for an update, we cannot get anything done. I have on average 15 calls per day of patients who want to know their status. UMMMM why would I know why your insurer is so slow??? CALL THEM, NOT ME!!!  Once we send it, there is little we can do. SO about one full hour of my day repeats the same sentence over and over "No, I have not heard from your insurance company. I can tell you that I faxed 32 pages to them on 05/02/08 at 943 am. WHy don't you try giving them a call and asking them. I know they received my fax, I have the comfirmation slip right here, 32 pages at 943 am, write that down becaus ethey will try to tell you they have not received anything from me." BCBS MI recently changed their policy because when I got the info in December 2007, it was a 12 month diet. In April I had to request it again and found it was now 6 months. You can call utilization review at your insurer and have them fax you the criteria. Be prepared to spend 1 hour on the phone and speak with 3 or 4 people.  First the customer service person will tell you to submit your records, say thanks but I need the utilization management, care coordination or pre-certification department that approves our requests for surgery, my soctors need the specific criteria that only that department has. Then you will prob have to repeat that about 2 or three times before you get to the right person. They can fax it to you in wiritng. Good luck! Bonnie

Hi Robyn, Your Anthem Insurance supervisor called me at the office today.  She said they finally received the criteria in writing from BCBS of MI just now.  She said she was told to go by the new BCBS of MI criteria.  She is still wrong.....go by your self funded employer's criteria that they sent you.  That would be the correct one. Isn't it crazy that the insurance companies can't even access the right answer from themselves?  It is because each self funded plan has their own set of criteria to follow.  The employer is in control of that.  BCBS of MI only adminstrates the plan for them.  I just didn't want you to get confused by Anthem again.  I have to say those calls I made the other day were some of my more interersting ones!  No wonder you were frustrated. Take care, Mary