Insurance Co Said They Don't Have Paperwork!!!
All,
I am lurker mostly, but I am coming out to talk about what ROT this is.
I have NO EXCLUSIONS on my policy. WLS is covered.
I went through the 6 month dr. supervised diet.
I had all consults. My file was perfecto. Insurance guru at Surgeon's office
sent said file over to my insurance CO 11/3 and 11/5. Confirmed RECEIVED 11/9.
When she called 12/7, she = Insurance Guru at Surgeon's office- was told that NOTHING WAS SENT, THAT THEY DIDN'T HAVE THE CLINICALS.
Ummmm how can that be!!? I had been calling as well, since 11/20 and was told STILL PROCESSING.
I only have 439- until I reach my Out of Pocket Deductible of 2grand. THEN it would be 100% covered.
My guess is they are stalling until the New Year, which upsets me greatly.
I started the process in MARCH, when I was told that all I needed was a letter of Medical Necessity (I have 2!), THEN when speaking to someone else, I was advised that I needed the 6 month Dr. Supervised diet. OK No big deal.
So, how is that this insurance CO. DOES NOT HAVE the file!?!?
I talked to a supervisor and asked her why the reps did not tell either myself or the insurance guru this information? I have kept excellent records, had dates, times names, etc.
Thing is, NOTHING can go forward UNTIL they receive the docs. SOOO Insurance guru refaxed 12/7. Yes, I know.
I find it incredible, really. Incredibly UNprofessional.
2 others in my office have had RNY without issue....why me!? I bet it has to be with the holidays, too, but come on!!
I have sent email after email to insurance guru to have her send all the info again to supervisor at insurance co., marking it URGENT. I want this surgery and I need it.
Sorry about the vent, I feel like I am getting the run-around.
What say you all out there? Am I being obnoxious by wanting an update or having insurance guru resend everything to supervisor, marking it URGENT?
Let me know what you all think!!
Cheers,
Megan
I am lurker mostly, but I am coming out to talk about what ROT this is.
I have NO EXCLUSIONS on my policy. WLS is covered.
I went through the 6 month dr. supervised diet.
I had all consults. My file was perfecto. Insurance guru at Surgeon's office
sent said file over to my insurance CO 11/3 and 11/5. Confirmed RECEIVED 11/9.
When she called 12/7, she = Insurance Guru at Surgeon's office- was told that NOTHING WAS SENT, THAT THEY DIDN'T HAVE THE CLINICALS.
Ummmm how can that be!!? I had been calling as well, since 11/20 and was told STILL PROCESSING.
I only have 439- until I reach my Out of Pocket Deductible of 2grand. THEN it would be 100% covered.
My guess is they are stalling until the New Year, which upsets me greatly.
I started the process in MARCH, when I was told that all I needed was a letter of Medical Necessity (I have 2!), THEN when speaking to someone else, I was advised that I needed the 6 month Dr. Supervised diet. OK No big deal.
So, how is that this insurance CO. DOES NOT HAVE the file!?!?
I talked to a supervisor and asked her why the reps did not tell either myself or the insurance guru this information? I have kept excellent records, had dates, times names, etc.
Thing is, NOTHING can go forward UNTIL they receive the docs. SOOO Insurance guru refaxed 12/7. Yes, I know.
I find it incredible, really. Incredibly UNprofessional.
2 others in my office have had RNY without issue....why me!? I bet it has to be with the holidays, too, but come on!!
I have sent email after email to insurance guru to have her send all the info again to supervisor at insurance co., marking it URGENT. I want this surgery and I need it.
Sorry about the vent, I feel like I am getting the run-around.
What say you all out there? Am I being obnoxious by wanting an update or having insurance guru resend everything to supervisor, marking it URGENT?
Let me know what you all think!!
Cheers,
Megan
Queen_Mom
on 12/10/09 8:36 am
on 12/10/09 8:36 am
I dont have any advice Megan, but wanted to say hang in there. My best friend has been fighting with her insurance Co for months trying to get approved for wls. They keep giving her the run around......making one excuse after another. I too believe they are trying to hold her off til the first of the year. Good luck! Cindy
I completely support your being pushy to get things done. This is about you and no one else. You are the only one that truly cares about the whole process and getting approved. The insurance guru is just along for the ride. I did the same thing and pushed and pushed until I was approved. I would call the insurance company once or twice a day to make sure things were moving along. I was initially denied and ended up submitting my own appeal because surgeon's office would not do it until they received the denial letter which none of us ever received despite numerous calls to the insurace company and their requesting it be resent three times. We have not received the denial letter to this day... almost two months later. If I hadn't taken matters into my own hands, we would still be sitting around waiting for that letter that is never going to come. I was approved after filing my own appeal and am having surgery next week. Hang in there and continue being persistent.
Thanks for the replies!!
I spoke to a supervisor at my insurance company; was very nice, explained the whole situation. The claim is that they only received the letter of medical necessity. I pushed my surgeon's office to fax all 47 documents to this supervisor so that she could walk it down to medical review. I called the surgeon's office 4 times Tuesday, 3 times Wed., sent NUMEROUS emails and finally, got a call from the Supe at Insurance CO stating she received ALL the docs and had walked it down to the Medical Review team.
I told the supe that I would give her a call next week to see how the process was going.
I did push, I stated that this is about my health, my life. I think I finally got through to the insurance guru at the surgeon's office as she did email me back; she sent the docs on 12/8. 12/9, 12/10 and they were received by the Supe 12/10. SO!
Now I wait...but I am going to keep calling, being sweet as honey, and make sure this happens!!
Yes, I got my denial because of NO CLINICALS. I filed it away and when the supervisor called me back, she said to file it away too because they NOW have all the documentation.
Patience is not one of my strength.
Thanks Guys! You are all awesome:)
I spoke to a supervisor at my insurance company; was very nice, explained the whole situation. The claim is that they only received the letter of medical necessity. I pushed my surgeon's office to fax all 47 documents to this supervisor so that she could walk it down to medical review. I called the surgeon's office 4 times Tuesday, 3 times Wed., sent NUMEROUS emails and finally, got a call from the Supe at Insurance CO stating she received ALL the docs and had walked it down to the Medical Review team.
I told the supe that I would give her a call next week to see how the process was going.
I did push, I stated that this is about my health, my life. I think I finally got through to the insurance guru at the surgeon's office as she did email me back; she sent the docs on 12/8. 12/9, 12/10 and they were received by the Supe 12/10. SO!
Now I wait...but I am going to keep calling, being sweet as honey, and make sure this happens!!
Yes, I got my denial because of NO CLINICALS. I filed it away and when the supervisor called me back, she said to file it away too because they NOW have all the documentation.
Patience is not one of my strength.
Thanks Guys! You are all awesome:)
On December 9, 2009 at 6:29 PM Pacific Time, megawatt823 wrote:
All, I am lurker mostly, but I am coming out to talk about what ROT this is.
I have NO EXCLUSIONS on my policy. WLS is covered.
I went through the 6 month dr. supervised diet.
I had all consults. My file was perfecto. Insurance guru at Surgeon's office
sent said file over to my insurance CO 11/3 and 11/5. Confirmed RECEIVED 11/9.
When she called 12/7, she = Insurance Guru at Surgeon's office- was told that NOTHING WAS SENT, THAT THEY DIDN'T HAVE THE CLINICALS.
Ummmm how can that be!!? I had been calling as well, since 11/20 and was told STILL PROCESSING.
I only have 439- until I reach my Out of Pocket Deductible of 2grand. THEN it would be 100% covered.
My guess is they are stalling until the New Year, which upsets me greatly.
I started the process in MARCH, when I was told that all I needed was a letter of Medical Necessity (I have 2!), THEN when speaking to someone else, I was advised that I needed the 6 month Dr. Supervised diet. OK No big deal.
So, how is that this insurance CO. DOES NOT HAVE the file!?!?
I talked to a supervisor and asked her why the reps did not tell either myself or the insurance guru this information? I have kept excellent records, had dates, times names, etc.
Thing is, NOTHING can go forward UNTIL they receive the docs. SOOO Insurance guru refaxed 12/7. Yes, I know.
I find it incredible, really. Incredibly UNprofessional.
2 others in my office have had RNY without issue....why me!? I bet it has to be with the holidays, too, but come on!!
I have sent email after email to insurance guru to have her send all the info again to supervisor at insurance co., marking it URGENT. I want this surgery and I need it.
Sorry about the vent, I feel like I am getting the run-around.
What say you all out there? Am I being obnoxious by wanting an update or having insurance guru resend everything to supervisor, marking it URGENT?
Let me know what you all think!!
Cheers,
Megan
You have every right to be angry but the "URGENT" thing... she really can't do that. That is typically saved for emergencies, like a doctor needs a very expensive diagnostic or the person could potentially be harmed if it's not done in a matter of hours or days. Sadly, WLS doesn't fall into that group.
If any doc puts urgent on things that are not medically urgent then when it is urgent the ins co will ignore it.
Hey All,
Thanks for the responses!
I FINALLY got the confirmation last Friday, 12/11, that the insurance co. received all 47 docs.
It is being reviewed as we speak. THe Supervisor even called me back to let me know she got them, and walked them to medical review.
SOOOOO I am waiting again.
No chance of having surgery before the new year, but that is OK! I am sure I will be approved.
I am trying to patiently wait.
I am FAT! HUGE! SUPER MORBIDLY OBESE, Weight related Asthma, joints aching constantly, diabetes, acid reflux, probable sleep apnea. My hips are killing me tonight. My knees ache, my back is killing me, too.
Wow. I sound whiney. I don't mean to whine, I am tired of hurting.
I hope the medical review people see that I have been fat since my mid 20's and I am 40 now and have yo-yo dieted for 15 years.
I am done! I Want the RNY!! ;) I will be patient, tho!
Thanks again for your responses!
Waiting. . . .
Cheers,
Megan
Thanks for the responses!
I FINALLY got the confirmation last Friday, 12/11, that the insurance co. received all 47 docs.
It is being reviewed as we speak. THe Supervisor even called me back to let me know she got them, and walked them to medical review.
SOOOOO I am waiting again.
No chance of having surgery before the new year, but that is OK! I am sure I will be approved.
I am trying to patiently wait.
I am FAT! HUGE! SUPER MORBIDLY OBESE, Weight related Asthma, joints aching constantly, diabetes, acid reflux, probable sleep apnea. My hips are killing me tonight. My knees ache, my back is killing me, too.
Wow. I sound whiney. I don't mean to whine, I am tired of hurting.
I hope the medical review people see that I have been fat since my mid 20's and I am 40 now and have yo-yo dieted for 15 years.
I am done! I Want the RNY!! ;) I will be patient, tho!
Thanks again for your responses!
Waiting. . . .
Cheers,
Megan
Hey Megan, I could have wrote this too - I'm getting the runaround big time and ready to cry! Everything was submitted the 1st week of November - I called week of Nov 15th and they said they received the paperwork 11/13 and wold take up to 30 days to review, okay so i've been patient and didn't call - Last Wednesday i called and now they said they have No paperwork! What?! I got transferred to i swear 10 different people then ended up in the area that gave approvals and they said my Dr. had to create a case then submit everything... that's now how my Dr.'s office has done any of these - i have a co-worker who had the surgery in March and didn't have this issue. So i e-mailed my Dr.'s office and they came back that i just needed to call again and i was probably given to the wrong dept. I didn't call till this morning and within this week the Dr. office did e-mail saying they tried calling and was waiting on a call back - so i called this morning and the 1st person i talked to said the paperwork was sent to the care coordination group on 11/27 - so she transfers me to them - they say they didn't get it! I'm so ready to scream/cry... my neighbor works for insurance and she said she'd help me call or help me get in contact with someone that would help - she did tell me to ask for a supervisor, but I'm at work and i really don't need the world knowing this yet. I have United Health Care...
I am thinking of calling again tomorrow; before and after work. I work weird hours;
I work 3 -12- hour days (Wed 6p - 6a, Sat & Sun 6a - 6p and then 4 hrs on Monday usually 10a - 2pm).
SOOO I am going to email insurance guru at surgeon's office and supervisor.
My file has been in med. review since 11 Dec. A week;) BUT! I want to make sure that it is being reviewed.
I think it's BS that the other two gals were approved in about 2 weeks.
Mine has now taken over a month, because of the "paperwork not being received".
I have Meritain Insurance.
I KNOW they will approve it, my file is complete! With all my awful co-morbidities.
Hell, I am sitting here at work in pain because I hardly slept and when I did sleep, I was on my back. NOT GOOD!
Anyway, all we can do is PUSH PUSH PUSH!
It will happen for us both!!
Cheers!
I work 3 -12- hour days (Wed 6p - 6a, Sat & Sun 6a - 6p and then 4 hrs on Monday usually 10a - 2pm).
SOOO I am going to email insurance guru at surgeon's office and supervisor.
My file has been in med. review since 11 Dec. A week;) BUT! I want to make sure that it is being reviewed.
I think it's BS that the other two gals were approved in about 2 weeks.
Mine has now taken over a month, because of the "paperwork not being received".
I have Meritain Insurance.
I KNOW they will approve it, my file is complete! With all my awful co-morbidities.
Hell, I am sitting here at work in pain because I hardly slept and when I did sleep, I was on my back. NOT GOOD!
Anyway, all we can do is PUSH PUSH PUSH!
It will happen for us both!!
Cheers!
Hi, I just wanted to see how things were going with your approval, sadly the exact same thing is going on with me and united Health Care , I been sending and resending things since Nov. getting wrong answers, paperwork sent to wrong dept. nobody knows anything,diffrent answer from every rep. Just this past mon.the 4th of Jan. they had my insur. cord refax my whole case again. I've cried , I'm stressed and I've don't know why there doing this.I'm trying to be patient but I think I'm upset because weve done our part and were paying our cost and there just running us around until we get tired I guess. I even gave then the benifet of the doubt and thought just my bad luck my case got lost and shuffled around but I keep running into people that are going through the same thing. I know it's hard but we have to hang in there.
Don't give up. I'm wondering if its an end of the year thing. I called and asked for the pre-authorization group who dealt with bariatric surgery and asked how they want it faxed in. My physician had to call to get a case # and then fax everything with it labeled with that case number, it was 1.5 weeks after it was re-submitted when they approved it. So it's probably being submitted wrong. Keep us updated! And don't give up!
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