Cruel Mistake by Insurance Company!!!
I posted a few days ago after hearing from my insurance company that I was denied. My surgns. office thought it had to be a mistake since I had satisfied every requirement (in fact, instead of having the 6 months cumulative physician-supervised weight loss, I had 14 months!). But, today the financial director at my surgns. office called me & said she actually ended up in a really heated argument with the insurance company about this. They are going to do a peer-to-peer review (for those of you who don't know...if you are denied, but BEFORE the appeal, you can request a peer-to-peer where your surgn. essentially goes to bat for you with their surgn. via telephone. Your surgn. argues why you are entitled to the surgery under your health care plan. From what I understand, a good percentage of the time, the denial is overturned prior to appeal, but time will tell......)....
And any rate....I was pretty bummed about the denial when I rcv'd a telephone call from Highmark's R.N. from their Case Management Department. I thought she was calling about the appeal, however, she started the telephone call by introducing herself & telling me that she would be working with me throughout my upcoming surgery as a liason between the insurance company and me. She said that she had RNY surgery 8 years ago & was there to offer any help she could. She started to tell me that I should bring baggy clothes to the hospital b/c I will be swollen post-surgery and on & on....I finally interrupted her (estatic!!!!!! happy!!! and in tears!!!!) and said, "You have given me the best news I could have gotten. Thank you so much. I am so glad that the denial was reviewed and I am approved." She said, "Yes, you are approved". I then said, "When did they approve me?" and she said, "Just now"....so, I thought that the conversations with the insurance company & my surgns office earlier that day had been productive & the insurance company saw the light. I could hear her, however, flipping through paperwork and she asked me to spell my name. I did so and she kept shuffling papers....she was talking to me about how successful her surgery was & how she had lost 140 pounds....I told her that I was so happy that I would have the chance to get healthy & be around to see my three little ones grow up & to be able to run around with them & then....she said, "Oh. Actually, here is your paperwork. You were actually in my denial stack, not approval. Someone else has a name close to yours and I must have mistaken you for them. You were denied and the denial was upheld."
Okay...my tears of joy & happiness froze on my face, I swear. I was stunned. I couldn't believe it....she was stammering & realized the mistake she had made....so, then, she said, "Well, hopefully you will be approved, so let me tell you about the surgery anyway and how it all went for me..." I listened for a second & then thanked her but told her that I really wasn't in the mood to listen to how great things went for her when the insurance company she works for denied me even though I met the criteria they require. It really sucked.
So, that's my update....hopefully the peer to peer will go well & I will be approved.
Apparently, the insurance company is stating that I have two months of the six months satisfied (ahhhh!!), so I ran to my PCP's office today to get an October visit in...that way I will only have to do November/December & January and then HOW can they say I don't have 6 months....they will think of something else.....ug, ug, ug....
And any rate....I was pretty bummed about the denial when I rcv'd a telephone call from Highmark's R.N. from their Case Management Department. I thought she was calling about the appeal, however, she started the telephone call by introducing herself & telling me that she would be working with me throughout my upcoming surgery as a liason between the insurance company and me. She said that she had RNY surgery 8 years ago & was there to offer any help she could. She started to tell me that I should bring baggy clothes to the hospital b/c I will be swollen post-surgery and on & on....I finally interrupted her (estatic!!!!!! happy!!! and in tears!!!!) and said, "You have given me the best news I could have gotten. Thank you so much. I am so glad that the denial was reviewed and I am approved." She said, "Yes, you are approved". I then said, "When did they approve me?" and she said, "Just now"....so, I thought that the conversations with the insurance company & my surgns office earlier that day had been productive & the insurance company saw the light. I could hear her, however, flipping through paperwork and she asked me to spell my name. I did so and she kept shuffling papers....she was talking to me about how successful her surgery was & how she had lost 140 pounds....I told her that I was so happy that I would have the chance to get healthy & be around to see my three little ones grow up & to be able to run around with them & then....she said, "Oh. Actually, here is your paperwork. You were actually in my denial stack, not approval. Someone else has a name close to yours and I must have mistaken you for them. You were denied and the denial was upheld."
Okay...my tears of joy & happiness froze on my face, I swear. I was stunned. I couldn't believe it....she was stammering & realized the mistake she had made....so, then, she said, "Well, hopefully you will be approved, so let me tell you about the surgery anyway and how it all went for me..." I listened for a second & then thanked her but told her that I really wasn't in the mood to listen to how great things went for her when the insurance company she works for denied me even though I met the criteria they require. It really sucked.
So, that's my update....hopefully the peer to peer will go well & I will be approved.
Apparently, the insurance company is stating that I have two months of the six months satisfied (ahhhh!!), so I ran to my PCP's office today to get an October visit in...that way I will only have to do November/December & January and then HOW can they say I don't have 6 months....they will think of something else.....ug, ug, ug....
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