Getting surgeon's office to FILE?!

I know most posts are about hearing back from insurance companies, but I need advice on how to get my doctor's office to even file.....or at least call me back and tell me why they haven't filed!

I finished my 3 month regime on January 27th and had my upper endoscopy on the 30th.  I told the woman at the reception desk I was done with all requirements (and yes, I've called and confirm they have copies of my weight history, psych eval, etc.) and asked her about insurance filing and she said it happens automatically when all my paperwork is there.  I don' t have any confidence in that since at my first surgeon's meeting the patient care coordinator told me I needed to do a six month diet for Aetna and provide a five year weight history, both of which are incorrect.

I called the insurance coordinator last Thursday and left a very nice message saying "I think you have everything you need and wanted to know about status, etc." and left both my home and work phone numbers.  No reply.

I called again this morning and said "just trying to get some information so I can manage my expectations."  We'll see if I get a return call but I don' t have my hopes up. 

I'd love to hear how you all would handle this.....call every day, every couple of days, wait for a couple more weeks....any advice?

How frusterating!! I would call and speak with the office manager. And yes, I would call every day until you get a response. It is not acceptable for them to not return your calls. Even if they don't know the answer, then they should call and say they are working on it. The squeaky wheel gets the oil. You will get further if you are nice and polite, which it sounds like you are being. No need to call up there screaming obscenities! LOL!! I think if you just stay calm and explain why you are frusterated with the situation, surely they will help you.
It's aggravating how clueless these people can act sometimes. It's like - surely I am not the first weight loss surgery patient that has been anxious and wanting to know what is going on. If they would just do their job and follow up with their patients everything would be a lot smoother!
Good luc****ep us posted on how it goes!

I had the same thing happen with me.  Aetna was great to work with but my surgeon's office had a couple of new people (very sweet) but didn't know the requirements as they should.  I had my medical history sent to the surgeon's office, had my letter of referral (required by surgeon's office, not aetna)  i also provided them with 8 months worth of Weigh****chers weekly weigh ins. 

I was in the process of completing my 3 month multidisciplinary program when i received a phone call from my surgeon's office saying 'we tried to surprise you and get you approved because you had 8 months of dieting with WW but it was denied'  I was sick about it because I knew Aetna didn't recognize WW as a physician supervised diet.  so i told her i was doing the 3 mo MD plan and I wasn't going to  be done until 12/29.  She said 'oh, well then we'll have to send an appeal'.

So that's exactly what i did.  I completed the program and got all my paperwork in order (letters from the dr and dietician saying i had completed the program).  i faxed it all down to my surgeon's office and she said 'we'll get it to aetna this week sometimes' (that was on a tuesday).  one week later, i called aetna to see if they had made a decision and they had not recieved anything yet!   So i asked for the number to where it could be faxed and i did it myself.  then i called my surgeon's and she said 'oh, i haven't gotten to your file yet'  I told her NOT to send anything b/c i had already faxed everything myself!   I was upset.   But, that was on a thursday and the following Tuesday (4 days later) I got a call from aetna saying i was approved!! 
My advice, keep on them....fax the stuff yourself if you have copies along with a letter....Aetna is very specific about the 3 month program it's hard enough to be approved on that so you want to make sure the people at the dr's office know HOW to submit and WHAT to submit.

Good luck to you!!!  I hope it all works out....as I said, Aetna was great, they will approve if you've met the requirments.  Keep on your Dr. office....!

Nan

I agree with Nan. Can you get copies of everything and fax them or send them yourself/ If not, be polite, but persistant. Good luck . :)

If possiable for your scenerio - I'd start searching for another surgeon.  This WLS is so very important in the post op care area and this type of attention or lack there of simply scares me.  If not...I'd go back down there and ask for the center's front office manager.  They should be able to help facilitate your needs a little better than the other staff memebers.  In a face to face situation - you can't be given the run around!  That's for sure.

I wish you all the best...

-To Be Me Again

 Keep calling and politely ask them if they've sent your info over to your insurance yet and if so have they received an answer.  I've found that speaking to an actual person gets better results, keep calling until you get ahold of the person. You are the boss. If they continue to stall and can't do their jobs ask to speak to the office manager or even your surgeon. You'd be surprised how many surgeon's office have the most inept people working for them and they have no clue. If worse comes to worse threaten to find a new surgeon.  Best of luck

Well. she did call me back and asked "have you gotten us your five year weight history?"  "Uh, no, I've gotten you my two year weight history along with the print-out from Aetna.com which shows you the requirement is only for a two year weight history."  Then she asked, "Did you do your supervised diet through your PCP?"  "Uh, no, I did it with the doctor sitting in the office next to you."  Clearly she hadn't even glanced at my file. 

She did say (presumably taking my word for the fact that I've turned everything in) that should we go ahead and tell the surgeon we were ready for him to prepare his medical necessity letter,  so I do feel like some progress was made. I'll give it a week or so and call back about that.

She was perfectly nice but clearly incompetent!